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“You’ve Been Served” Coping With the Stress of Malpractice Litigation Submitted by NORCAL Mutual Insurance Company As a physician, the odds are greater than 50/50 that you will be sued for malpractice at least once during the course of your career.1 A majority of malpractice lawsuits never go to trial, but the stress of being served can lead to serious emotional, and even physiological, consequences. Researchers have been redefining the way we think about the physician’s experience of being sued for malpractice, exploring professional and economic ramifications in addition to personal and emotional effects. This research is helping physicians manage the short- and long-term impact on their practices and personal lives.

The Myth of Infallibility: Why So Many Physicians Get Sued Physicians today are held to seemingly impossible standards by patients, the public, and themselves. According to Frank B. Kelly, MD and Mark C. Gebhardt, MD, members of the American Academy of Orthopaedic Surgeons’ (AAOS) Physician Stress Project Team, “more and more, the public is expecting perfection. The line between an unfortunate outcome and perceived malpractice is blurring. Many patients believe that a less-than-perfect result justifies a lawsuit.”2 Many do not realize or appreciate the extent to which a claim can disrupt a physician’s life. A malpractice suit often irrevocably alters the way physicians practice medicine. Because they tend to

be self-critical and often possess an acute sense of responsibility, they are especially vulnerable to feelings of doubt and guilt when something goes awry.3

Despite these symptoms, the physician is expected to manage the lawsuit, prepare for a trial if necessary, and carry on with his or her practice.

Emotional Impact Studies show that emotions experienced by physicians being sued are comparable to those that accompany any catastrophic life event, and typically include shock, denial, shame, anxiety, anger, and depression. Physicians often experience the following: •


A magnification of self-doubt

Persistent negative feelings

Isolation, frustration, and the feeling of being unjustly singled out

Massive guilt, even if their performance wasn’t to blame

An onset of physical symptoms such as GI and chest pains, or an exacerbation of preexisting conditions4

Despite these symptoms, the physician is expected to manage the lawsuit, prepare for a trial if necessary, PAGE 16  |  THE BULLETIN  |  MARCH / APRIL 2009

and carry on with his or her practice. Many physicians find themselves unable to cope. Researchers have found that two factors commonly contribute to physicians’ feelings of vulnerability, when faced with a malpractice suit: a lack of legal training and a lack of training in how to deal with emotions.5 According to Sara C. Charles, MD, a pioneer in the field of litigation stress, when a physician is unable to cope with the stress associated with litigation, he or she is likely to take counterproductive measures.3 The physician may begin to practice defensive medicine, engage in obsessive record keeping, avoid patients with a greater risk of experiencing adverse outcomes, become emotionally distant from patients, work fewer hours, and even retire early. Personally, the physician may feel isolated and withdraw from family, friends, and social activities.4

Methods for Coping Studies have shown that the following strategies can help physicians cope with the stress of a lawsuit more effectively: •

Accept that litigation is an occupational hazard of practicing medicine. “It’s important to accept the fact that no matter how good you are and how hard you try, there will be bad outcomes under your care.”6 Numerous studies have debunked the notion that incompetent doctors get sued and competent ones do not. It’s important to note that compensation

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