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The Nightmare of Litigation: a Survivor’S True Story After Being Sued, David Dreaded Seeing Patients and Felt Always on Guard

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The Nightmare of Litigation: a Survivor’S True Story After Being Sued, David Dreaded Seeing Patients and Felt Always on Guard OBG Barry Bub, MD MANAGEMENT Director and founder, Advanced Physician Awareness Training, Woodstock, NY. A psychotherapist and former practicing physician, Dr. Bub teaches and mentors health-care professionals on well-being, stress, and communication. He is the author of Communication Skills that Heal (Radcliffe Medical Press, 2005). The nightmare of litigation: A survivor’s true story After being sued, David dreaded seeing patients and felt always on guard. He was ready to quit obstetrics. A physician mentor explains how David reclaimed his life. “I was stunned, bewildered, and disoriented. aware of the nature of litigation stress. In Surely this wasn’t happening to me. I felt the process, he learns how to listen, under- cornered like a trapped animal and just ® stand,Dowden and support Health patients, employees,Media and had to escape so I spent most of the day colleagues in times of stress. wandering around in a daze. It was like During one-on-one telephone sessions, living a dream—no, more likeCopyright a nightmare.”For personalhis trauma was acknowledgeduse only and named; his losses were identified and mourned in he victim of an accident, criminal safety; and his isolation was relieved in a assault, or terrorist attack? No, this healing supportive relationship. T was David, an obstetrician describ- ing to me his reaction on being sued for The initial shock FAST TRACK medical malpractice. A day that started off This was his first. “I was a litigation vir- A physician’s life as hectic but routine suddenly turned into gin,” he sardonically commented. “You a nightmare. Later, colleagues would tell know, when you’re jumping the waves in is a set-up him not to worry, that he’d be OK and that the ocean at high tide and then you for acute stress litigation was a “normal” part of medical become confident, you turn your back, reaction. practice. But it didn’t feel normal to him, as and this big one hits you? It felt like that. All too often, the memories of that day continued to I had just begun to relax, believing it replay in thoughts and dreams. wouldn’t happen to me. Then the lawsuit a lawsuit Malpractice liability may be hit. It was a patient I’ve known for years. is the last straw omnipresent, but that doesn’t mean getting I delivered her other children and regard- sued is a “normal” everyday hazard that ed her almost as a friend, someone I liked Ob/Gyns should be able to take in stride. and trusted. Litigation is frequently unfair, abusive, and “I’ve made mistakes in the past but traumatizing, and can cause acute stress dis- this wasn’t one of those times. It’s so order and even posttraumatic stress disor- unfair—instead of being grateful that I der (PTSD) in both physicians and patients. saved her 9.5-pound baby, she hunted down a lawyer on the Internet. The Web is David’s story full of them just waiting to pounce.” In this true story, an obstetrician suffering disabling litigation stress reclaims a sense of The aftershocks empowerment and control as he becomes David recounted the journal articles1 he’d www.obgmanagement.com J anuary 2005 • OBG MANAGEMENT 21 For mass reproduction, content licensing and permissions contact Dowden Health Media. L The nightmare of litigation: A survivor’s true story reciting the facts of the case as he had told Loner? Perfectionist? Burned out? 9 factors that raise your risk for litigation stress and retold them many times. He sighed often and used negative expressions such Sociable persons who have a thoughtful, active coping style as can’t, but, should, have to, if only. He and a strong sense of their ability to control their destiny have was articulating a lament—an expression more capacity to resist stress. of suffering and loss, which is not uncom- mon among physicians3,4 and patients.5 Ask yourself: Within his narrative ran an unbroken 1. Am I a loner? thread of helplessness, grief, despair, and 2. Do I assign control of my destiny to others? absence of meaning and hope. 3. Am I a perfectionist? Rather than premature reassurance 4. Do I tend to beat up on myself when I miss the mark? and comfort, what David needed was to 5. Is my primary identity that of physician? have his trauma named and acknowl- 6. Do I lack a community of support? edged. Choosing my words carefully, I 7. Do I lack stress reduction practices? summarized his story and asked whether I 8. Do I suffer from burnout? had heard and understood him correctly. 