The nightmare of litigation: A survivor’s true story
After being sued, David dreaded seeing patients and felt always on guard. He was ready to quit obstetrics. A physician mentor explains how David reclaimed his life.
Rather than premature reassurance and comfort, what David needed was to have his trauma named and acknowledged. Choosing my words carefully, I summarized his story and asked whether I had heard and understood him correctly. He verified that I had. Going a step further, I reflected back his underlying emotions as I had heard them—his feelings of fear, helplessness, sadness, isolation, betrayal, violation, anger, and injustice. Then I paused to create space for his response. Soon, the silence was interrupted by the sounds of his sobbing. When he regained his composure, David apologized for losing control. This lawsuit had been a huge strain, he explained.
Symptoms of acute stress reaction
I agreed, pointing out that he had probably experienced an acute stress reaction: feelings of intense fear, horror, and helplessness in response to an unusually traumatic event threatening death or serious physical injury to self or others.
This explained his fright and dazed disorientation on the day he learned of the litigation.6 While the lawsuit was not life-threatening, it threatened his identity, career, and survival as a physician.
Symptoms of PTSD
Usually acute stress reaction settles down, but sometimes it progresses beyond a month into posttraumatic stress disorder, a pervasive chronic anxiety disorder characterized by 3 clusters of symptoms:
- Recurrent, intrusive recollection of the events; recurrent flashbacks and dreams.
- Persistent avoidance of stimuli associated with the event; numbness, detachment, avoidance of patients.
- Persistent symptoms of increased arousal; insomnia, hypervigilance, irritability, difficulty with concentration.
“I am a rock” mentality may predispose to PTSD
Litigation, because of its protracted nature, is particularly retraumatizing. David concurred: “This explains why just opening a lawyer’s letter now causes my heart to pound.”
Unlike the military, physicians do not enter a stressful environment organized into teams. Should trauma and acute stress reaction occur, most physicians continue working despite their intense physical responses. There is little community support, so withdrawal and isolation is the norm, and this “norm” may predispose to posttraumatic stress disorder.
As a result, some physicians manifest behavioral problems such as being hyperreactive, aloof, or disruptive, or they abuse alcohol and drugs. Ironically, these behaviors probably lay groundwork for additional lawsuits.7
Counting up the losses
David asked what I meant by “losses.” I explained that the nature of trauma is to create loss.
- Together we listed his loss of:
trust
safety
peace of mind
sense of justice
integrity of personal boundaries
control
self-esteem
self-confidence
passion
idealism
If you notice that you are stunned, bewildered, and feeling overwhelmed, even disoriented, accept that you may not be able to think clearly for a while. Avoid complex tasks and major decisions.
Take care of your physical health. Obstetricians take sleep deprivation, lack of exercise, long hours, and irregular eating habits for granted. This, however, is not the time to neglect your basic needs. If necessary, take time off (though many prefer to keep to a regular, albeit moderated, familiar schedule).
Do not isolate yourself. Share your feelings with those you can trust. Consider seeing an individual, such as a psychotherapist, who is trained to listen therapeutically. Do not use your lawyer for this purpose.
Limit use of substances (such as sedatives, hypnotics, alcohol) and limit activities (burying yourself in work or exercise) aimed at numbing your emotions.
Conserve your energy. You have limited control over legal proceedings. You can, however, apply your energy to improving your well-being.
If you develop symptoms of depression, do not hesitate to seek psychiatric help and certainly do not attempt to self-medicate.
For many reasons, not the least being shame, physicians avoid consulting a mental health professional and repercussions can be serious.16
Remember your life partner, children, and others around you may be affected too. Be gentle with them.
The power to choose how to respond
While he could not stop the lawsuit, he did have the power to choose how to respond to it. It was his choice whether to be demolished by this lawsuit or to use it to grow personally and professionally. If he agreed, I would partner him in transforming his suffering into growth. On the other hand, should his symptoms not recede, he would need to see a psychiatrist.
By now I had:
- validated his trauma, losses, and suffering
- provided him a cognitive framework
- interrupted his lament
- created safety for him to express his emotions
- emphasized he was not helpless, and that he had choices
- offered to partner with him, thereby relieving his isolation
- role-modeled listening
- offered him hope and a sense of some control.
