A recent article in the Annals of Family Medicine (PubMed) entitled “It Finally Happened To Me” featured a physician who was sued for medical malpractice when a young patient under her care died unexpectedly. She discussed how going through the process affected her. She wrote of her “embarrassment, shame, frustration and grief” and eventual realization that she was suffering from a form of post -traumatic distress syndrome. Additionally she spoke of her ongoing fear of being sued again and of her gravitating to relying on more and more “defensive medicine” practices as a coping mechanism. The good news was that eventually, with some professional help, the physician came to grips with her situation and seemed to have been able to resolve, or at least cope, with the issues that were a dominant part of her life during the litigation process.
So the question for each of us is, “What’s going to happen when ‘it finally happens to me’ ”? How will I get through the legal process? How can I cope during and after? How will it affect my family? Will I finally be able to move on?
Oregon psychiatrist Ron Holfeldt, an expert in the area of physician litigation stress says that, in the face of a malpractice lawsuit, many physicians become a plaintiff attorney’s dream because they suffer from “F.U.D., fear of the process of litigation, uncertainty and guilt about the outcome of the patient’s care; and doubt because of retrospective thoughts that perhaps more could have been done.”
How should we cope? Most physicians cannot get through a lawsuit without it affecting them in some way. Some may react with relatively unhealthy behaviors. They may try to ignore everything about the suit. Some may try to immerse themselves in their work and order “every test in the book”, become exercise addicts, become hateful of life, patients, and medicine, bully the plaintiff’s attorney, try the case to everyone they see, withdraw professionally or from family, turn to alcohol or drugs, quit medicine, or even commit suicide.
On the other hand, some physicians may take a different and healthier approach to being involved in litigation. Such approaches will often include learning the process of litigation and preparing to manage the stress with each step, assisting with one’s own defense, maintaining control of work hours and patient volume, making increased use of formal and informal second opinions, focusing on personal relationships with family, friends, and supportive organizations, maintaining a balance of work, rest, recreation, and, perhaps, worship, monitoring consumption of controlled and uncontrolled substances, and approaching new activities and ventures with moderation. These coping strategies may not be easily accomplished alone and may require professional help. Asking for this help may be, in and of itself, very difficult for some. Of course, decisions around quitting medicine and recognizing depression or suicidal ideation should always require professional guidance.
During the actual course of litigation it may be difficult to accept but with the right approach and support, coping, regaining self-confidence, overcoming embarrassment and moving on are all highly possible.
(Larry Veltman, MD, FACOG, CPHRM, is a Risk Management and Perinatal Safety Consultant.)