Getting Sued Is Extremely Emotional "Don't take it personally. It's just business." That's what gangsters in The Godfather say to a rival mobster they are about to rub out. In the same vein, plaintiffs' attorneys often think doctors shouldn't take medical malpractice suits personally. But these lawyers sue doctors for a living. For physicians, getting sued is intensely personal. The anxiety, anguish, depression, sense of betrayal, and shame it causes can last a lifetime. One obstetrician/gynecologist we spoke with broke down in tears when recalling the emotional distress she felt at being sued. And she won that lawsuit 21 years ago. "Getting sued is a total affront to everything doctors have trained to do," says Alan Woodward, MD, an emergency department physician in Concord, Massachusetts, and past president of the Massachusetts Medical Society. "It's devastating to your whole professional psyche. Many doctors leave practice, retire early, practice defensive medicine, and see patients as potential adversaries for the rest of their careers. While the case is pending, they don't sleep or eat well and are often depressed." "Even when doctors win in court, they've still lost," he points out. "It may take 6 or more years from the lawsuit until trial. The doctors may have lost perhaps $100,000 in time away from their practices due to depositions and hearings. The lawsuit takes a huge toll on their personal and professional lives," says Dr Woodward, who now works with the Massachusetts Alliance for Communication and Resolution Following Medical Injury, a group that promotes transparent communication, sincere apologies, and fair compensation in cases of avoidable medical harm. "Doctors often feel betrayed by patients who sue them," notes Doug McCullough, an attorney and assistant vice president for claims for The Doctors Company, the nation's largest professional liability carrier. "They thought of the patient as satisfied and a friend. They think, 'if this patient can sue me, then anyone can'." "Doctors are used to being in control," he says. "Once they've been sued, they are in an environment with very little control. Medical schools don't teach about malpractice. Doctors think that if they do everything they were taught, they won't be sued. That isn't the reality." The Doctors Company sponsors weekend retreats for physicians who are in the middle of malpractice cases. The goal is to help the doctor navigate the stress involved. "We invite spouses and discuss what they can expect, legally and emotionally, during the case. Other physicians who've been sued give talks about their experiences and coping mechanisms," he reports. "Litigation is an ongoing stress factor and we haven't done enough to address it." Other malpractice carriers—including COPIC Insurance Co., which is based in Colorado, and ProAssurance, which is based in Alabama—have similar programs to unite doctors who've been sued so they can share experiences and provide advice to each other. To illuminate this issue, five doctors describe the emotional stress they went through during their malpractice trials. Beware the Plaintiff's Attorney Thomas K. Wuest, MD, an orthopedic trauma surgeon in Eugene, Oregon, was sued by a utility company lineman who fell more than 20 feet from a pole and sustained multiple injuries. Dr Wuest was called in by his partners when they experienced problems obtaining union with the distal humerus fracture. During surgery, the radial nerve was partially injured. "I was served with legal papers just days before the statute of limitations would have tolled," he recounts. "I was totally surprised. I felt some guilt about whether I did anything wrong. I was also angry and felt betrayed. I'd worked hard in a complex case on someone who wasn't even my patient." The jury found for Dr Wuest, but it took a while for the stress to dissipate. "I did see new patients as potential litigants. I second-guessed some decisions and practiced defensive medicine, ordering additional imaging studies, labs, and second opinions when, in my heart of hearts, I didn't think they were really needed." "There was a strong sense of isolation and loneliness before trial because I couldn't discuss the details of the case with anyone but my attorney and insurer. Any such conversations could be discoverable," he points out. "Expect the plaintiff's attorney to be merciless," he advises. "I had been deposed a number of times in workers' compensation, car accident cases, etc. So I understood that if the attorney isn't raking you over the coals, he's probably not doing a good job for his client. Still, it's painful to hear in open court what a terrible doctor I am." Dr Wuest attended a retreat sponsored by The Doctors Company and later recorded a video on YouTube about his experience. "They let you know that this process is theater and you're one of the actors in the play. Once I got that down, the personal attacks were less painful. The mock depositions and trial testimony we rehearsed were very helpful." Thinking Twice About Helping Colleagues "My relations with colleagues changed somewhat. The lawsuit made me think twice when a colleague asks for help. When someone wants a 'curbside consult,' I decline more than I used to. I don't know the patient or family. It's become harder to be agreeable when I'm called in at the last minute." "I felt vindicated at the jury verdict but wondered why we had to go through all this when I knew I didn't do anything wrong. The plaintiff had already received settlements from workers comp, but that's not admissible as evidence. The jury sees this injured person but has no idea that he's already been compensated." "Don't expect to go back to work the day after your malpractice trial," he says. "The feelings are