Medical malpractice stress syndrome
Legally Speaking
Clifford Warren Lober, MD, JD, presents legal dilemmas in dermatology every other month. He is a dermatologist in practice in Florida and a partner in the law firm Lober, Brown, and Lober.
By Clifford Warren Lober, MD, JD, August 1, 2019
Question: What is medical malpractice stress syndrome?
Answer: Medical malpractice stress syndrome (MMSS) is a manifestation of post-traumatic stress disorder. Facing litigation is one of the most stressful situations a physician will ever encounter. Although one may intellectually understand that a malpractice suit is an inherent hazard of practicing medicine, it is psychologically devastating when it occurs. Instead of being respected, trusted, and valued, you are vilified and accused of professional incompetency or carelessness. Your judgment and character are questioned.
Regardless of whether the allegations have merit, physicians feel emotionally ambushed. A patient you have cared for and tried to help is now your accuser! You face months or years of litigation. Depending on the outcome, you may be reported to the National Practitioner Data Bank, the state Board of Medicine, and other regulatory authorities. Even if the case is dismissed or you are found not guilty, the fact you have been sued may have to be reported to hospitals, health care organizations, and others.
Q: What causes MMSS?
A: Although the obvious cause of MMSS is a malpractice lawsuit, even a formal complaint or investigation can trigger the symptoms of MMSS since they bring into question a physician’s competence, judgment, integrity, or character.
Q: How often are physicians sued?
A: Jena and colleagues analyzed data from 1991 through 2005, and reported in the New England Journal of Medicine that, “By the age of 65 years, 75% of physicians in low-risk specialties and 99% of those in high-risk specialties were projected to face a claim.”* Dermatology was considered a low-risk specialty. These findings should not be surprising, however, given the number of patient encounters a physician faces. Assuming a physician sees 30 patients a day, five days a week, for 50 weeks a year (taking two weeks for vacation), they would have 7,500 patient encounters annually, or 75,000 encounters every 10 years! Each individual instance provides the opportunity for a patient to perceive an adverse experience.
Q: What are the symptoms of MMSS?
A: MMSS has a variety of manifestations. Reactions of shock, anger, denial, and frustration are normal. Impairment of concentration, distractibility, difficulty sleeping at night, chronic fatigue, irritability, self-doubt, and a sense of helplessness occur as one’s personal integrity and competency are attacked. To make matters worse, you are instructed by your attorney to not discuss details of the case with anyone other than the attorney and your spouse. This leads to feelings of isolation and loneliness. Physicians accused of malpractice have even committed suicide.
Q: How can MMSS affect the doctor-patient relationship?
A: Physicians accused of malpractice may view patients as potential lawsuits walking on two legs. They may distance themselves from their patients, order more tests, request more second opinions, or refuse to treat patients with certain conditions. It is not uncommon for older physicians nearing the end of their careers to decide to quit practice when faced with a malpractice suit.
Q: How does MMSS affect a physician’s personal life?
A: An accused physician may be unable to forget about the lawsuit for more than a few hours at a time. A sense of helplessness or victimization may occur since resolution of the malpractice case is not solely up to the physician, but also involves the plaintiff, attorneys, and the insurance company. MMSS may lead to the use of alcohol or drugs, distancing oneself from relatives and friends, and social withdrawal. Decreased appetite, increased irritability, and lack of interest in sex are not uncommon. The symptoms of preexisting illnesses such as gastrointestinal disease, hypertension, or diabetes may worsen.
Q: What should you do if you have MMSS?
A: First of all, reach out to your attorney. They can discuss all aspects of your case and give you a realistic sense of what to expect. Working with your attorney will also allow you to participate in the case and have a role in decisions that have to be made.
If you find yourself unable to sleep or concentrate at work, or feel that your anger or frustration are great, contacting a mental health professional is certainly reasonable. This is definitely advisable if you are considering using alcohol or drugs, or even thinking of suicide.
Remember to take time to interact with friends and family. Eating healthy and exercising are always advisable. Reducing stress will enable you to concentrate more clearly, reduce irritability, and let you sleep more soundly.
Finally, understand that malpractice allegations are predictable, foreseeable hazards of our profession, that even “the best” physicians have been sued, and that most suits are found in favor of the physician.
*Jena, AB, Seabury, S, Lakdawalla, D., Chandra A.: Malpractice Risk According to Physician Specialty, New Engl J Med. 2011. 365:629-636.