Open-Doors-Online
Home Page

MALPRACTICE STRESS SYNDROME

Open Doors is a volunteer Peer Counseling site for Physicians. It is intended to bring  increased awareness to Malpractice Stress Syndrome and the effects it has on our lives and ability to practice our profession. 
 
Peer Counseling emphasizes physician wellness to achieve personal, professional and organizational goals. The stress of medical practice thrust upon highly dedicated, personally responsible and notoriously independent individuals can surface as emotional and behavioral difficulties that threaten the stability of medical practices and stable organizations. The same personality traits that make allow physicians to endure the rigors of medical training lead to their isolation and denial when litigation difficulties arise. This is the basis for Malpractice Stress Syndrome.

Please see the Links Page for access to my blog and leave a message if you would like. I also have my personal contact information you can use at any time to keep your identity off the internet. The only reason I would request your identification is to make introductions between colleagues who may have common interest. Below is an article I am hoping to publish and will let you know a little more about why I have chosen to pursue this venture.


Friday Night Lights and

Malpractice Stress Syndrome

 

You may be wondering about how these subjects fit together. Hopefully I can connect the dots in a coherent way, produce some recognition about a disorder that is not discussed openly in medical circles and change how we support ourselves and our colleagues undergoing litigation.

I like sports. Growing up in Iowa, it was a big part of our family. I played in high school and at a small NAIA college. My dad was the Athletic Director and coached many sports and athletes, including me. The Sisam Arena at our Alma Mater named after him. My favorite TV show is Friday Night Lights. It follows the dramatic events of a High School Football team, the kids, their parents and coaches who try to guide them on the right path into adulthood. It takes me back to the days of my youth when I was secure in the fact that my family was there to protect me. The team has a chant before each game that has become a revelation to me.

Clear Eyes, Full Heart, Can’t Lose.

Medical Malpractice Syndrome is a condition developing in health care workers subjected to malpractice litigation. It was first reported by EG Reading in New Jersey Medicine in 1986 and NEJM in 1987. Recently, Professional Liability Stress Syndrome was mentioned by Steve Buchanon, DO during the Ethical and Professional Standards Committee meeting for the ACOOG (American College of Osteopathic Obstetricians and Gynecologists). I like that terminology better. It’s more accurate but not as well known. In medical allegations, there is strong correlation between the severity of disability and outcome, but there is little correlation between negligence and outcome.[1]

 Malpractice Stress Syndrome is manifested by feelings of isolation, reduced self-image, emotional instability and withdrawing from relationship. A self assessment survey was developed by Louise B Andrew, MD, JD, is presented in Table 1 and can be viewed at her website, www.mdmentor.com. Overall, 1 in 5 Physicians is exposed to malpractice suits every year; for Neurosurgeons, Orthopedists and Obstetricians, the number is 1 in 2.5. To quote her seminal article, “malpractice claims are a completely predictable hazard of medical practice in the 21st century”.[2] 

Very few physicians seek any kind of help with their reactions to the stress of practice, let alone the emotional rollercoaster of lawsuits. We are the strong ones, the caregivers, the healers; we support our patients through their problems, not seek or accept help for our problems. About half of all professional liability insurance carriers offer programs for support to physicians being sued for malpractice and with only a fraction of physicians seeking out these services; too many remain alone with their troubles. There is strong evidence that peer counseling has a positive impact on the long term mental health of physicians and caregivers. My goal is to bring this to light. Provide a resource for others who are going through this very difficult assault on their well being.

Why would I be any good at this?

I have been an OBGYN Attending for 14 years. I’ve been sued seven times. After the initial “OMG!” [3] response, I’m sure you may have a couple other reactions. “He must be a bad doctor”. I’m not. I’ve handled thousands of cases with complication rate conservatively in the 0.2% range. “His bedside manner must be bad”.  After my first two cases I apologized to my patients before it became fashionable, it was used against me. I always tried to explain procedures fully to patients, advise them of their alternatives, make my calls every day and listen.

Was I projecting something they picked up on? After my first malpractice suit, maybe.

PICOM Insurance Company, a physician-owned in Okemos, Mich., studied its physicians undergoing litigation and found that 24% of sued physicians had another claim within 6 months. There are even studies to suggest that those who are the best in their field are sued more often.[4] Taking on the sick and high risk patients is risky, but when do we back down from a challenge.

