Every veterinarian experiences cases that end badly. The patient that sustains a tibial fracture after successful colic surgery. The horse that survives the diarrhea of Potomac horse fever before succumbing to severe laminitis. The little girl’s pony that develops fatal hyperammonemia on Christmas Day after the mild colic on Christmas Eve when you promised her that everything would be okay.
Some of these adverse case outcomes are expected due to the serious nature of the injury or illness, but some seem to arrive without warning. Equine veterinarians are always aware of the possible issues. These could include side effects of medications, the small percentage of poor recovery from anesthesia, and the patients that seemingly simply do not respond to treatment. But bad endings always have an impact.
The quality of client communication is a key component of the horse owner’s ability to process their grief or disappointment. Communication is also critical to that client’s ability to continue to have respect for and trust in the veterinarian.
Good Client Communication
Having the conversation about possible negative outcomes is important at the onset of the case, while taking care not to extinguish hope. People deserve to have full information in order to make the best possible decision for their animals.
While most practitioners will never see a case of hyperammonemia, they have almost all seen unexpectedly fatal colics. Learning to balance the need to dampen the worry of the owner with the statistical realities comes with experience.
While sharing risks does not guarantee that clients will not have an emotional reaction with a bad outcome, when they are able to think rationally, they will often become more accepting of an unfortunate stroke of fate when it is not a total surprise.
Updating clients as a case declines unexpectedly can feel difficult, but it is essential. Giving choices to stop treatment at every significant downturn helps shift responsibility to the owner, who ultimately will be financially responsible. Veterinarians sometimes feel like they have personally failed when their patients do poorly, but it is helpful to remember that there are no guarantees in equine veterinary medicine, and all one can give is give his or her best effort.
Staff and Unexpected Outcomes
When tragic outcomes occur, especially after much effort is expended, all members of the veterinary team might need their emotional responses to be accepted and their sadness recognized. Teams become fond of patients, and when they do poorly, it hurts. Having the entire team participate in an act of honoring the patient through a sympathy card or a memorial donation to The Foundation for the Horse or another charity can help. Simply acknowledging how difficult it is to lose a patient can help staff members by validating their responses as appropriate.
Some practices feel that they should bear the financial consequences of cases when the outcome is poor, but this is not recommended by the Professional Liability Insurance Trust (PLIT) or by most business consultants.
Full disclosure of risks beforehand allows horse owners to make informed decisions and shifts the financial responsibility to the client. Genuine expressions of caring and sympathy are preferable.
In the case of serious doctor error or omission, honest and transparent communication is the ethical path, along with prompt communication with the practitioner’s professional liability carrier.
Take-Home Message
In summary, veterinarians are never in control of outcomes, but simply shape them through careful examinations, appropriate treatment choices and attentive follow-up. Losing a patient is painful, and dealing with the loss compassionately helps with healing. Effective client communication must be continually present with every case to build trust in the client relationship and allow informed decision making.
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