Originally published in the January 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today! I’ve been practicing veterinary medicine in Florida for more than 20 years. Though it’s arguably the most litigious state in the country vis-a-vis medical malpractice claims, I’ve never been sued. Not even close. In fact, I can’t name one colleague who’s been successfully sued. I know of two who have had complaints lodged against their licenses and of a specialist group that was unsuccessfully sued twice (once by a referring veterinarian/client, no less!). But none that I know of ever lost much more than some sleep, a couple of days of work, and maybe a little faith in humanity. I don’t mean to minimize this experience. I know one of the veterinarians sued in the above example and I understand how much it can hurt to be targeted by an owner’s desire for retribution, misplaced or not. What’s more, for decades now, it’s been clear to our profession’s legal counsel that we veterinarians are a marked lot. These veterinarians represent only the first wave of veterinary medicine’s tort-ridden future. Consider the glossy AVMA PLIT newsletters you receive, trumpeting tales of financial loss and legal woe suffered by colleagues just like you who thought they were safe from legal redress and professional humiliation. True though these horror stories most certainly are, their intent isn’t to make you feel any safer now that you’re covered by PLIT. Rather, it’s to scare you into craving more coverage. Harder to quantify is the low hum of noise that’s been amped up over the years. Take these points as examples: We’re told we need to devise risk strategies for our practices, including policies to address clients who elect less-than-optimal protocols and those requiring written consent on even the simplest procedures. We hear how careful we have to be in our communications—and not just in our medical records but in our emails and text communications, too. We’re advised against letting clients observe us in action—even for blood draws!—lest they acquire legal ammunition. And, of course, we’re warned that we might want to re-evaluate our insurance needs. Yes, we’re told it’s all inevitable. That our lives will necessarily become more litigious. That our professional interactions will be uncomfortably scrutinized. That our clients and employees will turn against us. That veterinary life as we know it is over. And yet the sky has not fallen. Yet it seems we can’t pick up a veterinary trade publication without encountering some reference to this still-impending doom we’re asked to personally and professionally internalize. As evidence, consider Dr. Phil Zeltzman’s twin pieces on mistakes and apologies in November’s edition of this publication. In the first, he tells us how he very humanly handles mistakes and apologies via the truth-empathy-apologize-manage (TEAM) approach. In the second, he interviews Dr. David Carser, a veterinarian, attorney and professional liability insurance agent, who completely disagrees with issuing any sort of apology. We’re only human. Mistakes will happen. And when they do, the TEAM approach advocates that we act accordingly. This school of thought has been gaining ground, especially in human medicine, given that some studies suggest that expressing humanity usually gets you further than holding up a defense attorney. (What a concept!) Dr. Carser, on the other hand, argues that apologies are usually inappropriate. After all, we can’t accept responsibility for most adverse outcomes. And when they are appropriate, he adds, as when we’ve truly made an egregious mistake, apologies “could turn out to be a really bad idea.” They “might come back to bite you.” I get it, of course. Clients can be literal. They might theoretically interpret “I’m sorry” as an admission of guilt. They assume you’re taking responsibility for what happened. That’s why one practitioner I know of doesn’t let her employees use the words “I’m sorry” immediately after a euthanasia. I guess she doesn’t want the owner to get the impression that she (or they?) did anything wrong. I come from a different school of thought. I’ve always observed that “I’m sorry” is one of those terms that has a wide variety of interpretations. It runs the gamut from “my bad” to “I empathize.” In fact, the most obvious translation from English to Spanish is “Lo siento,” which translates right back to “I feel it.” As such, it’s my personal opinion as a member of the human race and a citizen of this culture that failing to say “I’m sorry” when bad things happen is tantamount to a cultural transgression. Beyond simple expressions of sympathy, I’m a big believer in honestly copping to your errors and communicating both your feelings and the remedies you’re prepared to make. It’s what you’d do if your receptionist made an error on an invoice. In fact, in many ways, it’s a failure of integrity to treat a medical mistake otherwise. Nonetheless, as Dr. Carsen points out, keeping mum and lawyering up is safer. Which is why it’s a great arm’s-length recommendation. But it’s simply not human. And let’s be honest, having real human interactions is one of the few sanity-preserving benefits this profession has to offer. Most of us are well insulated from our mistakes. That’s why we keep professional liability insurance, after all. This insurance affords us the ability to practice with all the trappings of humanity, errors and all. The way I see it, keeping liability insurance is my way of paying for the privilege of behaving like a real person while I’m at work. Those who have been sued will almost certainly beg to differ with my point of view—as no doubt will those who earn their living by telling us what not to say, defending the unluckiest among us and selling professional liability insurance on the side. They’ll point to the rising tide of pet-owner scrutiny and to the inexorable tide of litigiousness in our culture. To which I’ll counter with the simplest of observations you don’t need a law degree or even an MBA to interpret: Dig up your annual professional liability insurance bill. Last time I checked, mine was well under $500—only 3 percent of what my family doctor pays and 1 percent of what my internist pays. What’s more, it hasn’t risen much since I started practicing 20 years ago. These low, slow-moving rates speak volumes, mostly about the degree to which our profession has exaggerated the “crisis” of professional liability. For me, they offer some much-needed perspective on the true state of the profession, call into question the validity of some of our legal advice and raise questions about the unintended consequences of veterinary medicine’s heightened legal sensitivity. In a profession rife with burnout, rocked by suicide, stressed by a rising tide of reputation erosion and whipsawed by increased polarization within our ranks, we can ill afford to indulge any unnecessary anxiety—less so when it’s clear that our profession loses a little bit of its soul each time we’re told to avoid practicing with a personal touch and speaking from the heart.
