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Riding Out the Storm: Mitigating Malpractice Stress Melissa Piasecki, MD It was a routinely busy day in Dr. Miller’s outpatient clinic. Most of the chairs in the waiting room were occupied and the staff were doing their level best to keep the patient flow orderly. So it was particularly irritating when the front office staff called the back line to report that there was a man there looking for Dr. Miller and that he wouldn’t describe why except “official business.” Dr. Miller, sighed, grumbled and then ducked his head into the waiting area and saw a tall man wearing a cap standing near the reception desk. “Yes?” He asked. “Are you Dr. Anthony Miller?” asked the man in the cap. “I am.” “Then this is for you” replied the man, handing over a manila envelope with a large white sticker on the front. Dr. Miller looked at the return address. It was from a law firm. He realized with a thudding beat of his heart that he was being sued. He looked up and the man was already out the door. Dr. Miller is in for some predictable difficulties. He will likely suffer disruption in his practice and anxiety about the outcome of the malpractice suit. Some of the stress related to a lawsuit can be mitigated and the decisions that Dr. Miller makes in the next days and weeks will have a tremendous impact on how much wear and tear this lawsuit will have on his personal and professional life. Until a physician has been sued, it may be difficult to understand the impact of a malpractice suit. Some physicians have described malpractice suits as their worst life event, eclipsing even divorce and the death of family members. Others attributed lawsuits to be a trigger for a episode of clinical depression and/or suicidal thoughts. Many others have commented that a malpractice suit created doubts about career choice and that the shock, anger, fear and shame associated with the lawsuit significantly affected their practice and personal life. Research on the effects of malpractice suits on physicians suggests that the negative effects of a lawsuit persist over two years or more (Martin, 1991). Sarah Charles, M.D. , who has published several articles and a book on the impact of malpractice suits, notes that the unpredictability of malpractice allegations and the loss of control are important contributors to physician distress. Also important are the threats to professional achievement and the implications of one’s professional abilities (Charles, 2001, Charles and Firsch, 2005). Fortunately, there are practical steps physicians can take to mitigate malpractice stress. Be informed -- In medical school, physicians are not taught about the anatomy of a lawsuit. It is unknown territory and therefore has the potential to be a source of unbridled anxiety and unpleasant surprises. Although no physician can expect to understand the legal nuances of a malpractice suit, there are books and other resources that explain the process of a lawsuit for physicians. Malpractice defense attorneys can and should prepare physicians for the stages of a lawsuit and what to anticipate in each stage. Physicians can prepare lists of questions for their attorney and consult with colleagues who have already weathered the process for information to guide them. The resource section below lists books, articles and websites with helpful information aimed for physicians. Take an Active Role -- Many physicians see themselves as action-oriented people and may feel frustrated and marginalized during the proceedings of a malpractice suit. After getting up to speed on the general process of a malpractice suit, the physician can be a more active partner with the defense attorney. Specific activities a physician may be able to engage in include: o Preparation for their own deposition and the deposition of the opposing experts Ask for support -- By telling friends and family what is happening and the effects of malpractice allegations, physicians offer them the invitation to lend support. Colleagues can offer emotional support and suggestions on how to cope with this difficult time. Of particular value are senior colleagues who have weathered malpractice suits and who model resilience. Many medical societies and professional specialty groups have committees and other resources to offer members facing malpractice suits. Some examples are included below. Privileged relationships- psychologists, physicians, social workers, clergy- are another valuable source of support for the physicians who need it. Invest in work-life balance like never before -- Because a malpractice suit is such a predictable source of stress, a physician facing a suit should invest in stress management early in the process. General approaches- exercise, “escape” activities such as movies, reading fiction and scheduled time off- are typically helpful. It is particularly important to balance the afterhours activities directly related to a malpractice suit (such as preparing for a deposition) with time off from all things professional. This may be a time to reflect on the stress management techniques worked in the past or the advice of a close friend. In summary, malpractice suits have the potential to deeply disrupt and distress physician’s lives. Deliberate actions- learning about the process, becoming actively involved, activating a support network and work/life balancing can help. Professional groups recognize the toll of malpractice stress and offer resources to support colleagues. Resources: 1. Your local/ state medical society- do they have a malpractice committee? References: 1. Charles, S.C., (2001) Coping with a malpractice suit. Western Journal of Medicine 174(12):55-58 IND offers three risk management programs per year, two in Las Vegas and one in Reno. In addition, tailored programs are also held for nurses, administrators, and medical office staff. Information regarding these programs can be found here: http://www.ind-insurance.com/risk-management. Please contact Idora Silver, IND Director of Risk Management, at (775) 829-0606 if you have any specific risk management questions or would like to consult with her on customizing a program specific to your needs. |
