Litigation Stress

AKOSMED POSTS

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Litigation Stress Back in the day, as a newly-minted intern starting my residency in Emergency Medicine, I remember one of my venerated senior attendings say to me at the end of a long night shift, “You have an exactly 100% chance of being sued during your career. So stop worrying about it” … [Read more]

malpractice

So You’ve Been Sued! What to Expect Now THE SUMMONS The summons is often the first clue for most physicians that he or she is being sued. Normal reactions range from shock to disbelief to outright denial … [Read more]

JOURNAL ARTICLES

How to handle the stress of litigation. Charles SC. Clin Plast Surg 1999; 26(1): 69-77. Although most physicians experience emotional distress during the litigation process, there are certain factors that contribute to increased stress vulnerability, including commonly shared personality features. Social support is important during this time and there are both general and specific measures that may help with coping.

Coping with the stress of medical professional liability litigation. Committee Opinion No. 551. American College of Obstetrics and Gynecologists. Obstetrics & Gynecology 2013:121;220-2. Defendant physicians may experience a wide range of distressing emotions and increased stress, which can disrupt their personal lives and their relationships with patients. Guilt and shame are typically the primary feelings that should be recognized and addressed during and following liability litigation. Despite the advice to speak to no one regarding any aspect of a medical liability case, physicians need to express their emotional responses to being sued and literal adherence to the advice can result in isolation, increased stress, and dysfunctional behavior. Physicians may need help from professionals or their peers to cope with this stress.

Coping with the stress of being sued. Brazeau CM. Family Practice Management May 2001 41-44. Having familiarity with the litigation process and the emotional experience ahead of time can help manage stress. Being sued can be broken down into four stages—the summons, discovery, the trial and settlement, and the aftermath. Each stage is accompanied by its own mix of feelings and there are specific strategies available to cope with each step of the litigation process.

The nightmare of litigation: a survivor’s true story. Bub B. OBG Management 2005: 21-27. This is the true story of David, as told by his physician mentor, who suffered disabling litigation stress and eventually reclaimed his sense of empowerment and control as he became aware of the nature of litigation stress. During his counseling sessions, his trauma was acknowledged and named, his losses were identified and mourned in safety, and his isolation was relieved in a healing supportive relationship.

Physician’s psychologic reactions to malpractice litigation. Martin CA, Wilson JF, Fieblman ND 3rd, Gurley DN, Miller TW. South Med J 1991 Nov; 84(11): 1300-4. A questionnaire administered to both sued and non-sued physicians demonstrated clusters of symptoms in sued physicians including psychologic trauma, job strain, shame, doubt, and active coping. Stress decreased with time, but did not return to baseline after two years, and also decreased with winning a case and increased age. Even in non-sued physicians, being in a high-risk specialty led to great job strain and active coping, regardless of litigation experience.

Sued and non-sued physicians’ self-reported reactions to malpractice litigation. Charles SC, Wilbert JR, Franke KJ. Am J Psychiatry 1985; 142(4): 437-40. A random sample of both sued and non-sued physicians in the Chicago area reported changes in professional behavior and emotional reactions to the threat and actuality of litigation. However, sued physician reported significantly more symptoms and were more likely to stop seeing certain types of patients, retiring early, and discourage their children from entering medicine.

Appraisal of the event as a factor in coping with malpractice litigation. Charles SC, Warnecke RB, Nelson A, Pyskoty CE. Behav Med 1988 Winter; 14(4): 148-55. 51 physicians who had been sued for medical malpractice were interviewed to explore their attitudes regarding litigation stress, their appraisal of the situation, coping mechanisms, and the impact on their future practice. Those who identified litigation as their most stressful life event (n=11) experienced significantly more physical and emotional symptoms and used more emotion-focused coping mechanisms compared to those who identified some other life event as being more stressful (n=39). These findings may help inform future efforts to design more effective support programs for physicians experiencing litigation stress.

BOOKS

Physicians Survival Guide to Litigation Stress: Understanding, Managing, and Transcending a Malpractice Crisis. James JM, Davis W. Lafayette (CA): Physician Health Publications; 2006

  • This 270-page paperback provides evidence-based practical information needed to understand and respond to the stress of being a physician defendant in a medical malpractice case. It examines the personality patterns of physicians that make them vulnerable to emotions such as guilt and shame when errors are committed or a back outcome occurs. It also discusses the five phases of the litigation experience and then presents proactive steps that physicians can take to effectively handle the crisis and return to their normal lives.

The Health Care Providers Guide to Facing the Malpractice Deposition. Uribe CG. CRC Press (FL); 1999

  • The deposition is the most important piece of evidence in a medical malpractice lawsuit and the facts elicited often play a major role throughout the remainder of litigation. This short, but comprehensive, book includes excerpts from actual depositions and addresses topic such as law and legal thinking, the standard of care, preparing for the deposition, and common forms of interrogation.

The Jurisprudent Physician: A Physician’s Guide to Legal Process and Malpractice Litigation. Dean M. Legis Press (AZ); 1999

  • This exhaustive 404-page medical-legal primer provides an illuminating look at issues, problems, and situations that often intimidate medical practitioners. This book covers the basic structure of our legal system, why patients sue doctors, how to reduce the likelihood of legal claims, the physician’s role as an expert, testifying in depositions, hearings, and court, and follows the course of a medical malpractice case from beginning to end.

The Medical Malpractice Survival Handbook. American College of Legal Medicine. Mosby (PA); 2007

  • This plain language 500-page handbook written by a team of physicians attorneys addresses the issues surrounding the growing incidence of medical malpractice. It examines the scenarios that can result in a malpractice suit, the best course of action during the litigation process, and the most effective way to minimize any liabilities.