Dear Second Opinion,
I could use some guidance after a troubling incident left me feeling overwhelmed and inadequate. I recently made a serious mistake when calculating the dose of pain medication for a small dog. I wrote mL instead of mg on the treatment sheet, leading to an overdose that caused excessive sedation and respiratory depression. The team acted quickly, and the patient was stabilized and is expected to recover without lasting harm.
When I called the client to explain the incident, I was filled with anxiety and self-doubt. I intended to be factual and transparent, but they accused me of sounding careless and cold. They were understandably upset and chose to transfer the dog to another clinic, despite our successful intervention.
How can I handle these difficult conversations more effectively and compassionately in the future to hopefully retain client trust and minimize feelings of anger and upset?
Signed,
Striving for Integrity & Better Communication
Dear Striving for Integrity & Better Communication,
Reaching out for support after a challenging experience is commendable, as speaking openly can foster healing and growth. Handling the emotional complexity of medical errors, processing the experience, and aiming to avoid fear-based decision-making in future interactions are all important steps.
Managing Emotions After a Medical Error
Emotions like guilt and shame are common and understandable following a medical error. Guilt surfaces when we believe we have done something wrong, while shame reflects a deeper sense of unworthiness and inadequacy tied to self-identity. Essentially, guilt concerns what was done, whereas shame concerns who we are. Distinguishing these emotions is critical to an effective response.
Suppressing guilt should be avoided. Allowing yourself to feel guilty in manageable amounts can diminish the intensity of these emotions over time. Leaning into self-compassion rather than self-criticism supports growth without undermining self-worth. There are 3 key elements of self-compassion.1
Self-kindness: Recognizing when self-criticism arises and responding with gentler self-assessment
Common humanity: Remembering that others have made mistakes in medical practice, and nobody is alone in this experience. Many people have likely had similar experiences that they do not openly discuss.
Mindfulness: Staying focused on the present moment to help reduce rumination and future-oriented worry
Shame may be lessened by identifying self-protective behaviors (eg, perfectionism, people-pleasing) that are often rooted in shame. Working on a growth mindset, possibly with the support of a mental health professional, can help address these deeper patterns.
Managing Fear & Self-Doubt
Fear is a protective response that can be transformed into an opportunity for continued growth. Using a factual and transparent approach was a strong step toward minimizing miscommunication and demonstrating accountability; however, self-doubt and anxiety can make effectively expressing empathy challenging in these situations.
Practical strategies can help future challenging conversations.
Using Grounding Techniques
Before speaking with the client, physical sensations (eg, racing heart, sweating, shaking, brain fog) should be noted and grounding techniques (eg, progressive muscle relaxation, paced breathing, going for a short walk, running cold water over hands) employed. The goal is to consciously and mindfully engage in these activities to help discharge activated energy in the body and help re-engage parts of the brain that allow for clear communication, rational thinking, and effective problem-solving.
Applying the SPIKES Acronym for Breaking Bad News
The SPIKES model offers a helpful method for delivering difficult information to clients.2
Setting: Create a private, comfortable, and distraction-free environment.
Perception: Assess the client’s understanding of the situation.
Invitation: Ask the client to indicate their preference for how much detail should be included in the discussion.
Knowledge: Share the news clearly, using simple language (ie, avoid medical jargon) and pauses to allow the client time to process information being shared.
Emotions: Identify, acknowledge, and validate the client’s emotions, as well as the cause of emotions, while grounding yourself and responding with patience and empathy.
Strategy and summary: Answer any questions and outline next steps, ensuring the client fully understands the plan.
Although clients’ emotional responses cannot and should not be prevented, these approaches can foster effective communication, grounded compassion, and direct information delivery.