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OBG Management January 2005 ·
Vol. 17, No. 1
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.
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Fast Track
A physician’s
life is a set-up for acute stress reaction.
All too often, a lawsuit is the last straw
PTSD
symptoms:
1.
Memories
Flashbacks, dreams
2.
Avoidance
of patients, detachment, numbness
3.
Arousal
Insomnia, difficulty concentrating,
irritability, hypervigilance
Do not share
your feelings with your lawyer. Consider
seeing a psychotherapist trained to listen
therapeutically |
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Barry Bub, MD
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).
“I was stunned, bewildered, and
disoriented. Surely this wasn’t happening to me. I felt
cornered like a trapped animal and just had to escape so I
spent most of the day wandering around in a daze. It was
like living a dream—no, more like a nightmare.”
The victim of an
accident, criminal assault, or terrorist attack? No, this
was David, an obstetrician describing to me his reaction on
being sued for medical malpractice. A day that started off
as hectic but routine suddenly turned into a nightmare.
Later, colleagues would tell him not to worry, that he’d be
OK and that litigation was a “normal” part of medical
practice. But it didn’t feel normal to him, as the memories
of that day continued to replay in thoughts and dreams.
Malpractice liability may be omnipresent, but
that doesn’t mean getting sued is a “normal” everyday hazard
that Ob/Gyns should be able to take in stride. Litigation is
frequently unfair, abusive, and traumatizing, and can cause
acute stress disorder and even posttraumatic stress disorder
(PTSD) in both physicians and patients.
In this true story, an obstetrician suffering
disabling litigation stress reclaims a sense of empowerment
and control as he becomes aware of the nature of litigation
stress. In the process, he learns how to listen, understand,
and support patients, employees, and colleagues in times of
stress.
During one-on-one telephone 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.
 The initial
shock
This was his first. “I was a litigation
virgin,” he sardonically commented. “You know, when you’re
jumping the waves in the ocean at high tide and then you
become confident, you turn your back, and this big one hits
you? It felt like that. I had just begun to relax, believing
it wouldn’t happen to me. Then the lawsuit hit. It was a
patient I’ve known for years. I delivered her other children
and regarded her almost as a friend, someone I liked and
trusted.
“I’ve made mistakes in the past but this
wasn’t one of those times. It’s so unfair—instead of being
grateful that I saved her 9.5-pound baby, she hunted down a
lawyer on the Internet. The Web is full of them just waiting
to pounce.”
The
aftershocks
David recounted the journal articles1
he’d looked up, which recommended that he share his feelings
with a trusted colleague. Other articles cautioned against a
possible “discoverable” confidence.2
Colleagues’ attempts at reassurance did not really comfort
him.
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.
David contacted me when it became
increasingly difficult for him to see patients. He said that
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.
No, he did not want to see a psychiatrist or
a psychotherapist. He wasn’t crazy, he wasn’t thinking of
suicide or anything like that, he said, and the last thing
he needed was the credential committee of his local hospital
breathing down his neck.
His spoke in a a lifeless monotone, reciting
the facts of the case as he had told and retold them many
times. He sighed often and used negative expressions such as
can’t, but, should, have to, if only. He was
articulating a lament—an expression of suffering and loss,
which is not uncommon among physicians3,4
and patients.5
Within his narrative ran an unbroken thread of helplessness,
grief, despair, and absence of meaning and hope.
Rather than premature reassurance and
comfort, what David needed was to have his trauma named and
acknowledged. Choosing my words carefully, I summarized his
story and asked whether I had heard and understood him
correctly. He verified that I had. Going a step further, I
reflected back his underlying emotions as I had heard
them—his feelings of fear, helplessness, sadness, isolation,
betrayal, violation, anger, and injustice. Then I paused to
create space for his response. Soon, the silence was
interrupted by the sounds of his sobbing. When he regained
his composure, David apologized for losing control. This
lawsuit had been a huge strain, he explained. |