still too raw. My trial lasted 10 days. My wife advised that we take a week-long vacation after the trial, no matter how it ended. That was helpful. It took almost a year before I could see patients in a nonadversarial way." After being sued a second time a few years later, Dr Wuest decided to give up surgery and is now the chief medical officer for health plans in Oregon. "That lawsuit played into my decision to change careers." "One funny thing was when my attorney advised my wife on how to dress for the trial. He warned against a surgeon's wife coming to court with a Gucci bag and diamonds, etc. He told her to dress conservative and tastefully. We joke now about her 'courtroom collection' of serious suits." Getting sued is just a part of doing business in medicine. It doesn't mean you're a bad doctor; it's just your turn. "My tip for other doctors is that you have to have someone in your corner to talk with. My wife was wonderful. Unfortunately, getting sued is just a part of doing business in medicine. It doesn't mean you're a bad doctor; it's just your turn." An emergency department physician in the Midwest endured a lawsuit that went on for almost 7 years and was ultimately decided by the state supreme court. The patient had several strokes that left him almost totally disabled. In the hospital emergency department, the physician, who asked not to be identified, had to decide whether the patient needed a clot-busting medicine. In cases such as his, studies have shown that the drugs are contraindicated. "My first reaction to the lawsuit was concern about how the patient was doing. I hadn't seen him in almost 2 years. I firmly believed that I did everything I could for this patient and met the standard of care." "The lawsuit affected just about every moment of my being," the physician explains. "I thought about it on every shift and with every patient I met. I was often ill tempered; my moods would go up and down. That upset my girlfriend. But she stuck with me throughout, and that helped a great deal." Lawsuits Are Complex "I told my attorney that I planned to do modified ED shifts during the trial. He said that was a very bad idea. He said I'd be physically and mentally exhausted after each day in court and he was right. I didn't do the shifts." "Three other doctors and the hospital also were defendants in the suit. Just before trial, they all settled with the plaintiff. The hospital paid $5 million and the doctors $1 million each. I was the only defendant. The jury was never informed that the patient had already received $8 million. I felt awful that the hospital left me hanging out there alone, but my attorney was confident that we had a strong case." "It was a difficult case and I wasn't at all sure the jury would understand the complexities. But the jury was wonderful. After the 3-week trial, it took the jury less than an hour to find that I wasn't liable. I totally believe in the jury system. It's the fairest thing in our democratic society." The plaintiff appealed because he felt a comment from the doctor's attorney—that the patient was hoping for a runaway jury—was inflammatory and prejudicial. An appeals court and, ultimately, the state supreme court found for the doctor and awarded court costs. The experience did little to change the way this doctor practices. "It changed my view of the hospital; I don't trust them anymore. But I pretty much practice the same way. I don't see new patients as potential litigants. We ED docs are just wired to deliver good care. I do spend more time explaining things to patients and their families." "My tips to other doctors: Just take care of the patient as best you can. Trust yourself. Work closely with your attorney and insurer. If you and the lawyer don't trust each other, find someone else. Most importantly, continue to live your life. Love who you're with. Do what you enjoy. Live well." "The stress of a lawsuit is one of the hardest things you'll ever experience. Don't let the case consume you. Believe in yourself and your team. Eat well, exercise, get enough sleep. Remember that it's an honor to take care of patients and save lives. There will always be poor outcomes. You can't let them eat you up." Chukwuemeka Onyewu, MD, a plastic surgeon in Silver Spring, Maryland, was shocked when he learned that his patient intended to sue him. "My first thought was that I can't believe this patient betrayed me like this and was so ungrateful," he says. "I put all my energy into trying to do the best for her. I wrote letters to her insurance company to get the procedure covered. I spent a lot of time advising her. It really stung. If I was guessing who would sue me, it never would have been this person." "I felt thrust into this new world. I had no clue what goes on in a lawsuit. It felt like my own lawyer was speaking to me in Latin. The deposition was awful. They scrutinize every word you say, every picture you draw." Support From Family and Friends Is Key "My attorney said the trial would last 2 weeks. Naively, I asked if I had to be there. He started laughing and said I needed to be there every minute of the trial. So I couldn't see any patients then. I was scared out of my mind. It was depressing to know that I could lose even though I didn't do anything wrong." "The lawsuit affected my mood. I wasn't a very pleasant person to be around. I just felt so betrayed. It was very frustrating to just sit there and listen to the patient lie on the witness stand and listen to her lawyer twisting my words and attacking me." Dr Onyewu wasn't at all confident that the jury would find for him. "I had no way of telling what the jurors were thinking. The jury began deliberating but didn't reach a verdict that first day. Was that a good sign or a bad one? I