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Coping with Malpractice Stress

If you are named in a medical malpractice suit, you would be wise to remember this phrase: Stress is inevitable; struggling is optional.

This statement captures my approach to helping surgeons cope with malpractice stress. In today's malpractice environment, it is wise to consider this an anticipated, unavoidable event. And no matter how inherently hardy you might be, the malpractice process is stressful. A 2008 study by the Physicians' Foundation ranked medical liability pressures as the third leading stressor in medical practice, behind long hours and insurance issues (Autry, 2008).

Research has shown that 95% of physicians react to being sued by experiencing periods of emotional distress during all portions of the process of litigation (Charles, 2001).

But there are alternatives to simply struggling through this process.

Recognize the Risks
Realistic coping "roadmaps" can help. Start by recognizing the mis-match between the psychology of most surgeons and the process of most malpractice suits. Surgeons are trained to:
  • Seek Order from Chaos
  • Identify Patterns from Random Facts
  • Evaluate, Treat, Resolve
  • Stay Cognitive
In contrast, the malpractice suit process
  • Seems Chaotic
  • Endless
  • Random
  • Poor Follow-through
  • Unfocused
  • Emotional
Also note that that the style of coping you learned in your medical education may have left you harboring psychological wounds that can complicate your coping during times of vulnerability. These include perfectionism; fears of being shamed or humiliated; and a general distrust that others will react nurturingly when you are vulnerable. Practicing in a competitive medical community (and who doesn't?!) will heighten your risk of suffering undue self-doubts and shame in the wake of being named in a malpractice suit. In the wake of a suit, it is common to feel a combination of fear, outrage, embarrassment, and, sometimes, regret. If you cloak such emotions with a shroud of withdrawal or anger, they will fester into shame and anxiety, which can fuel a full-fledged malpractice stress syndrome.

The Malpractice Stress Syndrome Checklist
From the list below, check any signs of malpractice stress syndrome that describe you.

    __I am atypically cautious when treating patients
    __I am hesitant or refuse to treat difficult cases
    __I obsess on case details or on "cover my tracks" documentation
    __I am hyper-sensitive to perceived slights or criticism from colleagues
    __Due to my embarrassment over this suit, I have withdrawn from my colleagues
    __I find it difficult or impossible to talk with my family about this suit
    __I am questioning my commitment to my specialty
    __I am masking my vulnerability with a veneer of anger or indifference
    __I am considering changing jobs or taking early retirement
    __I am atypically struggling with some combination of depression, anger, or
         other forms of emotional distress
    __I am self-medicating with alcohol or other drugs

Protecting or Restoring Resilience
Controlling yourself during uncontrollable times means boosting perceived and actual control and support, even if you cannot eliminate the demanding stressor that you are facing.
  • Learn What to Expect, and Participate in the Process: Learn what you can expect from this process, psychologically and procedurally. Start by accepting the pace of a malpractice suit. From complaint through discovery, and trial or settlement, the typical malpractice suite unfolds over a period of two years. Many are then continued, due to appeals or retrials. Remember that no amount of urgency or obsessing on your part will alter this time frame.

  • Assure yourself that your attorneys and risk management professionals understand fully your side of the story. Seek their input regarding your anticipated role in each stage of the process. If appropriate and desirable , participate in selected aspects of your defense, like choosing expert witnesses. Most surgeons find it reassuring to have periodic contact with their attorneys throughout the long months that unfold between any clear events related to the suit.

  • Recognize that this is a Family Affair: Don't try to keep your angst a secret from your loved ones. Doing so will only serve to alienate you, confuse them, and generally strain your family relationships. Let your loved ones know what you are going through. Reassure them that the details of the suit are being attended to. And ask for their support. Accept that the types of support you each will need may vary through the process. At different stages of the suit, each of you may vary your needs for information, tangible help doing things, affection and positive social interactions.

  • Seek Support from Trusted Colleagues: Loneliness throughout the malpractice process is a major, avoidable stressor for most surgeons. Attorneys admonish that discussions about the case details may be discoverable. But supportive interactions with trusted colleagues about your own emotional needs and reactions are not discoverable. Let trusted colleagues know what you are going through, and ask for their support. I realize that this might sound like heresy to a competitive surgeon who may not trust the good will of his or her colleagues. But it does work far more often than not. Having self-confidence enough to admit when you are vulnerable tends to do two things: it deepens others' respect of you, and it begets support from others that will help you to cope.

  • Control What You Can: I encourage my physician clients to think of this process as being akin to competing in a lengthy season of athletic competition. Now, more than ever, it is important to pay attention to the basics of self-care in order to protect your stamina and resilience. Exercise regularly. Eat healthily. Avoid self-medicating with alcohol or other drugs. Get a medical check-up. Sleep when you can. Distract yourself from you worries by partaking of healthy pleasures. Appeal to a nurturing higher power. Learn a relaxation procedure, and practice it. Take care of yourself!

  • Be Mindful: One antidote to preoccupying anxiety is mindfulness. Most urologists I know love practicing their profession – when they are fully present and mindfully engaged in what they are doing. Resist the tendency to let malpractice stress disconnect you from the many sacred moments of your work. Each day, try to take conscious note of the aspects of your work and your career that you still enjoy and find meaningful and rewarding.

  • Reframe and Re-label: Remind yourself that your profession is not your entire life, and that this malpractice suit is not your entire profession. Example: "This suit is not about who I am. It's about what happened or one mistake made in a very long career." Or, as author Sara Charles reminds us, "This suit is not about competence. It's about compensation." In a nutshell, I encourage you to develop philosophies that help you to make sense of this experience. Remind yourself that yours is a high-risk profession, and that there are no perfect surgeons and no perfect patients or patient families. However, yours is also a noble profession. And, far and away, the majority of patients and family members of patients appreciate sincerely what you do for them.

  • When In Doubt, Get Physician-Friendly Help: Self-directed surgeons sometimes err in a manner that is easier to recognize in others than in oneself. What would you say to a patient who is considering performing surgery on him or herself? I hope that similar good sense will prevail if you need professional help to cope with this syndrome. In addition to specialized legal counsel, consider medical, mental health, or coaching consultation from providers who appreciate the special challenges and rewards that come with life as a surgeon.

Wayne M. Sotile, Ph.D. is Founder of Real Talk, Inc. and the author of The Resilient Physician (2002) and Letting Go of What's Holding You Back (2007). He is a sought-after speaker and consultant to medical organizations and group practices concerned about physician resilience and ways to make the workplace a positive interpersonal culture. Visit him at www.TheResilientPhysician.com, or contact him directly at wsotile@attglobal.net.




References

Autry, C.W. The physicians' perspective: Medical Practice in 2008.
http://www.physiciansfoundations.org/uploadedFiles/PF_Survey_Report_Nov08.pdf.
Posted August 25, 2008

Charles, S.C.. Coping with a medical malpractice suit. West J Med 2001;174:55-58
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