Nothing troubles physicians more than an unforeseen outcome and a malpractice lawsuit. It cracks open self-doubts and assumptions about medicine and may be life-changing. It commonly fuels burnout, loss of confidence, PTSD and early retirement. And there are links to depression and physician suicide. There’s another side to this story, though. Like all of life’s great challenges, a patient’s unexpected loss, and professional litigation present us with huge opportunities for growth. I am a believer in more information and less isolation. And while I have 1,001 things I’d like to tell the doctor who is in it, here are five to get you started. 1. On being a doctor and a human. People deeply engaged in caring for others can feel it hard when that other is harmed, especially if they think they may have caused the harm or might somehow have prevented it. Sounds simple from the outside. Usually does not feel so simple from the inside. Diverse emotions arise in these situations, among them grief, fear, guilt, and shame. Fight-or-flight responses, lost sleep, and questions about one’s competence may linger for quite some time. If you have these feelings, rejoice! You are not a failed physician. You are in fact the model. These feelings spring from the intersection of your deep commitment to humanity and life’s real fragility. They arose for you because you are willing to go where most people do not. What is revealed if you hurt when harm comes to your patient is not that you are weaker than most, but that you came in with heart. Never forget that society needs physicians with heart. 2. You are not alone. So many physicians say to me, verbatim, “The hardest thing about litigation was the isolation.” I’ve said it, too. Most of us have no idea how many or who among our colleagues have been through it. Until it was over and I began to teach about it, I certainly didn’t. As it turns out, data indicates that the vast majority of us in every specialty will be sued by the age of 65, many more than once. What does that mean? It means that people all around you — your favorite mentors even — have been through this. They might not talk about it much, but if they did, they’d say that it’s not just you. 3. The rules are different there. It sounds so basic, but it bears mentioning that the rules of the legal world are very different from the rules we operate by in medicine. That’s why some lawyers specialize exclusively in malpractice defense. For instance, while truthfulness is truthfulness everywhere, high integrity in a deposition looks different from high integrity in patient encounters. With patients, we try to answer questions fully, frequently offering information the patient didn’t know to ask for. Under deposition, it’s honest and appropriate to answer exactly the question you were asked. No more, no less. A defense lawyer I know calls that “letting the plaintiff’s lawyers do their work.” Your defense lawyer’s work is to prepare you to navigate this process truthfully and lawfully. Help them by being open. Read everything they request. Invite them to prepare you thoroughly. They can help you come out with your integrity in order. 4. It’s a marathon. Recovering after an unforeseen outcome and surviving a lawsuit is a lot like running a marathon. Unfortunately, you didn’t volunteer to run it and nobody can tell you how long it will be. Each case has its own story. Some go months, others years; some defendants are retained, others dropped; some settle early, others go to trial or appeal. Therefore, no one may know whether yours will be a mini-marathon or an ultra-marathon through the Gobi Desert. That unpredictability makes it essential that you take excellent care of yourself as long-distance runners do. I recently participated in the hilarious Cow Key Channel Bridge Race, Key West, FL —“The World’s Only Zero K.” Even there, organizers exhorted runners in flip-flops to “Hydrate!” and “Stay safe!” You do likewise. Eat right, get your sleep, drink more water, less alcohol and caffeine. Avoid working more! Enjoy loved ones, pray or meditate, get out into nature, the arts, or sports, commit to a regular massage even if your budget is tight. This experience commonly stimulates a level of distress you may have never known before, even as tough as a physician’s life can be. Draw around yourself those who will help you guard your mind and heart – a psychologist, a coach, a spiritual advisor. As with all marathons, know that you need not actually win in order to win. Let your goal be to finish with your conscience clean. If you do that, regardless of the legal outcome, I would say you’ve won. All life asks is that you keep putting one foot in front of the other. Follow Desiree Linden, winner of the Boston Marathon, and “just show up for one more mile.” 5. Post-traumatic growth is real. “Post-traumatic growth” is a concept we all know. We see it in patients and families, and for many of us, it touches us deeply. This notion goes beyond resilience, involving mining hardships for all the beauty they’re worth. My dad names it when he calls a diamond nothing but a lump of coal subjected to pressure. Now, I don’t want to make light of real hardship, but I want you to know that it is possible to thrive and grow after an unforeseen patient outcome and litigation. I was transformed in certain powerful ways by these experiences and am better for it. If I could open any door for you, it would be that door to thriving. You might open your heart and mind to that possibility, then keep your eye out for your path. I promise you, while you may not see it yet, it is there, waiting for you. Stacia Dearmin is a physician and founder, Thrive. Source
