To say that litigation results in significant stress is to state the obvious, but finding a way to live under the cloud of litigation takes more mindful and intentional action. There are many things one can do to mitigate the myriad negative feelings that can arise during what might be the darkest days of one’s professional life.
It is important to pay attention to your basic physical needs during this stressful time. Think of food as medicine, and eat a healthy diet that includes whole foods and grains as well as lots of fruits and vegetables. Avoid the temptation to use alcohol as a relaxant; it’s actually a depressant and interferes with sleep.
Speaking of sleep, it’s important to get at least 7-9 hours each night. To promote healthy sleep:
- avoid caffeine within 4-6 hours of sleep onset
- skip the snooze button, which decreases the amount of quality sleep you get
- spend time outside in the natural afternoon light daily to reset circadian rhythms
- avoid eating within 2-3 hours of sleep onset because digestion disrupts sleep
- exercise daily, preferably in the morning because it provides a burst of energy, decreases stress hormones, and improves sleep quality
- avoid stimulating or upsetting television before bed
- develop sleep-promoting routines like taking a warm bath to which you’ve added a few drops of lavender essential oil or drinking a cup of chamomile tea before bed.
In addition to regular exercise (try for at least a 30-minute brisk walk per day), consider other activities that can help you manage the stress of litigation, such as yoga, Qi-Gong, Tai-Chi, mindfulness/ meditation tapes or classes, and breathing exercises. One simple exercise is the 4-7-8 breathing technique, which comes from ancient India. For this exercise, get comfortably seated; inhale deeply through your nose for a count of 4; hold for a count of 7; exhale through your mouth for a count of 8 with the tip of your tongue against the inside of your upper teeth. Do four cycles twice per day, taking in and expelling as much air as you can; it will help offset the stress hormones circulating in your body. It does this by stimulating the parasympathetic nervous system via the vagus nerve.
There are two journaling activities that have been well studied and can help with feelings of depression. First, keep a gratefulness journal by your bedside. Each night, just before sleep, write down three things for which you are grateful. In experiments, doing this exercise for two weeks resulted in a decrease in feelings of depression and an increase in feelings of happiness. A more in-depth exercise is called resilience writing. This involves writing about an unsettling event for 25 minutes for three days in a row. By the end of the third writing session, one typically gains some helpful perspective on the event — regardless of how long ago it occurred.
Most importantly, resist the impulse to isolate yourself. It’s a normal response to feeling threatened, but it’s maladaptive. Unfortunately, it’s also perpetuated by our medical-legal culture. The truth is that doctors who are being sued can talk about their feelings about a case with either professionals or people in their support network. It is only the specifics of the case that should be discussed only with one’s attorney or claim adjuster. Support options include litigation or peer coaches, psychologists, clergy, as well as friends and family with whom one can talk about one’s feelings, which may be of great help.
Lastly, I want to suggest the importance of community. This could mean joining a support group of people going through litigation, talking with other doctors who are challenged by the myriad demands of medical practice, joining a book club, or engaging with a spiritual or religious community. We physicians tend to have developed isolating behaviors in order to succeed and survive in our careers, but the fact is that we all need connection and support. Asking for help is hard, but can be very helpful when being sued. To be at your best, emotionally, spiritually, intellectually, and physically, I invite you to consider these simple suggestions and resources.
Resources
A Network for Grateful Living
Three Good Things gratitude exercise
https://www.youtube.com/watch?v=ZOGAp9dw8Ac
4-7-8 breathing technique
https://www.youtube.com/watch?v=YRPh_GaiL8s
MMIC Well-being Center
http://www.mmicgroup.com/resources/well-being-center
(Laurie Drill-Mellum, M.D., MPH, a Board-certified emergency medicine physician who served as chief of the medical staff and medical director of the emergency department at Ridgeview Medical Center in Waconia, Minnesota, before assuming her role as MMIC’s chief medical officer. She continues to serve as co-medical director of Ridgeview’s hospice program. A Bush Medical Fellow, Drill-Mellum completed a two-year fellowship in integrative medicine at the University of Arizona where her interest in helping fellow clinicians develop greater well-being and resiliency took shape).