Embracing Spectrum of Care: Tips for Reducing Your Risk of Client and Board Complaints
The threat of a board complaint or malpractice lawsuit can impact veterinary wellbeing and patient care.
For early-career veterinarians who already face many challenges in their transition to practice, the concerns around receiving a board complaint may be magnified. Fear of making a mistake was found to be a common concern in a recent qualitative study of recent graduate stressors (Reinhard et al., 2021), and this fear of making mistakes can lead to lower confidence levels.
In a previous article, we discussed the concept of spectrum of care. Embracing this concept requires that veterinary professionals offer a range of options that fit the individual socioeconomic factors as well as expectations and goals of care for each client. Often, these options range from the gold standard care that is taught during veterinary school to more basic treatment options.
Veterinarians may worry that by offering alternative treatment plans, they can open themselves up to liability. Yet, with effective communication, client education, and diligent medical record-keeping, veterinarians can practice compassionately and lower their risk of a complaint.
The Frequency of Mistakes and Client Complaints
Making a mistake is extremely common among new graduates — an estimated 75% of veterinarians will make a mistake in their first year and a half of practice — and these mistakes often had an emotional impact on the veterinarians who made the mistake (Mellanby & Herrtage, 2004). Mistakes can result in board complaints if not effectively addressed.
In addition, client complaints are not uncommon in veterinary practice. Bryce et al. (2019) found that client complaints were received by 64% of board-certified internists within the preceding 6 months. While the majority of these complaints were made to hospital management, online, or directly to the veterinarian, 8.4% of complaints were made to the veterinary board.
Because client complaints appear to be so common, they can have significant impacts on the wellbeing of the veterinary team as well as patient care.
The Consequences of Client Complaints
Negative Impacts on Mental Health and Wellbeing
Not surprisingly, receiving a client complaint negatively impacted the mental health of the veterinarian with over 71.7% of respondents saying their feelings of depression increased following a complaint and 77.2% reporting reduced enjoyment of their job. This is one of the many stressors that can contribute to burnout in veterinarians.
A recent study (Rogers et al., 2022) found similar negative impacts on the mental health and wellbeing of veterinary team members. Around half of veterinary support staff reported feeling depressed due to a client complaint and a similar proportion felt that these complaints negatively impacted their enjoyment of their job. Concerningly, around one-fourth of veterinary support staff considered changing careers because of client complaints.
If you are experiencing negative impacts on your mental health because of a complaint, it is recommended that you seek help from a mental health professional. You can also reach out for additional support from a trusted veterinary mentor or join a structured veterinary mentorship program for additional support!
Defensive Medicine
Bryce et al. (2019) found that both receiving a client complaint and the fear of receiving one can lead to the practice of defensive medicine. When practicing defensively, additional diagnostics and treatments are often recommended in an effort to prevent complaints.
While it may not be wrong to offer additional diagnostics and treatments, these come with a higher cost to the client and certain tests and treatments may be unnecessary in the overall outcome and prognosis of the case. For clients that are already financially limited, feeling like they are being pressured to approve excessive diagnostics and treatments can have a detrimental effect on the relationship between client and veterinarian.
Tips for Reducing Client Complaints
Client-Centered Approach to Communication:
Numerous studies have found that clinicians with excellent communication skills are less likely to receive complaints and malpractice claims. While communication training is growing in veterinary schools, it is still limited. Early career veterinarians should make it a priority to develop effective client communication strategies.
Adopt a Client-Centered Approach to Communication: Shaw et al (2006) described two patterns of communication in veterinary practice. The biomedical approach, or veterinarian-centered approach, places focus on medical discussion and the veterinarian directs the client towards recommendations with limited input from the client.
Alternatively, the biolifestyle-social, or client-centered approach, creates an opportunity for more discussion between veterinarian and client by creating a partnership between the two parties to arrive at the best possible plan for the pet. While it may sound time-consuming to utilize the second approach, Shaw et al found that appointments that were dominated by the biomedical approach were on average 1.5 minutes longer than those with a biolifestyle-social approach.
Ask Open-Ended Questions: When using a client-centered approach, it is important to utilize open-ended questions to elicit client concerns and allow the client to share their feelings and thoughts about the patient as well as treatment options. Ask questions that will uncover the goals of the veterinary visit and the client’s most pressing concerns.
Actively Listen: It is crucial to give the client time to answer questions without interrupting them and practice active listening. This will give the client the opportunity to be involved in the decision-making process for their pet and ensures that all of their questions and concerns are met.
