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Physician Reaction
96 % of physicians who are sued suffer physically and emotionally regardless of the outcome in court
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Sara C. Charles, MD, certified by the American Board of Psychiatry and Neurology, Chicago, has conducted extensive research regarding the impact of malpractice litigation on physicians and the grief process.
Studies conducted by Charles indicate that 96% of physicians reported at least a temporary period of emotional disruption in response to litigation.
Common responses include the following:
“A blow, personally and professionally.”
“I felt stunned, shocked, and frightened.”
“I had a 'Maybe you’re a bad doctor' feeling.”
“I felt embarrassed.”
“I got angry when it finally settled in. Why are they doing this to me?”
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Impact of Litigation Stress
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Anger
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Frustration |
| Denial |
Onset of Physical Illness |
| Guilt |
Isolation |
| Shame |
Feelings of Betrayal |
| Loss of Self-Esteem |
Risk of Ethical Violations |
| Depression/suicide risk |
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Approximately 33% acknowledged symptoms of depression. 26% acknowledged anger and related symptoms. 16% reported the onset or exacerbation of physical illness.
The most traumatic moment in the litigation process appears to be when the plaintiff's expert witness makes a deposition criticizing the physician's treatment or action.
One physician said, "The legal jargon felt like an inflammatory attack on my character." It is important to recognize that the legal definitions of certain terms are not the same as medical or personal definitions.
Ethical violations could include altering the medical records, attempting to influence the witnesses, and negotiation with patient outside of legal channels.
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If You Are Sued, Expect To...
- Be personally angry
- Feel disillusioned, including global mistrust of patients
- Magnify self-doubts/question your own competence
- Experience persistence of negative feelings
- Feel isolated, frustrated and unjustly singled out
- Experience guilt even if your performance and professionalism was faultless
- Experience symptoms and episodes of illness and depressive effect
- Lose some ground in your practice (for a variety of complex, aggravating factors - rarely permanent)
[Andrew, L.B. and Pfifferling, J. Managing and Neutralizing Medical Malpractice Stress, 2000. Draft article to be published in a book on medical malpractice. Material utilized with permission of author (3/7/05).]
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Physicians who are sued experience a range of negative emotions that can have a paralyzing effect personally and professionally.
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If You Are Sued, Don't Expect...
- Compassion from colleagues
- Understanding from family, friends and partners
- Support from administrators
- A change of heart from the plaintiff or their attorney
- Your attorney to handle the case with you taking a back seat
- To be able to discuss the case with their defendants, colleagues, or anyone
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Being sued has an isolating effect on the physician. This is the time when a physician especially needs the support of his or her colleagues.
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Difference in Perception
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| Patient |
Perceives the physician to be negligent (97%)
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| Sued Physician |
Patient’s desire for financial compensation (83%)
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| Nonsued Physician |
Continues to have high expectations of medical technology and of physicians (95%)
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A retrospective study of sued and non-sued physicians, as well as suing patients, perceives the litigation process from very different perspectives.
Litigation dramatically changes the physician-patient interaction.
Perception is greater than reality.
[Charles, S., et al. Sued and Nonsued Physicians: Satisfactions, Dissatisfactions,
and Sources of Stress. Psychosomatics, 28(9): 462-466, 1987]
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Immediate Impact on the
Physician’s Perception of Self
Intense negative emotional response in the days and first weeks following receipt of the complaint
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Receipt of a complaint affects the physician's views of patients, society and the disciplinary process. There is immediate negative emotional response that is sustained in the long term. Physicians report changes in their practice of medicine with reduced ability to work confidently and decisively. They alter practice towards defensive medicine by withdrawing from providing some services and avoiding perceived at-risk activities.
The ethical impact is the questioning of the legal system and society's demands and erosion of personal autonomy.
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Immediate Impact on the Physician’s Practice of Medicine
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Fear and uncertainty creep into the physician's daily practice.
This is a true story of David, an obstetrician suffering from the stress of litigation. It became increasingly difficult for him to see patients. He felt he had to be constantly on guard, watching every word and action as if patients were an enemy waiting to ambush him. He dreaded going to work and wondered if he should quit obstetrics. His wife was mostly supportive, but it was difficult for her to stay calm and objective since the lawsuit upset her, too. In fact, their relationship was quite strained.
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Immediate Impact on the Patient-Physician Relationship
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Separate themselves from newer patients
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Become defensive in their approaches to patients
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Loss of trust in the patient-physician relationship
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The frustration of the litigation process interferes with the patient-physician relationship.
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Immediate Impact on Relationships
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Studies show that defendant physicians experience a wide range of emotions that disrupt their personal lives and the lives of their families.
Physicians are often told by claim adjusters and attorneys not to speak to anyone, but adherence to this advice can result in dysfunctional behavior, jeopardizing professional and family relationships.
It is important to share feelings generated by the litigation process even though specific facts cannot be imparted.
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Last Published: 6/4/2009
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