I cannot recall a feeling more dreadful than opening up a thick packet from an unknown attorney’s office to discover that I had been named in a medical malpractice lawsuit. It is difficult to explain, but far more difficult to forget. As a physician, I struggle with the balance of involvement in a patient’s life and disease process, and the emotional detachment required to protect me. But I must admit, it is often the case that my sickest patients draw me in with a deep level of emotional investment. It is that investment that makes it so painful when a poor outcome occurs, and more so when a lawsuit is filed.The entire process of a medical malpractice lawsuit is built to keep physicians and patients (or their families) apart. I recall numerous occasions when my personal struggle with the inability to speak with a patient’s family, to voice my sympathies, and to discuss my regret, led me to frustration with legal counsel and the entire process. I recall sitting in my priest’s office and voicing my agony at not being able to speak openly with a patient’s family. I sought comfort from so many outlets and very few things seemed to provide it. To compound matters, the legal process was exceedingly distasteful. The lawyers had a camaraderie outside the conference rooms and an aggressive inflammatory approach on the record. At no point was there any interest in reconciliation.
It is not clear to me if there would have been any point in meeting with the patient’s family, discussing the unexpected outcome, or even reviewing the medical care together. But here is what is clear:
- A medical malpractice lawsuit is one of the most stressful experiences a physician can undergo. Cases take years to be deliberated. Multiple attempts at financial settlements occur. Both sides dig deeper and deeper into their trenches with each subsequent meeting. Lines of expert witnesses form, rendering opinions based solely on their own interpretations of what is documented. Many of the actual medical facts are twisted or misinterpreted (sometimes deliberately) purely for the purpose of demonstrating how one side or the other could sway a jury. Countless hours are spent in preparation for court. Many days are consumed in court with seemingly endless sifting of the scientific minutia of a case, often distracting jurors from the true reality of medical practice. And finally, a jury renders a verdict only to open a door for the appeals process. Stressors in this scenario are second to none.
- Regardless of what you are told, having an outlet to discuss the case is critical. Many will tell you that you should not discuss details of the case, or anything related to it, with anyone but your legal council because those are not confidential conversations. Hiwever, risk managers have means for providing safe environments with counselors, other physicians, or even psychiatrists. There are national programs and organizations built to provide safe harbor for the open discussion of a malpractice case in progress. It is critical that you have someone to speak to, especially when you are experiencing this type of mental torment. Having walked through that tunnel and emerged back into the light, by the grace of God, I cannot emphasize this enough. Open and honest discussion about what is going on inside your head and heart will make an impact. Having someone to walk with you through the process (other than your lawyer) can be a literal life saver. Physicians suffer with extremely high burnout rates, especially in emergency medicine. We also suffer with high rates of suicide and the temporal relationship to bad outcomes or lawsuits have been proven. Do not suffer in silence. There is no heroism in it. Ignore the passive sarcasm of colleagues and be sure you have an outlet for help.
A doctor sued is a doctor changed. It does not make the physician better at medicine, but it does leave them different. In my experience, this leads to a handful of responses and a physician may move through more than one of these.
- Retirement: The experience can be so catastrophic and scarring that a physician leaves practice, unable to cope with the outcomes and the pressures of a similar scenario occurring.
- Anxiety: The fear of repetition, no matter how rare, can lead to irrational medical testing or over testing, and poor decision making. This is often recognized by colleagues, but not necessarily attributed to the correct cause. Some will see this and believe it to be a personality defect, an unethical way to drive up visit complexity and pay, or a lack of medical knowledge. In truth, it is a reaction to a traumatic moment, leading to a deep lack of confidence in one’s own judgement and abilities. It is often unspoken and sometimes unrecognized by the physician in question but obvious to those of us who have walked the path. Often we rely on medical directors or close professional friends and colleagues to point this behavior out and push the physician to seek help. Some will never move beyond this step.
- Balance: This is the area where we land when we emerge “changed”. Ideally, it is a place of understanding of the events that occurred, the frailty of human life, the pressures of the job, and the limitations of human judgement. We accept that there are circumstances that will lead to poor outcomes because of incorrect but well intended care, and some conditions that will lead to poor outcomes despite the best care. We study, pray, and strive to maintain an empathy with our patients without dwelling on the fact that the very people whom we are trying to help may chose to file the next lawsuit. It takes much time, emotional healing, and personal growth to land here. I am convinced that any physician who successfully lands here becomes a sounding board for the pain and suffering this process can bring.
If you are currently going through or have been through this process and are suffering, please know that there are resources out there for physicians in your situation. I offer my personal experience and support and the excellent support of these resources as well:
- Medical Malpractice Stress Syndrome (ACEP)
- Physician Litigation Stress.org (LinkedIn Site)
- MD Mentor
- Coping With Stress Of Being Sued (AAFP)
- How to Survive a Medical Malpractice Lawsuit: The Physician’s Roadmap for Success
- Resources for Professional Liability Litigation Process and Physician Coping Mechanisms (ACEP)
- Litigation Stress (black-bile.com)