Chunk and Check: Additionally, veterinarians should provide information to the client in small pieces and pause periodically to check for understanding. This is a technique known as “chunking and checking.” This can be helpful when reviewing diagnostic results or physical examination findings, especially if there are multiple abnormalities or the disease process is complex. Utilizing this technique when delivering information also allows the veterinarian to gradually clarify information instead of ending the appointment with a confused client who didn’t understand the veterinarian’s lengthy explanation.
Pursue Advanced Training in Communication: Many of these skills can be difficult to learn! Any opportunities to gain advanced training in communications may be valuable. Consider attending the AVMA Veterinary Leadership Conference or participating in the MentorVet veterinary mentorship and professional development program to hone your communication skills.
Obtaining Informed Consent
As a young veterinarian, it can be scary to offer options outside of what you were taught in veterinary school but learning to embrace spectrum of care will enrich your career. It allows us to improve the lives of more patients and clients by offering a range of options that fit their individual needs while maintaining our ethical duty to be an advocate for our patients and prevent and relieve their suffering.
Medical Records
Finally, an excellent medical record is the cornerstone of protecting yourself from potential liability. Should a complaint be made against your license or a malpractice suit, your medical records will be evaluated and assessed. Here are some tips for medical record writing to ensure you have maximal protection in the event of an official complaint.
Be Thorough: At some point, you have likely heard, “If you didn’t write it down, it didn’t happen.” In addition to history, physical examination findings, diagnostic results, and treatment plan, medical records should include a thorough summary of all client communication. This includes all recommendations, discussion of potential complications, owner's decisions, and monitoring and follow-up recommendations. Be sure to document who you spoke to and when. Medical records should also include a copy of all signed treatment plans and estimates as well as any other written communication the owner received.
Templates can be very helpful to develop when you have a lot of records to complete. Some electronic medical records have customizable templates that you can save and use as needed. If your software does not have this feature, creating a Google drive document that you can copy and paste from can be a huge time-saver. These templates will allow you to include more detail on your records without having to write it all from scratch every time.
Be Timely: Medical records can be time-consuming to write, and it can be tempting to postpone record-keeping for a later date, particularly after a long day in the clinic, but this can lead to missing information and decreased detail in medical records. Waiting to write records also increases the risk that you will forget to complete a record entirely.
Time management is a skill that takes time to develop in practice and will be influenced by practice workflow. Creating a system that works for you to ensure complete and thorough records is essential. Some doctors like to make a few brief notes during or just after the appointment and add more detail to the record later in the day while others prefer to complete the record before moving on to the next patient. Find a system that works for you and stick to it.
Don’t Forget About the Team: Ask all staff members who were involved in communication with a client to include their notes in the record, especially in regards to financial discussions, specific medical questions, or complaints in the clinic. This will ensure nothing gets missed!
In addition, you can also leverage your team members to assist you in your record-keeping. You can do this in a few different ways including having them document your physical exam findings while you perform your physical exam or documenting what treatment plans were offered to the client.
Putting it All Together
Ultimately, veterinarians should offer gold standard care to clients and patients. However, veterinarians should also be comfortable with offering a wide range of options that best suit the individual needs, goals, and expectations of the client and patient. By creating a partnership with the client, educating them on all treatment options, obtaining informed consent for the treatment plan selected, and maintaining thorough records, veterinarians can reduce their risk of liability without sacrificing their ability to practice compassionately.
References and Further Reading:
Reinhard AR, Hains KD, Hains BJ, and Strand EB. Are they ready? Trials, tribulations, and professional skills vital for new veterinary graduate success. Frontiers 2021:https://doi.org/10.3389/fvets.2021.785844.
Mellanby RJ, Herrtage ME. Survey of mistakes made by recent veterinary graduates. Vet Rec. (2004) 155:761–5. doi: 10.1136/vr.155.24.761
Bryce AR, Rossi TA, Tansey C, Murphy RA, Murphy LA, and Nakamura RK. Effect of client complaints on small animal veterinary internists. JSAP 2019:60(3);167-172. https://doi.org/10.1111/jsap.12936
Rogers CW, Murphy LA, Murphy RA, Malouf KA, Natsume RE, Ward BD, Tansey C, and Nakamura RK. An analysis of client complaints and their effects on veterinary support staff. Vet Med Sci 2022;1-10. DOI: 10.1002/vms3.725
Shaw JR, Bonnet BN, Adams CL, and Roter DL. Veterinarian-client-patient communication patterns used during clinical appointments in companion animal practice. J Am Vet MEd Assoc 2006;228:714-721.