The author can be reached at docbarryB@aol.com. Web site: www.processmedicine.com
The author reports no relevant financial relationships.
“I was stunned, bewildered, and disoriented. Surely this wasn’t happening to me. I felt cornered like a trapped animal and just had to escape so I spent most of the day wandering around in a daze. It was like living a dream—no, more like a nightmare.”
The victim of an accident, criminal assault, or terrorist attack? No, this was David, an obstetrician describing to me his reaction on being sued for medical malpractice. A day that started off as hectic but routine suddenly turned into a nightmare. Later, colleagues would tell him not to worry, that he’d be OK and that litigation was a “normal” part of medical practice. But it didn’t feel normal to him, as the memories of that day continued to replay in thoughts and dreams.
Malpractice liability may be omnipresent, but that doesn’t mean getting sued is a “normal” everyday hazard that Ob/Gyns should be able to take in stride. Litigation is frequently unfair, abusive, and traumatizing, and can cause acute stress disorder and even posttraumatic stress disorder (PTSD) in both physicians and patients.
In this true story, an obstetrician suffering disabling litigation stress reclaims a sense of empowerment and control as he becomes aware of the nature of litigation stress. In the process, he learns how to listen, understand, and support patients, employees, and colleagues in times of stress.
During one-on-one telephone sessions, his trauma was acknowledged and named; his losses were identified and mourned in safety; and his isolation was relieved in a healing supportive relationship.
The initial shock
This was his first. “I was a litigation virgin,” he sardonically commented. “You know, when you’re jumping the waves in the ocean at high tide and then you become confident, you turn your back, and this big one hits you? It felt like that. I had just begun to relax, believing it wouldn’t happen to me. Then the lawsuit hit. It was a patient I’ve known for years. I delivered her other children and regarded her almost as a friend, someone I liked and trusted.
“I’ve made mistakes in the past but this wasn’t one of those times. It’s so unfair—instead of being grateful that I saved her 9.5-pound baby, she hunted down a lawyer on the Internet. The Web is full of them just waiting to pounce.”
David recounted the journal articles1 he’d looked up, which recommended that he share his feelings with a trusted colleague. Other articles cautioned against a possible “discoverable” confidence.2 Colleagues’ attempts at reassurance did not really comfort him.
Sociable persons who have a thoughtful, active coping style and a strong sense of their ability to control their destiny have more capacity to resist stress.
- Am I a loner?
- Do I assign control of my destiny to others?
- Am I a perfectionist?
- Do I tend to beat up on myself when I miss the mark?
- Is my primary identity that of physician?
- Do I lack a community of support?
- Do I lack stress reduction practices?
- Do I suffer from burnout?
- Do I have a history of serious trauma?
If you answer yes to any of these questions, you are probably at greater risk of litigation stress. Begin attending to your personal needs and well-being now.
Expand your resilience. You have invested time and money in your education; now invest in yourself.
David contacted me when it became increasingly difficult for him to see patients. He said that he felt he had to be constantly on guard, watching every word and action as if patients were an enemy waiting to ambush him. He dreaded going to work and wondered if he should quit obstetrics.
No, he did not want to see a psychiatrist or a psychotherapist. He wasn’t crazy, he wasn’t thinking of suicide or anything like that, he said, and the last thing he needed was the credential committee of his local hospital breathing down his neck.
He spoke in a a lifeless monotone, reciting the facts of the case as he had told and retold them many times. He sighed often and used negative expressions such as can’t, but, should, have to, if only. He was articulating a lament—an expression of suffering and loss, which is not uncommon among physicians3,4 and patients.5 Within his narrative ran an unbroken thread of helplessness, grief, despair, and absence of meaning and hope.