Burnout and Malpractice Litigation

As the public and research interest in physician burnout increases as well as the proportion of US physicians affected, it is well to remind ourselves of the important work of Balch et al on the relationship between burnout and malpractice litigation. Six years ago, his group published the results of a survey of 7,197 members of the American College of Surgeons (PMID 21890381), 24.6% of whom had been sued during the previous 24 months. As compared with members not recently sued, these surgeons had higher rates of burnout, symptoms of depression and suicidal ideation. This study reinforces the association between burnout and lawsuits as was demonstrated by a study of Sloan-Kettering cancer surgeons, 71% of whom had been sued. (PMID 21399883)

Balch et al noted that they were unable to establish whether the physician’s burnout contributed to the risk for malpractice or was among the effects of having been involved in a suit. They posited, however, that since burnout can contribute to poor decision making, less compassion and diminished dedication to safe, optimal care, it is reasonable to suggest that these physicians were more likely than their non-sued counterparts to be at risk for error.

In 1995, prior to most of the established studies on the degree of burnout among physicians, we studied the impact of litigation on a group of Oregon physicians (PMID 7483591). They experienced a wide range of emotional symptoms that affected both their personal and professional lives. For physicians who had a claim in the previous year, the risk for an additional claim doubled (from 7% to 14%) in the immediate 12 months after their initial incident as compared to their non-sued counterparts. In retrospect, a valid argument could be made that whether or not the physicians experienced burnout, as it is currently assessed, prior to their litigation, the aftermath of an adverse incident on these physicians contributed to feelings that may well have set the stage for a subsequent adverse event. In other words burnout may have contributed to the initial adverse event as well as further the risk for additional events by exacerbating symptoms in an already compromised physician.

As Balch et al suggest, individual, organizational and societal interventions to support physicians who have been sued need to be identified. In addition, if the data from the numerous studies on burnout are to be believed, the need for such interventions to support a demoralized and overburdened workforce before errors occur is only reinforced. Such efforts could stem the tide of events that can result from, or lead to, further emotional complications that accompany the litigation process.

Sara C. Charles M.D.

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