Medical Malpractice Stress Syndrome

CHAPTER 2 Medical Malpractice Stress Syndrome



S. Sandy Sanbar, M.D., Ph.D., J.D., F.C.L.M. , Marvin H. Firestone, M.D., J.D., F.C.L.M.




GOLDEN RULES



1. Medical malpractice lawsuits are extremely stressful.

2. The allegation of medical malpractice may be extremely traumatic to the accused physician.

3. The primary manifestations of medical malpractice stress syndrome are psychological symptoms (e.g., acute or chronic anxiety and depression), and the secondary manifestations are physical symptoms.

4. The accused physician must acknowledge that he or she may be suffering from a medical malpractice stress syndrome.

5. The distressed physician should seek support, understanding, and comfort from immediate family members, close friends, defense counsel, and professional colleagues.

6. The physician needs help to acknowledge and address the fears of medical malpractice stress.

7. The accused physician must continually be reminded that being sued for medical negligence is a predictable hazard of medical practice in our times.

8. Education of the sued physician about medical malpractice stress is the key to dealing with the fear of litigation.

The purpose of this chapter is to provide an overview of the medical malpractice stress syndrome (MMSS), its symptoms, diagnosis, and management in hopes of providing physicians who are suffering from, or who are caring for other litigation-stressed physicians, with the necessary tools to effectively manage this disorder.




CASE PRESENTATION


Dr. Ray Sunshine is a 43-year-old second-generation family physician. While in medical school, Dr. Ray met and fell in love with his classmate, Angela. They got married the same month they graduated from medical school. He and his wife have three children, two daughters and a son. After Dr. Ray and his wife graduated from medical school at the University of Florida, Dr. Ray completed a residency training program in Family Medicine; Angela also trained at the University of Florida as an Emergency Physician. He has been practicing medicine for 12 years, working with his wife, Angela, and his father, Christopher, at the Family Medical Clinic, in Sun City, Florida.


On January 13, 2001, at approximately 1:00 p.m., Dr. Ray returned from lunch to resume his work at the Clinic. His nurse approached Dr. Ray and informed him that the Sheriff (a patient treated by his father) was here to see him. The Sheriff was ushered into Dr. Ray’s office. The two of them exchanged greetings. Apologetically, but in a businesslike manner, the Sheriff served Dr. Ray with a summons and complaint, alleging medical malpractice. The Sheriff told Dr. Ray that he was being sued by one of his patients. The Sheriff said goodbye and walked out of the office.


Dr. Ray was stunned, shocked, and dismayed. He could not believe that he was being sued by one of his patients. He had never been sued before. He could not think of having done wrong to his patients. He thought to himself: “All my patients love me. Who would do such a horrible thing?” He had flashbacks of many patients that he had treated in the last few years. He gently placed the petition on his desk without opening it, and he stepped away from his desk, all the time staring at the petition.


His forehead became sweaty, as did the palms of his hands. His hands were shaking and his body felt like it was trembling all over. His chest felt tight and he could not breathe deeply enough. He had goose bumps all over. He became weak and nauseated. His lunch-filled stomach felt heavy, and he was afraid he might vomit any time. He felt momentarily unstable on his feet and dizzy. Dr. Ray could not believe what was happening to him.


Nurse Susan knocked at his door and entered the office to inform Dr. Ray that his first afternoon patient has been waiting to see him. The doctor, now visibly pale and diaphoretic, did not look back to acknowledge the nurse’s presence. Instead, he walked two steps and sat in a nearby chair, with his head bent forward. He felt ashamed and did not want to tell his nurse what had happened. He took his handkerchief out of his back pocket and wiped his forehead.


The nurse, realizing that there was something wrong, asked the doctor if he felt all right. The doctor did not answer at first, but then he told the nurse to cancel all his patients for the rest of the day because he was not feeling well. The nurse then informed Angela, Dr. Ray’s wife, that Dr. Ray was not feeling well.


Angela excused herself and ran to her husband’s office. He was still sitting in the chair, staring at his desk. “Honey,” she said, “What is the matter? What is bothering you? Are you hurting anywhere?” Dr. Ray could not talk. He felt lonely even in his wife’s presence. Guilt feelings were running through his mind. Angela asked him what the Sheriff was doing here. Dr. Ray stared at the petition on his desk and nodded ever so slightly. Angela walked toward the desk, picked up the envelope, opened it, and slowly read allegations of negligence and gross negligent acts by her husband. She was shocked herself, but she quickly realized that her husband was suffering from an acute stress disorder.


Angela called her father-in-law, Dr. Christopher, who was in his office, and informed him about Dr. Ray. He rushed to Dr. Ray’s office and expressed concern and when he was informed of the lawsuit, he told his son that when he was sued by one of his patients for medical malpractice, he likewise suffered symptoms of distress throughout the five years of litigation, until the lawsuit ended in his favor.


Dr. Ray’s malpractice litigation lasted three years, during which time both his wife and father were extremely sympathetic and supportive. Nevertheless, Dr. Ray suffered distress symptoms throughout the course of the litigation. The trial ended with a defense verdict. Dr. Ray was relieved, but continued to suffer from symptoms similar to those who have post-traumatic stress disorder.1



STRESS OF MEDICAL MALPRACTICE LITIGATION


Medical malpractice lawsuits are extremely stressful. They are predictable hazards of medical practice. Some medical professionals view malpractice lawsuits as an inherent part of providing medical care. Indeed, no individual physician is immune from medical malpractice, and the majority of physicians are affected, directly or indirectly, by patients alleging negligent professional care as the cause of their injuries.


It is known that litigation distress may affect any individual who is involved in litigation. There are predictable effects of medical malpractice lawsuits on the defendant physicians characterized by the medical malpractice stress syndrome, a unique variation of the well-accepted litigation stress syndrome.


Even though medical malpractice lawsuits are common, most physicians are ill-prepared to deal with the devastating psychological effects of medical malpractice litigation on the physicians, their families, and their medical practices.


The stress of medical malpractice litigation may directly contribute to physical illness of the physician, as well as dissatisfaction with medical practice leading to burnout and early retirement. Tragically, if the reaction of the physician is extreme, depression may lead to suicide.

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Mar 25, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Medical Malpractice Stress Syndrome

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