9. Do I have a history of serious trauma? He verified that I had. Going a step further, I reflected back his underlying emotions as If you answer yes to any of these questions, you are probably I had heard them—his feelings of fear, at greater risk of litigation stress. Begin attending to your helplessness, sadness, isolation, betrayal, personal needs and well-being now. violation, anger, and injustice. Then I paused to create space for his response. Expand your resilience. You have invested time and money in Soon, the silence was interrupted by the your education; now invest in yourself. sounds of his sobbing. When he regained his composure, David apologized for los- ing control. This lawsuit had been a huge looked up, which recommended that he strain, he explained. share his feelings with a trusted colleague. FAST TRACK Other articles cautioned against a possible Symptoms of acute stress reaction PTSD symptoms: “discoverable” confidence.2 Colleagues’ I agreed, pointing out that he had probably attempts at reassurance did not really com- experienced an acute stress reaction: feelings 1. Memories fort him. of intense fear, horror, and helplessness in Flashbacks, His wife was mostly supportive, but it response to an unusually traumatic event dreams was difficult for her to stay calm and threatening death or serious physical injury objective since the lawsuit upset her, too. In to self or others. 2. Avoidance fact, their relationship was quite strained. This explained his fright and dazed dis- of patients, David contacted me when it became orientation on the day he learned of the liti- increasingly difficult for him to see gation.6 While the lawsuit was not life- detachment, patients. He said that he felt he had to be threatening, it threatened his identity, career, numbness constantly on guard, watching every word and survival as a physician. and action as if patients were an enemy 3. Arousal waiting to ambush him. He dreaded going Symptoms of PTSD Insomnia, difficulty to work and wondered if he should quit Usually acute stress reaction settles down, concentrating, obstetrics. but sometimes it progresses beyond a irritability, No, he did not want to see a psychia- month into posttraumatic stress disorder, a hypervigilance trist or a psychotherapist. He wasn’t crazy, pervasive chronic anxiety disorder charac- he wasn’t thinking of suicide or anything terized by 3 clusters of symptoms: like that, he said, and the last thing he • Recurrent, intrusive recollection of the needed was the credential committee of his events; recurrent flashbacks and dreams. local hospital breathing down his neck. • Persistent avoidance of stimuli associat- His spoke in a a lifeless monotone, ed with the event; numbness, detach- 22 OBG MANAGEMENT • J anuary 2005 L ment, avoidance of patients. EARN FREE • Persistent symptoms of increased arous- al; insomnia, hypervigilance, irritability, CME CREDITS difficulty with concentration. I suggested that some level of post- ONLINE! traumatic stress disorder was the explana- tion for many of his symptoms. “I am a rock” mentality may predispose to PTSD Litigation, because of its protracted nature, is particularly retraumatizing. David concurred: “This explains why just opening a lawyer’s letter now causes my heart to pound.” Unlike the military, physicians do not enter a stressful environment organized into teams. Should trauma and acute stress reaction occur, most physicians continue working despite their intense physical responses. There is little commu- nity support, so withdrawal and isolation is the norm, and this “norm” may predis- pose to posttraumatic stress disorder. Explore a range As a result, some physicians manifest behavioral problems such as being hyper- of free CME reactive, aloof, or disruptive, or they and educational abuse alcohol and drugs. Ironically, these opportunities at behaviors probably lay groundwork for FAST TRACK 7 www.hormonecme.org: additional lawsuits. The underneath • Courses include CME Slide on the dock for a Counting up the losses Libraries, Symposiums, David asked what I meant by “losses.” I Newsletters & more the purple situation explained that the nature of trauma is to • Receive your CME certificate where play. create loss. & credits award instantly Together we listed his loss of: trust • Additional features include Ask the Expert & LOG ON safety Expert Commentary peace of mind TODAY! sense of justice • Completely redesigned www.hormonecme.org integrity of personal boundaries & updated website is better organized and easier to use control self-esteem • Registration & courses are self-confidence free to all qualified physicians passion idealism Mourning these losses and releasing pent-up emotions of anger, grief, disap- pointment, frustration, shame, and guilt was essential. Putting Research into Practice. www.hormonecme.org CONTINUED Jointly sponsored by the University of Wisconsin Medical School and DesignWrite, Inc., in cooperation with the Council on Hormone Education. J anuary 2005 • OBG MANAGEMENT 25 SUPPORTED BY AN UNRESTRICTED EDUCATIONAL GRANT FROM WYETH PHARMACEUTICALS. L The nightmare of litigation: A survivor’s true story What if you have symptoms of litigation stress? If you notice that you are stunned, bewildered, and Limit use of substances (such as sedatives, feeling overwhelmed, even disoriented, accept that hypnotics, alcohol) and limit activities (burying you may not be able to think clearly for a while.
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