Dr. Khuly, Should you feel badly? Maybe a little, but not enough to crawl under the covers---it didn't cause any harm.

Let me cheer you up. On 11/6/01, I brought my old male Scot in because of limping & asked for an x-ray. Machine was down, exam noted bad nail beds (what does that mean to a Vet?)and RF limp--went home with cephlexin. Brought the same dog back Dec, Feb., Mar, June, and finally mid-June has x-ray with advanced bone lesions entire leg into shoulder.

It didn't upset me that he didn't get surgery, nor chemo or radiation. But it would have made me feel better to give him appropriate pain medication and be extra careful with stairs (would have carried him). On his last day, he still climbed 3 stairs and ate his last meal(s). He could not become comfortable to sleep. I forgave it & got over it, he lived a good life & died humanely.

Well, at least you admit it. That is a very good sign. Its clear you took this hard and learned from it, and it takes character to admit (especially in a public forum) that you missed a diagnosis.

Given your frankness here, I'm sure you were similarly frank and apologetic with the clients and that they really appreciated it.

The only way we can learn from our mistakes and also identify our blind spots and weaknesses so that we can compensate for them is by admitting to ourselves when we do these things, being open about it, and then doing what we can to do better next time.

That kind of self-assessment and honesty will serve you well in dealing with your clients and earning their fair treatment in return, and will also help you improve. The fact that you feel bad about it is also a good sign (functioning conscience in working order).

It's when we lie to ourselves ("there is no way I could have caught it . . . "), justify or defend, and then communicate that to others that we begin to slide down that slippery slope into becoming a danger. You aren't doing that, so it bodes well for you and I'm sure your clients are appropriately forgiving especially since the few days delay in diagnosis probably didn't make a clinical difference, right?

Will they amputate or will the pup be PTS? Poor lil guy.

Tara, just a word on the thing about medical doctors -- things are changing in the medical realm, and it is no longer true that NO doctor will ever admit a mistake. In fact, there is a well-supported movement afoot that shows that disclosure and apology actually reduces medical malpractice cases.

For information on this movement, see http://www.sorryworks.net/.

Think about it: Who would you want to sue, a doctor who admitted his mistake, and who offered to cover the costs of any injuries you suffered or loss of function as a result, OR a doctor who denied that he did anything wrong, even though you knew darned well he did?

As someone who has had this happen to them with a pet, I can tell you that failure to disclose pertinent information about what occurred, and/or failure to take responsibilty, is the single thing that makes us the maddest. It is really hard to be angry at someone who truly accepts full responsibility in every way.

At this year's AVMA confernce, there will apparently be a discussion on disclosure/apology in the veterinary profession.

I feel your pain Dr. K, where I work if I mess up on any medicines -- I can potentially kill a person. >.< So much pressure -- even if I give a little more or too little I have to check on the person until my shift is over. Or if I make the mistake and don't call an ambulance on something I perceive as a cold or an ache/pain.

Everyone makes mistakes. Medicine is an art that uses science. I can't imagine how much harder veterinary medicine is since you have to know how many more species - all disparate from one another?

I do have one question since you mentioned cage rest. How on earth do you keep a dog (read escape artist) rested without tranquilizers? My dog who fell off our bed and hurt himself believes himself fine and has busted through a baby gate! This is a pekinese! Seriously, who can keep a dog quiet if he or she believes their fine without resorting to tranquilizers?

i wouldn't call that a misdiagnosis. you didn't have diagnostic tests with which to make a diagnosis. you had a physical exam and suspicions. you neglected to mention an important differential to your owners...BUT you still recommended the RIGHT course of diagnostics - radiographs. if you had done the radiographs yourself - you would have seen the lesion and made the probable diagnosis. so your primary differential was wrong - did it change anything for your patient? no. he had xrays, osteosarcoma (i'm assuming) was found - and he will receive appropriate therapy. don't be hard on yourself. we're only human - and we all - human and animal doctor alike make mistakes. you owned up to what you feel was a mistake, but i really think you're being too hard on yourself.