Symptoms You Should Watch For
These distinct symptom clusters often arise after adverse events and during litigation because of the nature of litigation and its threat of losses, its intermittent nature, and its chronic course. As a physician, health and well being (your own) should be front and center – especially during a malpractice lawsuit.
Depression is a normal reaction to loss and we all feel depressed or blue at some time or another. We are particularly vulnerable after an adverse event and during litigation in which our risk for sustaining losses is significant. These may involve losses associated with our sense of integrity, the patient's injury or death, feelings of self-esteem and reputation, positive feelings about patients and peers, the reluctant loss of valuable time ordinarily devoted to patient care, rising insurance premiums, and the outcome of the case itself. We react to these actual and potential losses in our own way. We may also experience unanticipated losses in our lives (illness, divorce, the death of a family member) not related to litigation, but occurring during the lengthy litigation process.
For some, the following signs and symptoms of depression may last for long periods of time and interfere with our living our normal lives.
- Loss of pleasure in previously enjoyable pursuits
- Loss of energy
- Feelings of hopelessness or worthlessness
- Difficulty concentrating
- Difficulty making decisions
- Insomnia or excessive sleep
- A change in appetite accompanied by a gain or loss of weight
- Such unexplained aches or pains as recurrent headaches
- Sexual problems especially decreased sexual interest
- Digestive complaints
- Thoughts of death or suicide
These symptoms, if they persist on a daily basis and for a few weeks, may be signs of a serious depression and require professional evaluation. It is important to note that there are different types of depression. Bipolar depression may manifest itself as irritability and in manic behaviors rather than depressed mood. Effective treatments exist for all of these conditions after they are properly diagnosed. We can resume our normal activities and eventually regain our feelings of pleasure and comfort in daily life with timely treatment, most often with the use of antidepressants, mood stabilizers, and psychotherapy suited to our individual situation.
Post-Traumatic Stress Disorder
Post-traumatic Stress Disorder (PTSD) may occur after a person has experienced or witnessed a traumatic event in which serious physical or emotional harm was threatened or occurred. Unforeseen but catastrophic events or the development of a known but unexpected serious complication is not unusual in medical practice. Most of us who experience such traumatic events respond with feelings of shock, fear, anxiety, anger, guilt, and horror. These events are especially painful if we feel that we contributed in some way to the outcome. Generally, these feelings and their associated symptoms of sleep disturbances and preoccupying distractions resolve within a short period. If named in a malpractice suit over the event, the lengthy process of litigation often exacerbates rather than contributes to the resolution of these emotions.
PTSD is a possibility if the following symptoms begin within three months of the stressful event. They may, on occasion, emerge even many years later. When these symptoms persist, they may interfere with living a normal life.
- Re-living the Event - When we suffer from PTSD, we are constantly preoccupied with memories of the event. When reminded of the event, we may experience flash-backs, disturbing dreams, and psychological and physical distress. Passing by the surgical suite in which the event took place or seeing the injured person at the supermarket may bring back a rush of emotions and painful memories. Despite our best efforts to rid ourselves of such thoughts and feelings, we are unsuccessful and feel totally helpless.
- Avoiding Behaviors - In order to protect ourselves from experiencing such painful thoughts and feelings, we may instinctively avoid people, places, thoughts, or situations that remind of us the trauma. There is a possibility this may result in feelings of emotional detachment and isolation not only from our family and friends, but also from our patients and colleagues. We may feel emotionally “numb” and no longer be able to enjoy our work.
- Hyperarousal - After a traumatic event, we may feel jumpy and irritable, easily startled, and react excessively to external stimuli. We may have difficulty falling and staying asleep. We may suddenly have outbursts of anger over minor irritations. We may also notice an increase in our blood pressure, heart rate, and respirations. Some of us will experience diarrhea, headache, and increased muscle tension.
Each of us reacts to stress in our own way. Some of us are more resilient and manage stress more successfully than others. There is evidence that support from family members, friends, and professionals may may be helpful. When serious symptoms persist, however, consultation with a psychiatrist or psychologist is necessary. The goal is to reduce the symptoms by treatment with psychotherapy, medication, or both.
After an adverse event and during litigation, we may engage in uncharacteristic behaviors that may or may not merit a clinical diagnosis but that affect our work and relationships and that impel us to seek consultation.
Withdrawal behaviors - Withdrawal behaviors - Sometimes we feel shame before our colleagues or family or so emotionally overwhelmed that we withdraw from all communication except when our daily work requires it. When we finally arrive home after a long day, we may, for example, take refuge in watching TV alone for hours and isolating ourselves from our spouse or children. We may skip hospital or clinic committee meetings in which we were formerly active. We may be chronically late for appointments or careless in our work habits, delaying dictation or neglecting to check completed laboratory tests. The persistence of such behaviors complicates our lives and, unless we recognize and change them, may create new stressors that only intensify our feelings of being overwhelmed and defenseless.
"Acting out" behaviors - Some of us engage in such uncharacteristic activities as promiscuity, gambling, or an illicit affair. We may spend money beyond our means or eat excessively. Unless we recognize and address them, such behaviors can create profound long term changes in our financial stability and family/professional lives.
Self-medication - Physicians are particularly prone to self-medicate when they self-diagnose a medical or psychological condition. We may, for example, use sedatives to manage our anxiety and promote sleep. We may use stimulants such as amphetamines to elevate our mood or nicotine or marijuana to relax us. Addiction to such drugs may result in complicating physical illnesses and disrupt our lives and careers. We can protect ourselves from such developments by consulting with our own internist about any symptoms we develop and by steadfastly refusing to self-medicate despite the added stress associated with litigation.
Alcohol Use Disorder - Although most of us drink moderately, we may feel the need to dampen the effects of undue stress and sleeplessness by drinking excessively. We may not notice this change in our use of alcohol until our work suffers or others draw our attention to it. Consultation is useful when a number of the following signs are present:
- Hangovers that cause us to arrive late or unprepared for our work
- Arrests for driving while intoxicated
- Arguments with spouse or family members about our drinking
- Carelessness about ordinary obligations
- Unwarranted irritability and aggressiveness
- Tolerance (we need larger amounts of alcohol to feel its effects)
- Withdrawal symptoms (shakiness, agitation, confusion) after stopping alcohol
- Drinking larger amounts or over a longer period than intended
- Constantly thinking about or trying to control our drinking
- Spending a great deal of time getting or using alcohol
- Avoiding activities because of drinking
- Continuing to drink even though it complicates our lives or causes work or legal problems.
The first step to recovery is to acknowledge that there is a problem. Ideally, we should consult with our personal physician who can refer us, when indicated, to the appropriate resource. There are well-established recovery programs for both substance and alcohol abuse that use a range of treatments including counseling, education, support groups, and medications. Many of these programs have on-going relationships with medical societies that facilitate privacy and licensure protections while physicians are in treatment.