As we’ve previously talked about here, the unfortunate reality is that a lifetime spent in medicine most likely means facing at least one medical malpractice lawsuit. According to a frequently cited 2011 New England Journal of Medicine article, authored by a group of respected Harvard researches, a physician in a low risk specialty has a more than 75% likelihood of being sued by the age of 65. For those in high risk specialties the number is over 95%. It truly is almost a given for surgeons, ob/gyns, and others in high risk fields.
While we often hear about the financial difficulties that a malpractice claim poses and the problems surrounding malpractice insurance in such a litigious environment, we would do well to consider the other costs that being sued carries for physicians–specifically, the mental, physical, and relational costs. Those costs are substantial, and the healthcare community is now beginning to realize just how substantial they are.
What is Medical Malpractice Stress Syndrome?
Medical Malpractice Stress Syndrome (MMSS) is the name given to a set of symptoms common among those facing malpractice litigation. In fact, initial research indicates that MMSS has characteristics very similar to those of PTSD. While it’s easy to be dismissive of a seeming proliferation of new maladies and disorders, it’s important to keep in mind that a syndrome, as such, is just a set of symptoms that have been shown to consistently occur together and under like circumstances, often forming a discernible and predictable pattern. That is certainly the case with MMSS. These are symptoms that are seen over and over again in the lives of physicians facing the unique difficulties of malpractice litigation, and their effects can be extremely serious—in at least one case that we are aware of even fatal.
What Causes MMSS?
At the most basic level the answer is, of course, being sued. But more to the point, a malpractice lawsuit is unique in many ways and has a unique capacity to function as a stressor and a depressant in a physician’s life. Unlike many lawsuits, a malpractice claim strikes at what many physicians see as a fundamental part of their identity—their vocation. It can cause them to question their competency, even their self-worth. It can cause doubt and be a source of shame. It can be isolating, whether due to legal restrictions on talking to others, a sense of being judged, or depression and consequent lack of interest in being social. As Salem, OR, psychiatrist Ronald L. Hofeldt to notes, “Doctors in litigation often withdraw from social and professional activities… Instead of taking elevators, they take back stairs. They get to meetings late and leave early. They feel that the outside world is judging them harshly, so they avoid interaction with others.”
These behaviors are not those of someone dealing with a little extra stress. These are the outward manifestations of a set of symptoms, a syndrome, which can be extremely destructive not only to one’s mental health but also to relationships with family and colleagues, and even to one’s physical health. MMSS frequently takes its toll on marriages and friendships, and it has been linked to both the onset of physical symptoms associated with stress and depression as well as the exacerbation of symptoms of chronic disorders like heart and immune diseases.
Finally, Hofeldt, also speaks about “the 5 Rs”: Reputation, Referrals, Recredentialing, Reinsurability, and Remuneration. These are all things that doctors consistently worry about when faced with a malpractice claim. Any one of them is a major aspect of a physician’s life and career. Yet in the course of a malpractice lawsuit it can seem that all of them are hanging in the balance, that one’s life is literally falling apart.
What are the Symptoms of MMSS?
So what are the symptoms of MMSS? While there is no single definitive list, here are some of the most commonly cited indications to look out for.
Mental Symptoms of MMSS
- Negative self-image
- Excessive worry
- Decreased interest in recreation and/or work
- Sense of being shunned by colleagues
- Sense of having been assaulted
Physical Symptoms of MMSS
- Inability to concentrate
- Tense muscles
- Loss of sex-drive
- Alcohol consumption or drug use
- Gastrointestinal upset
- Chest pains
- Changes in appetite
Of course any one or even a few of these could be just a normal part of dealing with a stressful event, which a malpractice lawsuit no doubt is. And indeed, it is probably helpful to think of MMSS in terms of a spectrum ranging from healthy processing of and coping with a stressful reality to the failure of coping mechanisms leading to some or even many of the symptoms listed above being experienced at extreme or highly intense levels.
How Can You Manage MMSS?
The first key is awareness. Many physicians simply don’t realize how common the things they are experiencing are. It is easy to get to a place where you have completely isolated yourself mentally and are thus feeding your own neurosis. This can prove all the more easy when lawyers are constantly reminding you not to talk to anyone about the case. While you shouldn’t ever ignore your lawyers’ advice, you should remember that just as there is “defensive medicine” there is also “defensive representation.” Ask your attorneys about privileged (protected) communication and the specifics of what you can and can’t do. You should always be able to speak to your spouse and communication with clergy, attorneys, and therapists is also protected.
Speaking of clergy and therapists, one of the best things you can do is find someone you can open up to. With the council of your attorneys you should be able to speak with either a counselor or a minister, but support groups also offer an opportunity to talk with others who are facing similar situations. Realizing just how many truly good doctors face malpractice suits every day can be a huge step to realizing that you are not alone, and that the fact that you have been sued doesn’t mean that you are a bad doctor, let alone a bad person.
In addition to the therapeutic effects of having someone else to talk to, make sure that you work with your physician if you experience any of the physical symptoms mentioned above. Doctors need doctors too, and taking care of your health is an important part of dealing with stress and anxiety effectively. If you are experiencing insomnia, for instance, depression and anxiety are bound to only get worse. Pay attention to your body.
Additionally, as with any stressful circumstance, one of the keys to dealing with a malpractice lawsuit is to increase your intentionality and emphasis on living a balanced, engaged life. More than at other times it will be essential that you force yourself to exercise, spend time with your family, engage in hobbies and recreation, read, eat well, etc. All the things that you do (or try to do) to live a healthy, productive, and enjoyable life will become even more important during this time of stress. These are the things that keep us from being consumed by any one thing, and they function as a powerful antidote to the negative and anxious feelings that can dominate in the course of an extended period of stress and uncertainty.
Finally, recognize that there are lots of resources out there for doctors facing a malpractice claim. It may be cliché, but you really are not alone. While we can’t begin to list all of the great tools and resources that a bit of research will turn up, we do want to point you to a few:
- The American Association of Nurse Anesthetists has a helpful two-page PDF overview of how to deal with MMSS here.
- Dr. Louise B. Andrew, MD JD FACEP has put together an online self-test for medical malpractice stress. Further, her website is chock full of articles and resources for those dealing with malpractice litigation.
- The website of the Physician Litigation Stress Resource Center is another helpful source of information, with this video being a particularly helpful introduction.
- And finally, if you really want to delve into medical malpractice stress and MMSS the host of that video linked above, Sara C. Charles has been a pioneer in the area and has authored two books on the subject that come highly recommended.
This post was written by Justin Donathan.
Justin at Google+