Question for doctors: how intense is the stress associated with the fear of a lawsuit?

[965978]

Is it something you worry about constantly and every day? Or is it in the back burner compared to other stressors such as money, time, charting, paperwork, etc?

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[Bacchus]

I don’t worry about it but I’m young and haven’t had anything brought against me. Things will change with time.

 

[emergentmd]

Never crosses my mind. Do your best, practice good medicine.

There are 1000 more things bad in life that can happen. Why worry about something you have little control over?

 

[DrFortiusNatando]

It likely would be dependent on state and specialty. Some states, (typically "red" politically), are more protective of the physicians in terms of malpractice laws - tort reform has made practicing medicine in many of these states less risky from a malpractice standpoint. And of course, specialty choice matters as well. OB/GYN, Neurosurgery, EM are particularly high risk, for different reasons. Cardiologists are named for big $$ cases. Various surgeons are also at least moderate risk. With the advent of better stroke treatment in the form of tPA (clot buster drug), neurologists are getting named more often, for failure to recognize stroke symptoms and failure to treat expediently when consulted by ED's, especially if the stroke symptoms are atypical or waxing and waning.

What does seem to be true is that providers who are nice to their patients are rarely sued. Providers who do not listen to their patients (or families), who harbor implicit or explicit biases, or who are arrogant or otherwise unprofessional and not compassionate, are much more likely to be sued. I have seen some very nice physicians virtually assassinate a patient, but as long as the family feels cared for, they are not likely to sue.

Juries generally overwhelmingly find for the defense (doctors, hospitals) in most jurisdictions. They too are swayed by physician arrogance when they do find for the plaintiffs. But there are cases, often with terrible outcomes, where the physicians did nothing that wrong (ie did not violate the standard of care), but the jury was unduly affected by a really sad outcome.

I used to be worried about being sued earlier in my career. Now I worry much more that I will actually make a mistake that could hurt a patient.

 

[OrthoTraumaMD]

Unfortunately, yes. It rears its ugly head every once in a while for me… particularly as a resident, you may find yourself involved with a patient who will sue the hospital, and because your name is on the chart, you will get dragged into that. Lawsuits tend to last for a long time. As an attending, the best defense is prevention. Document, document, document. Cover your butt and try not to think about it too much.

 

[Angus Avagadro]

When you are sued, you usually wont see it coming. Some are set ups where the last pt on a fri will be from out of town and want their spine manipulated just like their DO back home. 2 yrs later, with no memory of the visit and little documentation, you are sued. Happened to someone I know. The fear of being sued is not great
Do your best
Once the suit is filed, it is a huge pain in the butt. Depositions, experts criticizing you, delays...suits take years. You review and study only to have the event postponed and do it all again. It's the cost of doing business, but it has a big emotional cost for you

 

[Crayola227]

the emotional cost is far higher than what a simple rational analysis would tell you

ultimately you can't control it beyond doing the best job you can do, which you are doing anyway (or should be), so in that sense, it actually serves to underscore the feeling of being out of control (you can't do any better of a job than the best that you can do), which is part of the emotional cost

a lot of the time, frankly you're doing what you're SUPPOSED to be doing, ie, your job, so it literally feels like being punished for helping people

chew on how that feels

beyond a case where you don't feel like you did wrong, then there's an extra layer that can be present, where it feels like a betrayal because everything with you and the patient seemed copacetic

or they're just really are jerks out to get you, or make you the bad guy

also, frequently these things are built on misunderstandings, and beyond what you can do to educate a patient, and hopefully communicated clearly enough, sometimes the failure of communication isn't your own, it's that the patient has unrealistic expectations, won't listen, doesn't have the comprehension to understand the issues

this is all in the vein of being on a certain side of what is ultimately described above, a misunderstanding or failure of communication, and that is always extremely upsetting to anyone anywhere, you could think of petty social interactions that really steam you up this way, only in this case it drags on forever, costs money and time, and can permanently impact your career

none of this is getting into, what if there's some basis to it, what if you did actually screw up - and now you're paying the pied piper. That is not a feel good either.

No, there's no winning no matter from what quarter these suits come.

 

[Med Ed]

I have observed that the ability to adapt to this threat is a very strong marker of job satisfaction.

 

[EdgeTrimmer]

After one or two lawsuits you get used to it 🙂 My spouse is a physician and we don't loose sleep over the lawsuits. She is not in private practice though. Malpractice insurance should take care of most law suits.

 

[LizzyM]

After one or two lawsuits you get used to it 🙂 My spouse is a physician and we don't loose sleep over the lawsuits. She is not in private practice though. Malpractice insurance should take care of most law suits.

That said, there is an emotional component for the provider (physician, physician assistant, nurse, etc). It is an "old" book at this point (published in 2001) but The Lazarus Case by John D. Lantos, MD has an interesting take on being the subject of a malpractice lawsuit.

 

[Campana]

Being at the beginning of this journey, I have no personal experiences in medmal, but seeing @LizzyM reference The Lazarus Case, makes me think of another book, Baby Catcher by Peggy Vincent, mostly about deliveries, but she also has a chapter where she describes her first, horrible, experience with being sued. It gets into the sad realities on both sides of that lawsuit. I've added Lazarus to my reading list (almost done with your last recommendation by Tommy Tomlinson 🙂 )

 

[dpmd]

It is not something I stress over usually. I do consider the possibility when things go wrong and endeavor to communicate well with patients always but especially when stuff doesn't go how we plan. I also have it in the back of my mind when documenting so I try to explain my rationale for decisions that aren't straightforward and include some specific increased risks that is discussed with high risk patients. But I don't worry too much about it as I am doing so. I have had a few things occur that I thought could lead to lawsuit so I actually discussed things with my malpractice insurer. They then talk through documentation and how to approach things with the patient and family. After realizing that all their recommendations were things I normally do anyway I feel pretty good that when it happens (don't want to jinx it by saying if) I will be in a position where my insurance will handle things and defend me. Plus my state has a cap on non-economic damages so I don't stress much about people coming after my personal assets.

 

[Mr.S]

I personally worry about it from time to timesince I have been sued a few years back . I just think its a huge hassle and you worry about it from time to time depending on the type of person you are. How can you NOT worry since your carreer can end depending on the narrative of the lawsuit. SO yes it definitely is at least 1/4 of my stress all day wondering if I am doing the right thing, to do the intervention least likely to be sued.

It actually makes you a better clnician having been sued.
Nowadays, I stay away from blocks on certain patients . I wish i could stay away from blocks altogether to be honest but the surgeons want it. It just increases my liability. Avoid spinals on some patients. because that will be the source of their back pain. Positioning injuries are a pain in the arse. I say positioned by nursing and surgical staff. Teeth damage is a pain too.

SO I think about it everyday, and it definitely is stress.