Why mistakes matter

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After graduating Dr Veronika Smart VetMB MA (hons.) MRCVS headed off on an adventure to Madagascar, where she worked as an equine vet and occasionally caring for some of the wildlife on that beautiful island. After 5 years she returned to the UK and now practices in small animal clinic. She is honest about the mental health struggles she has had and how she has overcome them. She wanted to share the knowledge she had gained, and her passion for wellbeing, with her fellow professionals, so she is now a mental health first aider and holds a level 5 diploma in Mental Health and Wellbeing. Through her company MentaVet she offers wellbeing CPD, team training and content creation to vets and their teams. You can also follow MentaVet on Instagram

In my first few years of clinical practice, I remember wondering when the pressure of feeling like I knew what I was talking about would finally transform into confidence. I remember wondering when I’d finally be considered – and feel – ‘experienced’.  The truth is, though (as any honest vet will tell you), that we learn every day in our careers, irrespective of our years in practice. So why do we expect perfection from ourselves and why do we use our inevitable mistakes as a stick with which to beat ourselves?

I’ve come to realise that the qualities we select for in veterinary students are at odds with the realities of the job. By selecting academic excellence in an educational system that rewards memorisation over problem solving, we are selecting for people who thrive on control, predictability and perfection. Our jobs, however, are inherently varied and unpredictable. We never know what might walk through the door. Our patients can’t tell us what’s wrong, they seldom read the textbook and each patient’s response to treatment varies hugely. Add to this the reality of dealing with twenty or more different clients each day, each with different levels of understanding, financial constraints and expectations, and it’s no wonder that navigating the profession can seem overwhelming. Especially when something goes wrong and we slip up. 

The fear of making a mistake is an unavoidable part of veterinary life. The gravity of being responsible for lives is so immense that this fear is not only completely valid, but valuable and instructive. It is our respect for animal life and our fear of getting it wrong that keep us diligent and thorough. Ultimately, we fear mistakes because we care.

However, Robin Sharma said: “the fears we don’t face become our limits”. If we don’t learn to manage our fear of failure, then we risk making stress and anxiety our permanent bedfellows, precipitating very real physical and psychological effects. Unmanaged, unrealistic perfectionism and an intolerance of error are undoubtedly contributing to the  concerning exodus of vets out of clinical practice. 

So what can we do to fall back in love with the profession we dreamed of as children? How do we reconcile our desire for optimal patient outcomes with errors that risk compromising patient welfare? Well, perfectionism should be challenged and mistakes must be decriminalised. We are only human, and mistakes are inescapable sequelae of our humanity. No one is born an expert and the road to excellence (note: I didn’t say perfection!) is paved with error. There can be no learning without it. 

To expect perfection in any part of our lives is to be permanently disappointed and to rob ourselves of any enjoyment of our successes. Instead, we need to respect the process of making mistakes as an essential step to progress. In doing so, when something inevitably goes wrong, we’re more prepared to start the process of working out what needs to be done differently, instead of letting our errors define us or mar our sense of self-worth.

Now all that’s easily said but what can we do practically to help foster this healthier attitude? When working through mistakes, I believe the best approach is to devote time to thinking about the two Es: Emotions and Events. ‘Emotions’ explores how making the mistake made you feel; how it may have impacted on your confidence or sense of self-worth. ‘Events’ refers to all the practical considerations around the mistake and appeals to our desire to problem solve and prevent similar issues arising in the future.

Without working through the emotions surrounding a mistake, we open ourselves to unresolved feelings of guilt, shame that can lead to imposter syndrome, indecision, crippling self-doubt and debilitating reassurance seeking and indecision, all of which can impact seriously on patient outcomes as well as our wellbeing.

I find working through these areas in writing using prompts is most helpful. It helps to structure your thoughts and means you can constructively look back on the way you worked through past problems when faced with a new one.  

Emotions prompts:

  • Explore how you feel about the mistake. Talk it through with family/ friends or colleagues whom you trust.
  • Take care with language you use when talking or thinking about the error – use ‘mistake’ instead of the word ‘fail’ or ‘failure’. When describing yourself, use verbs and adverbs instead of nouns and adjective e.g. instead of “I am a total failure” or “I am so useless”, think “I have made a human error” or “I am still learning”. These are not absolutes and so, they recognise that we have a capacity to grow and evolve and that single events or decisions do not define us. 
  • Draw on evidence. Consider having some evidence to hand to remind you of your achievements and worth. A little notebook or journal you can have a quick read of in practice when having a crisis of confidence can be really useful.
    • Record your successes – we so easily overlook them but our days are littered with successes, however small.
    • Keep thank you cards and gifts from clients. They serve as a reminder of the worth of your work and dedication.
    • List any previous achievements e.g. I completed veterinary school, I was hired for this job so I was deemed qualified, I have learned many new procedures in the last year. 
    • Finally, look back to past mistakes – did they help you learn something? Did this keep you from repeating the mistake? Did it make you a better vet? This can be useful to remind you that the current mistake is not the first mistake you made and that you survived previous occasions. 

Events prompts:

  • Factually summarise what happened e.g. Metacam given i/v.
  • What caused or contributed to the error? E.g. human error, lack of training, distraction, poorly maintained equipment, outdated protocols, pressure from colleagues, tiredness, sickness.
  • Could it have been prevented? How? How can a repetition be prevented? E.g. syringe labels, targeted CPD, surgical checklists, updating practice protocols.
  • Can anyone else benefit from learning from this mistake? Hiding clinical mistakes is never ethical or appropriate and it’s important to remember that we can not only learn from our own mistakes but also those of our colleagues. Where there is an open and collaborative practice culture where mistakes are constructively shared, there develops an environment where all can learn and grow.

While sadly mistakes are inevitable, I find the above approach helps to maintain clinical quality control while promoting a culture of growth and compassion in your clinic. Additionally on a personal level, it maintains ongoing faith in your own decision making and gives back some control and confidence in dealing with problems in the future. 

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