My experience started with that ruptured uterus during a VBAC (Vaginal Birth after Cesarean Section) in 1997. They were all the rage and our group was progressive. Labor progressed routinely but as she became complete, the baby suffered severe bradycardia. I was notified 20 minutes after it started, got to the room in 1 minute, went to the OR and delivered the baby by Cesarean Section in 7 more. I beat the Standard of Care by 2 minutes. It didn’t matter. The baby, Taylor, suffered profound hypoxemia and was later diagnosed with Spastic Cerebral Palsy. The suit was difficult. They said I didn’t obtain proper Informed Consent, altered records and was negligent. During the trial they misrepresented my deposition, their expert lied and they said I was a bad doctor. It was hard. I was affected.

My other cases run the gamut. The Absurd: emotional stress after passing retained products of conception. Unfair: stabilizing a “no doc” patient for PTL at 27 weeks and transferring her to the tertiary center. Puzzling: how did a bladder laceration occur in the retro pubic space during a Cesarean Section? Surprising: shoulder dystocia on a mom who had a previous 4000 gram baby! Troubling: a missed sigmoid laceration during a diagnostic laparoscopy. How does that occur with a mid- line trocar and tubal insufflation? To the routine: A bowel laceration during extensive lysis of adhesions, a known complications and discussed during informed consent.

I’m lucky I didn’t make worse choices. A stressful job, a child with Autism; I reacted poorly to my troubles. All good reasons to have addiction or marital problems. My wife stuck by me and we worked through it. My addiction was food and Halo on Xbox Live. A lot of sleepless nights and some weight gain. Finally I found a counselor to who helped me realize how much I was projecting my anger into my personal interactions. Maybe the fact that my family continued to love me kept my head above water. Not everyone does. Too many others have turned to other transgressions or isolation and lost their relationships or ability to practice medicine.

Why would I tell you all this?

Do I have thick skin, no remorse or a super sized ego? No, I want to help anyone who is or has gone through what I did. Too many physicians remain alone with their problems. We need to it out from behind closed doors. Addiction in the medical profession approaches 20%. Every year we lose almost 400 colleagues to suicide. After accidents, suicide is the most common cause of death among medical students[5].

We practice medicine as a calling; not for the money. We want to take care of people, watch them get better and see their children safely into the world. We need you, patients need you and our Health Care relies on your skill. I am leaving OBGYN. My calling now is to help some of you stay.

My blog, linked on this site, is dedicated to helping doctors deal with Professional Liability Stress Syndrome, a very similar disorder to Post Traumatic Stress Disorder. There is a lot of information on the signs and symptoms of the disorder, contacts for support groups and peer counselors, as well as ideas and techniques to combat the emotional trials ahead. The unfortunate part of our healing profession is that we have complications. The events surrounding complications; lawsuits, depositions and trials; can cause many difficulties for physicians and we don’t always deal with them well. Guilt, shame, flashbacks, emotional numbing, avoidance of relationships, addictions; all of these can occur due to Malpractice Stress Syndrome.

I am enrolled in the MBA program at UMass. I will go into private business when I am done. It will give me the time I need to stay involved in medicine, teaching and ACOOG, but my true devotion will be to addressing Malpractice Stress Syndrome.

Why now?

I recently received a letter from Taylor’s mom, remember the ruptured VBAC? He is a straight A student at his small, rural school. He is in the same class as all the other children his age, he gets some additional help but does the work required of his peers. He sings in the church choir and wants to be a preacher. He doesn’t know he has any limitations. His mom calls him a gift from God; he has saved from her from the bitterness of life. To quote her directly, “He is an Inspiration to me and everyone that come in contact with him.”

She thanked me.

CLEAR EYES…FULL HEART…CAN’T LOSE!




 

 

[1] Thiebaud S. Who supports physicians in malpractice cases? Physician Executive, Mar 2002

[2] Andrew LB, Pfifferling JH. Managing Medical Malpractice Stress. NCPHP

[3] Oh my God!

[4] The Journal of Family Practice, Vol. 48, No. 1 (Jan), 1999

[5] Physician Suicide. Louise B Andrew, MD, JD. MD Mentor

 

 

 

 

Web Hosting Companies