Every claims executive handling medical malpractice claims has seen it. So has every lawyer who defends physicians in med mal cases. They know how destructive this phenomenon can be to the defendant and their case, just as hospital administrators know how damaging it can be to an entire practice group.

With more than half the physicians surveyed in a recent study reporting having been sued at some point in their careers, medical malpractice stress syndrome (MMSS) is likely affecting thousands of doctors. It often goes unrecognized, with the client’s behavior simply written off as defensive or angry or hostile or arrogant or, especially in relationships with their lawyers, attributed to the client simply being a difficult person to work with.

There is too little recognition among physicians and those around them that these reactions to litigation are commonplace, especially in the many cases where the claims are unwarranted, and there is too little understanding of what MMSS is and how it can be addressed.

With billions of dollars being paid out annually in settlements, the question for insurers and defense attorneys is this: How many of those settlements involved potentially winnable cases that were settled because of “difficult defendants” who could not be adequately prepared for depositions or trials? Could we have achieved a better outcome?

These are not isolated cases. What these highly intelligent, high-functioning physicians are going through is a common occurrence. My firm has worked with numerous physicians with MMSS and we know, if it’s recognized and acknowledged, it can be addressed through practical, short-term, results-oriented strategies.

What does MMSS look like? Mixed in with their feelings of anxiety and depression, physicians with MMSS are often having thoughts like:

1. Am I going to lose all of my assets? After all my hard work, am I going to end up broke?
2. Am I going to lose my license? Will I be able to practice medicine again?
3. I don’t think I did anything wrong, but what if I’m still found to be at fault?
4. Am I a bad doctor?
5. Did I miss something? Did I make a mistake? Was there something more I should have done?
6. If I lose everything, will my spouse divorce me; will I lose my kids?
7. What’s going to happen next? What else could go wrong?
8. Are there more people out there who are going to sue me?
9. I’m used to being in control, but I feel overwhelming – not in control of anything.
10. My entire identity as a professional and as a person is now in question.
11. How do I get this case out of my head? I can’t focus on anything else.
12. I’m developing medical problems of my own.
13. I’m having difficulty focusing on my patients – how do I know who’s going to sue me next?
14. Am I now going to be in the National Database for the rest of my life? My reputation will be destroyed.
15. I wish I could escape it all – I feel like killing myself.

This list is obviously not meant as a diagnostic guide – it’s merely a sampling of some of the many issues that typically cloud the judgment and affect the behavior of physicians with MMSS. It’s important to note that, for physicians with MMSS, these are not experienced as detached, hypothetical thoughts, but as actual realities they now must face.

Everyone in this field will likely recognize them in someone they know. And perhaps some physicians who are in the midst of litigation will recognize that they themselves are having thoughts along these lines. Those physicians need to know they are not alone. While there have been few if any studies of MMSS, other studies have found that as many as 95 percent of doctors become so stressed during the litigation process that they experience PTSD-like symptoms, including anxiety, depression, diminished thinking capacity, and serious health problems.

Although these are psychological symptoms, traditional psychotherapy is not an effective way of dealing with them because its focus is too diffuse, and results may take years to achieve. What’s necessary is a practical type of litigation stress coaching – short-term, goal-oriented, and tailored to the specifics of litigation challenges and process.

This isn’t a job for traditional therapists and it’s also not a job for lawyers, although they are the ones who often bear the brunt of it.

Physicians need coaching that is clear and straightforward, that’s covered by privilege, and is intended to improve communication between them and their legal team. Several of the major liability insurance carriers are beginning to utilize litigation stress coaching, which is designed to provide clear, straightforward results: improving physician-attorney communications and helping physicians get into a frame of mind where they can be effective witnesses and successful defendants.

The process may unfold in a variety of ways, but typically claims consultants or attorneys recognize during their initial conversations with physicians that they are dealing with someone who is going to need help and, if the client is amenable, they bring the coaching firm on board. Recognition that MMSS is a common phenomenon will help move the client toward a productive coaching relationship.

Outlining goals and expectations helps get the client into a frame of mind where they can be an effective witness and successful defendant. Focused litigation stress coaching can improve outcomes in legal cases as well as reducing the likelihood of a downhill spiral that results in future claims. At the same time, it helps restore a good doctor’s confidence and focus, allowing them to thrive and maintain the quality of care they provide to their patients.

Gail Fiore is a psychotherapist and litigation stress coach. 

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