had no idea. Fortunately, the jury came back the next day and found that I wasn't liable. I felt relief that this ordeal was over but was still upset that I lost so much time out of my life over this." The experience changed the way Dr Onyewu interacts with patients. "I'm absolutely more wary that any patient could be a potential lawsuit. We're not on the same team anymore. I don't engage in defensive medicine, but my way of documentation is very different now. I document completely unnecessary information. In court, if it isn't written on the chart, it's like it didn't happen. At trial, it's your word against the patient's. So I include notes on every conversation. It's burdensome but necessary." What advice would he give to other physicians facing a lawsuit? "Your support network is important. My wife was very supportive. She knew when to be with me and when to leave me alone. I don't know what I would have done without her." "Doctors should know that the outcome of any case isn't an indictment of your quality as a physician," he said. "That took me a while to realize. I know how much I care for my patients, how much empathy and concern I have. Now I realize that it wouldn't be the end of the world if I lost the case, as long as I know I did my best. "I still have faith that if you're kind to patients and provide good care, most will appreciate it. But some may not." 'The Trauma of Being Sued Never Leaves You' Stephen Metz, a gynecologic surgeon in Springfield, Massachusetts, was sued by the estranged son of an elderly patient who died of a heart attack 2 days after he operated on her. "She had a known cardiac condition and we did what we could to minimize the risk. Her EKG and cardiac enzymes were normal upon discharge. The allegation was that I should have known she'd have a fatal heart attack." "My first reaction was shock and anger. I'd worked very hard for this elderly sick patient. Her son, who had nothing to do with her care, was accusing me of being a bad doctor. I also felt some doubt about what happened. There are always things you wish you could have done better. Did I cause this? It's hard to figure out when you can't talk to your colleagues." "The allegations in the lawsuit made it seem like I was the world's most terrible doctor. It was 7 years from the filing of the lawsuit until the trial. Most of the time was spent waiting to give my side. At the deposition, the plaintiff's attorney kept trying to get my goat, to blurt out something I'd regret. It was a highly stressful business." "My attorney gave good advice: do not lose your temper during depositions or at the trial. Your nerves are on edge and it's not hard to be provoked." "After many postponements, we finally got to trial. It was difficult not knowing what the jury was thinking. I was worried the jury might be moved by sympathy for the son. I wasn't at all confident. Thankfully, the jury understood what I was saying and found that I wasn't liable." "I have a very supportive wife and family. Without them, I couldn't have gotten through this ordeal. I know of some medical families that have broken up because of a malpractice suit. But in my house, I was still honored. It was a big help." "Since the trial, I tend to be more careful in how I document the patient's care. I do more to make sure the patient and her family are aware of the risks. I'm quicker to get confirmation from a consultant in areas that aren't strictly within my expertise. Also, I never operate on someone whom I've seen only once. I make sure to get to know them better and let them know me before an operation." "I'd advise other doctors to have confidence in themselves. Nobody wakes up in the morning intending to harm a patient. Remember why you became a doctor. Review your records and be helpful to your attorney." "The stress and trauma of being sued lasts for a long time. It's always just below the surface. Being reminded of it brings it all back again. It really never leaves you." Still Upset After 21 Years A Kansas obstetrician/gynecologist, who asked not to be identified, was sued after a baby she delivered died 23 hours after birth. The patient was at 36 weeks and febrile. "It was unclear where the fever was coming from. I had a concern that the fluid around the baby might be infected. We did an amniocentesis. The baby decompensated quickly after that. We performed an emergency C-section. The baby was infected and died a short time after delivery." "The allegation was that we hit the umbilical cord with the needle, and that caused the baby to go into distress and require a C-section," she explains. "I was very upset and sad over the outcome, but it wasn't my fault. I felt I did everything right. Getting sued felt like someone kicking me in the belly. Fortunately, the jury found for me." "I was involved in another lawsuit around that time. It was ultimately dropped. But it made me wonder if I'd done the right thing going into medicine." "Lawsuits do make you think more about the risks involved. But I didn't shun patients or change my practice by doing more defensive medicine." The doctor volunteers at a low-income clinic. She urges physicians who've been sued to have someone to talk with. The doctor now works in the risk-management department of a malpractice carrier. "We have a 'care for the caregiver' program. If a doctor is sued, we help hook them up with a colleague to talk to. That can really help." "The worst part of being sued is the sense of isolation. No doctor wants to hurt patients. But at trial, the plaintiff's lawyer says you're an awful doctor. You can't take it personally, but that's hard." "Just talking about those cases gets me so upset, now 21 years later. It just stays with you. I get teary just talking about it." Source
