You may remember that a while ago, I wrote about a study I was working on, about veterinarians and their emotional reactions and coping strategies for complications and patient deaths in spay neuter practice. I’m excited to say that it has just been published! The official version is available on the Anthrozoös website, but if you are unable to access the full text there, I have uploaded the accepted manuscript here on my website.
(Edit: and now, see a webinar version here)
What the study showed is that while we all have immediate, visceral reactions of sadness, fear, anxiety, empathy, and self-doubt in the face of a serious complication or patient death, what happens next isn’t always the same. For many veterinarians in the study, these immediate reactions evolved over time into a long-term resilience, whereas for a few, they were experienced as recurring trauma. There were four factors that seemed to make the difference between these two possibilities: Technical Learning; Perspective and Appraisal; Support and Collegiality; and Emotional Learning. 
Technical Learning means learning about the technical aspects of patient care, or what went wrong and how to improve to make it better. Sometimes this meant learning a different surgical technique, learning more about equipment, or modifying anesthesia protocols.
Perspective is the frame of reference that the veterinarians used to put the loss into a greater context. Maybe their perspective was how many animals they had helped successfully; maybe it was the big picture of their life; maybe it was the big picture of their religion.
Support was important, especially from colleagues, whether co-workers, bosses, distant friends, or spay neuter list serve buddies.
Emotional Learning means the way that, with time and experience, some veterinarians learned how to handle and support themselves through the adverse event. They learned what to expect from themselves and their emotions, and how long that would take.
So even though all veterinarians in the study were deeply affected by adverse events, some of them were able to use these four tools to help them through.
But it doesn’t end there: successfully coping with adverse events is important not just for the mental health and peace of mind of individual vets, but for their future patients as well. The more comfortable vets can be thinking about dealing with things that don’t go as planned, the better they will be at evaluating, refining, and updating the way they care for patients.
One of my favorite lines from an article I read when preparing for this study was from a human surgeon, stating:
“As a profession, is it possible to strive for perfection and accept and embrace failure transparently when it occurs?”
-Luu, Patel, et al. (2012)
I love this quote so much because it embodies the tension and the paradox of high performance. I love it because it asks us to strive, but at the same time, to be open about our failures. It is about abandoning shame and accepting that having things go wrong is a possibility in any system, and reminds us that continuous improvement and reassessment is necessary.
So what’s the takeaway? If something goes wrong, find colleagues you trust and talk about it. Try to figure out what happened and how to avoid it. Remember to keep the loss in perspective (how many other animals have you helped? And how much more is in your life than being a veterinarian?), and understand that these events happen to everyone. And take care of yourself emotionally, through mindfulness practice or other training in acceptance.
My hope is that the more each of us understands that our responses are normal, the more comfortable we can be in thinking and talking about complications, and the more we can use these shared experiences to improve our patient care.
Reference:
Luu, S., Patel, P., St-Martin, L., Leung, A. S. O., Regehr, G., Murnaghan, M. L., Gallinger, S., & Moulton, C.-a. (2012). Waking up the next morning: Surgeons’ emotional reactions to adverse events. Medical Education,46, 1,179–1,188. doi: 10.1111/medu.12058.