Malpractice distress: Help yourself and others survive
Prepare for stress by knowing what to expect and how to respond.
Table 3
Managing your emotions before and during litigation
| Anticipate having repeated thoughts and preoccupations about the event; work toward a realistic view of it |
| Recognize your feelings and work to understand their source |
| Talk with a trusted confidant (your spouse, colleague, etc.) about your feelings |
| Monitor your emotional and physical status and, if indicated, seek appropriate consultation |
| Avoid situations that generate anxiety and increase stress |
| Monitor and address changes in relationships with family, patients, colleagues, and staff |
| Be understanding of yourself and others; develop a realistic view of yourself as a ‘good doctor’ |
| Engage in active sports and take regular vacations unrelated to professional activities |
| Control what can be controlled |
Self-evaluation. To cope with distress when a patient dies, you could attend the funeral. If the death was by suicide, consider consulting with a therapist about your reactions or review the case with your supervisor. 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 resource12,13
- 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.
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. As one ObGyn stated, learning that a lawsuit was filed “just prolonged my misery.”14
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 each case
- our relationship with the patient
- the public nature of a lawsuit
- a range of other variables that makes each case unique.
Suddenly, we who perceive ourselves as caring, beneficent, well-meaning, and devoted to our patients are publicly accused of being careless and incompetent, of harming the patient by failing to meet our minimal obligations. Psychiatrists Richard Ferrell and Trevor Price15 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). We have little control over a slow-paced process that involves an array of participants (lawyers, judges, jury, and experts) whose behavior is not predictable. This makes us feel dependent, vulnerable, and impotent.
Table 4
Stages of litigation: What happens in court
| Stage | Definitions |
|---|---|
| Summons | Notification that a suit has been filed |
| Complaint | The nature of the allegation in legal terms |
| Pleadings | The attorney begins to communicate with the court by filing motions, a request that the court do something |
| Discovery | A process designed to obtain information about the case:
|
| Summary judgment | A motion asking the court, after the facts have been established by discovery, to decide the validity of the case; if granted, the case is resolved without a trial by jury |
| Settlement | An agreement between parties that resolves their legal dispute |
| Trial | Case is presented to the judge or a judge and jury to determine culpability |
| Verdict | Decision reached by the deciding body |
| Post-trial | If the defendant receives an unfavorable verdict, motions may be offered to the court to void or appeal the verdict |
BE ACTIVE, NOT PASSIVE
What you can do. Contact your insurer and risk manager immediately. Inquire about the average length of litigation in your jurisdiction (might be 1 to 5 or more years, depending on locality, type of case, and severity of injury). Ask your lawyer to describe the steps in the process and your role as the case proceeds.
Take whatever steps are necessary to cover your clinical duties. If your initial emotional reaction is disruptive, obtain coverage or rearrange your schedule. Expect to change or limit your schedule before depositions and during trial to allow adequate time for preparation.
Accept the fact that you must play by rules far different from those of medical care. Litigation is time-consuming and frustrating. Delays and “continuances” are common in legal proceedings, so expect them. Consider adapting to your own situation strategies that other sued physicians have found useful in regaining control over their lives and work (Table 5).
