Malpractice distress: Help yourself and others survive
Prepare for stress by knowing what to expect and how to respond.
Table 5
Regaining control: Managing your practice during litigation
| Learn as much as you can about the legal process |
| Introduce good risk management strategies, such as efficient record-keeping, into your practice |
| Clarify the responsibilities of office personnel and coverage responsibilities with associates |
| Rearrange office schedules during periods of increased stress |
| Re-evaluate your time commitments to work and family |
| Participate in relevant continuing education |
| Make sure your financial and estate planning is current |
| Cooperate with legal counsel |
| Devote sufficient time to deposition preparation and other demands of the case |
| Carefully evaluate the advice of legal and insurance counsel regarding a settlement |
| Do not try to “fit patients in” while on trial; trial is a full-time job |
GET NEEDED SUPPORT
Talking about the case. Sharing with responsible confidants your emotional reactions to being sued is healthy for you and others affected. Lawyers, however, may caution you not to “talk to anybody” about the case. They don’t want you to say anything that would suggest liability or jeopardize their defense of the case.
As psychiatrists, we know this is not good psychological advice. The support of others is a natural help during major life events that cause enormous stress and disruption.16 You can resolve this dilemma by accepting the discipline of talking about your feelings regarding the case without discussing the specifics of the case.
In addition to lawyers and claims representatives, you may talk with your spouse or another trusted person or colleague about your feelings. When other physicians or psychiatrists formally consult with you about their litigation experiences, you are protected by the confidentiality inherent in the doctor-patient relationship.
Trust issues. Trust lies at the core of psychotherapeutic work. After being sued, you may find it difficult to re-establish trusting and comfortable relationships with patients, especially those who are seriously ill.
Well-trained, competent physicians who keep current with standards of care and have good relationships with patients do not expect to be sued. Psychiatrists often feel unrealistically immune to litigation because we believe our training helps us understand our own psychology and relationships with others. A charge of negligence exposes our vulnerabilities and leaves us feeling hurt and betrayed. As one psychiatrist ruefully observed, “I lost my innocence.”14
Countertransference feelings may emerge. Most physicians acknowledge that after being sued their relationships with patients change17,18—a particularly distressing outcome for psychiatrists. We may feel uncomfortable and threatened when we need to “stretch the patient-doctor relationship in a paternalistic direction,” such as when a psychotic patient needs involuntary commitment.15
Feelings that you must change the way you practice and chronic anxiety about your work are barriers to good practice. You may contemplate changing practice circumstances or retiring early. Personal therapy may help if you remain uneasy or cannot resolve life choices that overshadow your work with patients.
Medical or psychiatric care. Be alert to the point at which you or others involved in litigation need a referral for medical or psychiatric consultation. Sued physicians, their families, or colleagues often experience diagnosable psychiatric conditions or other behavioral problems, such as:
- major depression
- adjustment disorders
- posttraumatic stress disorder
- worsening of a previously diagnosed psychiatric illness
- physical symptoms that require diagnosis and treatment
- alcohol and drug misuse or abuse
- anxiety and distress that interfere with work
- self-medication, especially for insomnia
- disturbances and dysfunctional behaviors that affect marital and family life.19,20
SUPPORT YOUR COLLEAGUES
When consulting with other physicians, be aware of litigation factors that may influence treatment.
Become familiar with the climate of litigation in the jurisdiction where the case was filed, including the incidence and outcome of cases. For example, does an attempted suicide case usually result in settlement or—if it goes to trial—take 2 to 5 or more years to resolve? More than 70% of cases filed nationwide result in no payment (no settlement) for the plaintiff. If cases go to trial, physicians win 80% of the time.21
Recognize that the source of the physician’s distress may be the trauma associated with the initial bad outcome, rather than the malpractice suit itself. As the case progresses and facts emerge, you may play a large role in helping your physician patient correct previous distortions of the event. Certain periods—during trial, for example—might require more-frequent visits, medication, and expressions of support.
You may harbor a bias about the case, but withhold judgment until it is resolved.
Related resources
- American College of Obstetricians and Gynecologists. From exam room to court room: navigating litigation and coping with stress (CD-ROM) https://sales.acog.com/acb/stores/1/product1.cfm?SID=1&Product_ID=589).
- Charles SC, Frisch PR. Adverse events, stress and litigation: a physician’s guide. New York: Oxford University Press; 2005.
- Physician Litigation Stress Resource Center. www.physicianlitigationstress.org.
Disclosure
Dr. Charles reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
