Got malpractice distress? You can help yourself survive

Expect that your view of the circumstances will generate a complex array of feelings: shock, anxiety, depression, shame, guilt, self-blame, disbelief, self-doubt and inadequacy, anger, and, even, relief from not having to work with a difficult patient anymore.

Most physicians feel a personal sense of failure and inadequacy when they are unable to prevent a patient’s death or serious injury. Although serious events evoke greater distress, any event that may eventually be judged an error or become the subject of a lawsuit can give rise to anxiety, decreased confidence, sleep disturbances, and decreased job satisfaction.⁶ In the midst of such feelings, you must:

• deal with the event’s medical complications, relevant notifications, and disclosures (TABLE 2)
• address the emotional pain of the injured patient or family
• participate in mandated reviews
• recognize and manage the emotional disruption to you (TABLE 3).

Self-evaluation. To cope with distress when a patient dies, you could attend the funeral. You also might:

• make changes in your practice that alert you to problem patients
• introduce a more structured approach to patients with particular clinical conditions, using practice guidelines as a resource⁷
• become more alert to patients who may benefit from consultation or referral.

Balance the time you devote to work and personal life. Schedule regular time for recreation and active sports, which can help you prepare for the prolonged stress that follows being sued. Engage a personal physician to monitor your physical and emotional health and to recommend appropriate referrals, when indicated.

TABLE 3

Get a grip on your emotions, before and during litigation

Knowledge is power

What can I expect? A lawsuit generates a mixture of common emotions and exacerbates those felt at the time of the bad outcome: shock, outrage, anxiety, anguish, dread, depression, helplessness, hopelessness, feelings of being misunderstood, and the anger and vulnerability associated with a narcissistic injury. Ordinarily we possess a healthy narcissism—that is, good feelings of self-esteem and a set of ideals that motivate and gratify us. When we suffer a tragic outcome or are sued, our self-esteem and ideals are directly challenged, resulting in feelings of failure, criticism, and public humiliation. These feelings can damage our sense of self and generate further feelings of shame, depression, and rage—all signs of a so-called narcissistic injury. As one ObGyn stated, learning that a lawsuit was filed “just prolonged my misery.”⁸

Each of us reacts in our own way to a lawsuit—and differently to each lawsuit if we are sued more than once—because of:

• our personality traits and personal circumstances
• the specifics of a case
• our relationship with the patient
• the public nature of a lawsuit
• a range of other variables that makes each case unique.

Suddenly, you who perceive yourself as caring, beneficent, well-meaning, and devoted to your patients are publicly accused of being careless and incompetent, of harming the patient by failing to meet your minimal obligations. Psychiatrists Ferrell and Price⁹ capture the impact of these allegations:

Here are the sense of assault and violation, the feelings of outrage and fear. Most painfully, here is the narcissistic injury, the astonishing wound to our understanding of ourselves as admirable, well-meaning people.

Litigation is a lengthy process with defined stages (TABLE 4). You have little control over a slow-paced process that involves an array of participants (lawyers, judges, jury, experts) whose behavior is unpredictable. This can make you feel dependent, vulnerable, and impotent.

TABLE 4

Pocket guide to what happens in court