As I have confessed in this column many times before, I’m no poster child for veterinary practice. No one in their right mind would nominate me for clinician of the year. In fact, I’m prone to thinking my bad habits alone should probably disqualify me for any kind of a mentorship role. I am, however, extremely realistic. In no universe do I reckon I’m any different than the vast majority of the rest of you. Apart from our chosen profession, humanity after all is our one common denominator. And, of course, veterinary medicine is a profoundly human science. The irony of veterinary science is that it’s deeply human. So much so that it perfectly mirrors the many deficiencies, failings and flaws that characterize our hominid experience. It is, by its very nature, shockingly imperfect. But that’s not what anyone wants to hear when they entrust their pets to our care. They don’t want to know about our deep-seated fear of failure or hear us rattle off a lengthy list of things we know for sure we could have done better yesterday if only we’d tried harder, felt better or indulged our laziness less. And they definitely don’t want to hear about our mistakes. Instead, our clients want to believe that: Their veterinarian has paid her dues and graduated at the top of her class; She’s spent at least 20 years acquiring the skills only experience can burnish to perfection and; She never, ever makes mistakes. No One Is Perfect If they stopped to think about it (and few seem to want to), it wouldn’t be hard to observe the obvious: It’s patently impossible to supply a veterinarian who can offer C., much less all three. Not only does everyone, without fail, make mistakes, but it’s a statistical impossibility for everybody to graduate at the top of their class. And—guess what?—it takes 20 years to acquire 20 years of experience. Moreover, as someone who’s been practicing for 21 years will gladly attest, 20 years is no guarantee of skill or polish, much less perfection. Which is why so many of our clients complain about the youthful appearance of our after-hours clinicians. But here’s the thing. Whenever we encounter extreme youth during times we believe we need the best, most experienced clinician for ourselves, our kid or our pet, we’re coming face-to-face with the most visible reality of the allied medical professions: They are imperfect. No, not every veterinarian offers years of experience. No, not every clinician will have performed the procedure they’ll perform on your loved one. And yes, regardless of their skill or years of experience, they may well make a mistake anyway. Personal Tale That was the case a few months ago when our hospital hosted one of the worst clinical disasters of my career. As the result of a simple misunderstanding, a staff member gave 10 times the normal dose of a subcutaneous medication to a postoperative patient. Thankfully, I double-checked on my team, digested the recorded dose and flipped out in time to do something about it. Unfortunately, however, this was a catastrophic amount of drug for which the toxicology service I called offered few answers. Luckily, the injected area was amenable to wide surgical excision, and the patient survived. (We have since instituted a medication error policy that includes zero consequences for employees who quickly admit to a medication error.) But can you imagine the owner’s shock as I explained the mistake? What would you have done after receiving a loved one who displayed a hideously huge incision site following what should have been a routine procedure? You’d have been right to blame me. (I did, for sure.) You would have a right to expect your veterinarian to pay for all treatments. (We did, of course.) And you would have been justified in feeling angry and harmed. But here’s the thing: It might not have been fair if you’d condemned me as a person or perceived my act as a betrayal of your trust. This was a mistake. An honest one. One that was caught in the course of the checks and balances medicine has to employ by way of mitigating risks we know we take each time we suck medicine into a syringe and administer it to a patient. Because almost everything we do carries risks. An Imperfect Science After losing exactly one patient to an adverse anesthetic event in all my years of practice, I’d been starting to feel rather charmed. But if you practice medicine long enough, things will happen. Good things and bad things. And I choose to believe it’s how you react to the crappy ones that counts. Here’s where I’ll blatantly appropriate a quote by my favorite medical writer, human surgeon Atul Gawande, from his seminal book “Complications: A Surgeon’s Notes on an Imperfect Science”: “[Veterinary] medicine is, I have found, a strange and in many ways disturbing business. The stakes are high, the liberties taken tremendous. We drug [pets], put needles and tubes into them, manipulate their chemistry, biology and physics, lay them unconscious and open their bodies up to the world. We do so out of an abiding confidence in our know-how as a profession. What you find when you get in close, however—close enough to see the furrowed brows, the doubts and missteps, the failures as well as the successes—is how messy, uncertain and also surprising [veterinary] medicine turns out to be.” Atul Gawande is no James Herriot, of course, but in this book he uses stories to make many of the same points Dr. Herriot so charmingly made in his “All Creatures” series of books: Medicine, even veterinary medicine, can get messy. Very messy. And that’s as it should be. To err is human and all that. Thankfully, as Gawande and Herriot teach us, it is in the midst of all that muck that we learn and progress. Indeed, it’s no cliché to say that it’s in making mistakes that we learn the most. After all, though it won’t make most pet owners (or patients) happy to hear it said aloud, they don’t call medicine “a practice” for nothing. Dr. Patty Khuly owns a small animal practice in Miami and is a passionate blogger at www.drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News. Originally published in the August 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!
