Managing Medical Malpractice Stress by Louise Andrew, MD, JD and John-Henry Pfifferling, PhD
Although malpractice claims are a completely predictable hazard of medical practice in the 21st century, medical training rarely addresses, let alone confers immunity from the harmful effects of malpractice litigation. Here is what you need to know to begin to transform the experience.
The impact of a medical malpractice suit on the physician, and on his or her family, produces the symptoms of medical malpractice stress (MSS).
The term “malpractice” is often a misnomer, as many - if not the majority of - suits, upon suitable investigation, are non-meritorious, mal-occurrences, mistakes caused by systemic errors, or harm associated with disease or illness processes. Because of the stigma associated with negligent injury, intense shame and negative consequences accrue to sued physicians. This reality alone behooves us to find alternatives to a current system that is not a sensible mode of compensation, or a valid and effective strategy for maintaining or improving medical care. Comparisons of medical malpractice and other personal injury awards were three times as high as in motor vehicle cases (Bovbjerg, et al, 1991). Physicians can find good data to support their claims that their status as victim is real. Physicians who are sued usually perceive the claim as an assault on their own integrity. Sued physicians report reactions such as the following, to describe the emotional roller coaster of the experience:
“Over the weeks, months, and years of the suit, I felt waves of shame and betrayal.”
“Very annoying and humiliating... an affront to my competency.”
“An embittering experience.”
“Now, I watch myself react to patients with a subtle distance.”
“I had a frantic, furious reaction; now I realize my practice is no longer worth the sacrifice.”
“It was the most stressful experience in my life. It reinforced my commitment to leave medicine.”
“No one, not even my close colleagues, offered to support me.”
Typical symptoms of the medical malpractice stress syndrome
In retrospective analyses of sued physicians, regardless of outcome of the suit, almost all report physician or emotional reactions. Common symptoms include:
Isolation. Most feel alone in their efforts to vindicate themselves. This feeling of aloneness persisted, in spite of having an attorney on the case. Rarely did the sued physician seek support from colleagues. When queried, their colleagues admitted they feared reaching out to help or did not know what they could offer.
Massive emotional impact. Most experienced anger, free-floating tension, increased negative moods, depression-like fatigue, frustration and violated sleep (insomnia). Many reports suggest depressive disorders lasting longer than two weeks. This litigation depression occurred in people who previously had not reported depression. Feeling an assaultive anger seemed to be the most common recurrent sensation.
Anger syndromes. Many sued physicians, regardless of legal outcome, report anger clusters including expected anger outbursts, irritability (with seemingly slight provocation), frustration, an dull or negative affect, as well as physical symptoms. These included GI and chest pains mimicking MI symptoms. .
Fatigue syndromes. Many report changes in concentration, decreased libido, appetite apathy, and exhaustion or fatigue clusters in many arenas. .
Absence of symptoms. Some physicians report no symptoms. Little data is available on the characteristics of these “resilient” physicians. Further research is needed on this group, to determine whether there are “immunizing” factors (i.e., available peer support, shared disclosure by peers, previous claims, successful defense, etc.) which might offer protection from the MMS, or whether denial is the explanation for these outliers. .
Results of medical malpractice stress
If you are sued, expect to:
Be personally angry
Magnify self-doubts; questions your own competence
Experience persistence of negative feelings
Feel isolated, frustrated, and unjustly singled out
Experience guilt even if your performance and professionalism were faultless
Experience symptoms or episodes of illness or depressive affect
Lose some ground in your practice, although rarely permanently
Compassion from colleagues, especially if they have not yet been sued
Immediate understanding from family, friends, and partners
Support from administrators, if insurance may be jeopardized or more parties brought into the case because of your defense
A change of heart on the part of the plaintiff or plaintiff's attorney
That your attorney will just handle the case with you taking a back seat
Re-printed by permission of the Center for Professional Well-Being in Durham, NC, www.cpwb.org
The MPHP is always available to assist physicians who are experiencing difficulties in response to a medical malpractice suit.