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Monday Jul 21, 2014

Surviving Malpractice: Don't Lose Your Passion for Helping People

During my training, I was told numerous times to expect to be sued for malpractice at least once during my career. It was always said with an attitude of "This is the way it is, so just get used to it."

In fact, more than 60 percent of physicians 55 and older have been sued at least once, according to the AMA. But what happens when that dreaded letter arrives early in your career? And how do you keep it from derailing your passion for medicine?

Unfortunately, I found out about a year into my practice that I was being sued for malpractice, along with a number of my colleagues. For obvious legal reasons, I cannot divulge details of the case. But I would like to share much of the advice that was given to me and how this has affected me as a physician and as a person.

I found out about the lawsuit when a letter arrived at my clinic, stating that I was being sued for malpractice due to neglect of a patient I had seen a few months before.

My heart sank when I read that letter. For some reason, because it came in the form of a letter, it added to the cold and impersonal nature of the process. I wasn't sure whom I should call or what I should do. I spoke with my colleagues who had been named in the suit. Our emotions ran the gamut from anger and fear to stunned disbelief.

One of my senior colleagues had been through this process before and offered some simple advice: "This is going to take a long time, and it's going to be frustrating. Just try not to let it change you. We are all still good physicians."

I found great comfort in knowing that a physician I respected had been through the process and could help guide me along.

Being fairly new to practice, this suit shattered my self-confidence for a few months. I second-guessed everything I did, even fairly simple things. I seemed to see the plaintiff in the face of every other patient I saw. I spent lots of time looking up things that I already knew "just to make sure." I likely referred more people to subspecialists than I needed to for diagnostic confirmation.

One of the perks of being employed by a health care system is that we have a risk management department to help us. When we shared the information with them, I received this second piece of advice: "This is going to be very stressful, but make sure you don't bottle this up inside. I strongly encourage you to talk with a therapist about this process."

In some ways, this was difficult. I was not allowed to discuss the case with anyone who was not involved in it. I could speak with my named colleagues, our medical director and division chief, risk management and our law firm. That meant that those closest to me -- namely, my family and friends -- couldn't know anything about it. I could tell them that I was being sued, but I could not discuss any specifics.

Although I could share my experience in a limited sense professionally, I had to bear the burden alone in my personal life. This underscores the absolute necessity of having a therapist with whom to share your emotions and experiences.

We next met with our legal counsel, who offered yet more sage advice: Participate in the process as much as you can. Provide medical evidence for your choices as much as possible. Be in frequent contact with your attorney.

This process began nearly a year ago, and I have yet to be deposed. Part of the delay has been because of legal posturing, and part of it has been due to cancellations and rescheduling. But mostly, it has been because of the fact that the legal system moves slowly.

Yet despite this, I am feeling much better about things. Understanding the process and having others I can rely on for professional and emotional support has been a huge help. The existential medical crisis I went through has waned, although I am more conscious of wanting to have a specific reason for everything I do clinically that I can use to justify my actions to myself, at least, if to no one else. This puts my mind more at ease for potential future lawsuits, and I don't think about the current case all the time any more.

I was initially worried that my passion for medicine had been stolen from me. Thankfully, due in part to the advice I've received, it hasn't. And the reason people seek our help and opinions remains the same -- it's based in hope. We should never let our ability to assist perish because of our own circumstances.

Family Practice Management has compiled a collection of journal articles on malpractice -- covering everything from malpractice insurance to depositions -- for those who don't know what to expect. But for those of you who have been through this, what advice do you have for your fellow physicians?

Kyle Jones, M.D., is a faculty member at the University of Utah Family Medicine Residency Program in Salt Lake City. He is the director of primary care at the Neurobehavior HOME Program, a patient-centered medical home for those with developmental disabilities. You can follow him on Twitter @kbjones11.

Comments:

The author correctly identified this as one of the most painful issues you will face. Most of us are obsessive enough to keep going back to revisit the case and finding areas where we "could have done more." Always doing more is dangerous to our patients and doesn't necessarily reduce malpractice risk. It may increase exposure of your patients to complications and you to charges of malpractice. A common difficulty is finding the perspective to realize that we are held responsible (legally) for practicing as well as other physicians with our same level of training and experience--not necessarily in the way that the "hired gun" specialist who will be brought in to argue your incompetence. That still doen't make it easy to listen to his glib assertion that the patient would have been fine in his hands rather than yours. Finally, as the author advises, find and use a good counselor. Whether this is a PhD psychologist or a trained pastoral counselor is not so important as finding someone with good training who you can be open with. Simply explaining to the counselor what you're facing can make it somewhat less terrifying, and a good counselor can make it easier to forgive yourself and the others in the process.

Posted by Donald Milligan on July 24, 2014 at 10:19 AM CDT #

A well written and hearfelt article--thank you, Dr. Jones. Early in my professional career a malpractice suit nearly derailed me from medical practice. Now, 25 years later, I am glad I didn't listen to the only advice I received "Don't talk to anyone but your attorney". Now, as a faculty member, my gift to FM Residents is to tell them "Not if, but when you get sued..." and "Write any chart entry knowing that you may have to read it to a jury."

Posted by Mary C. Spalding, MD on July 24, 2014 at 10:36 AM CDT #

Thanks for sharing Donald and Mary! It's always reassuring to know that what happens to others is similar to your own experiences.

Posted by Kyle Jones on July 24, 2014 at 10:50 AM CDT #

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.