Coping with a medical malpractice suit

In this article, I discuss how and why physicians react to an accusation of malpractice and the range of strategies that they can use to diminish the emotional disequilibrium that accompanies this experience. Information presented here is based on survey and interview studies and extensive clinical experience. ​experience.,​, Table 1 Before the complaint: useful attributes of clinicians Competent practice, including good risk-management procedures Adequate self-knowledge A balanced personal and professional life A capacity for intimacy and sharing Good relationships with patients, their families, and other health professionals View it in a separate window Table 2 Common postcomplaint experiences Symptoms may develop during any of these stages when adequate coping fails The complaint is served: initial feelings of surprise, shock, outrage, anxiety, or dread Consultation with lawyer: depending on the initial assessment of the case, reactions of anger, denial, concern, reassurance, panic Lengthy period of denials and intrusions: active attempts to erase thoughts about the case, followed by automatic reminders and intrusive thoughts about it; becoming preoccupied by ruminating excessively—exacerbated whenever case-related activity increases, such as before the deposition, when experts testify, and before and during the trial Working through the lengthy process, during which physicians psychologically and intellectually “process” the meaning of the case, their role in it, and their approach to their own defense Relative completion of response: physicians change in many ways as a result of being sued; ideally, adaptations lead to greater competence and a more satisfying personal and professional life View it in a separate window Medical work is highly stressful, and physicians increasingly feel loss of control over their clinical decision making. Nonetheless, most physicians are competent and achieve a reasonable level of satisfaction in their personal and professional lives that serves as good preparation for managing the litigation experience (box 1). Physicians are especially challenged, however, when an unexpected outcome—such as an unanticipated death—occurs. If this event is followed by a charge of malpractice, they may feel suddenly over-whelmed and “out of control,” with their ability to function temporarily compromised.