“Your worst enemy cannot hurt you as much as your own unguarded thoughts.”
– The Buddha.

On her 44th birthday, Dr. Maya Williams took in all she had accomplished: her recent partnership in her radiology practice, two beautiful middle-school daughters, and the enduring marriage to her medical school sweetheart.

It was devastating when she opened a registered letter outlining a malpractice case against her later that day. Allegedly, she had failed to communicate the results of a study to the referring clinician. Her heedlessness, per the summons, had caused irremediable damage to a patient’s health.

Her lawyer tried to reassure her not to worry. Her neglect had been minor, the grievances highly inflated: she would be just fine.

Maya was not consoled; in fact, she was wholly unnerved, unable to get the accusation out of her mind. Images of losing her peers’ respect, being shamed by her parents, losing her partnership, and even her license plagued her. In her worse moments, she saw herself helpless and destitute, having to move out of her home into a cheaper school district.

She experienced revulsion for the plaintiff’s lawyer, who had a reputation for unnerving clients by “getting under their skin.” She worried she would “lose it” on the stand by recoiling and admitting guilt or lashing out and becoming “hysterical.”

What mental bombshells she did not send the plaintiff, she saved for herself. She questioned if she was cut out for medicine and second-guessed her value as a physician, mother, and wife. How could she have been so careless?

She started drinking wine to “get the case out of her head,” spent more time binge-watching Netflix, dropped out of her running group and book club, and avoided her sibling’s phone calls. She used sleeping pills at night and Pepcid by day.

She implored her lawyer to settle the case at any cost. She could not handle the stress a moment longer.

Maya had full-blown medical malpractice stress syndrome, a forme fruste of post-traumatic stress disorder, a diagnosis all too common in this litigious age. Concerned for her wellbeing and capacity to stand trial, her lawyer recommended we explore inquiry-based stress reduction (ISBR) before her deposition.

ISBR, a widely used cognitive-behavioral self-help tool, is now being scientifically validated in the scientific literature. ISBR posits that it is not external events that are inherently stressful, but the stories we make up about them cause us to suffer.

In the ISBR model, stress is believing in a thought that is not true. Like a microscope stuck on a high-power field, stressful thoughts make us myopic, unable to see reality as it truly is. When we question our underlying beliefs, we let go of stressful thoughts and can open the lens of our reality and see things more clearly.

We made a list of her stressful thoughts:

“My peers will judge me.”

“The lawyer will badger me into saying the wrong thing.”

“I cannot stand the stress of a trial”

“I will lose my home and medical license.”

“Being sued means that I am not a competent physician.”

“I need to be perfect to be loved.”

Once isolated, we questioned these beliefs. Was it, in fact, true that her peers would judge her? How did she react when she believed this thought? How did she treat her peers, the plaintiff’s lawyer, and herself when she held onto this narrative? Then we explored the situation without believing, “My peers will judge me.” Who would she be if this thought no longer plagued her?

Next, in the “turnaround” portion of the process, we explored the possibility of other realities. We reversed the beliefs. “My peers will judge” to “I will judge me” and “they will not judge me.”

“Can you find examples where you judge yourself?” I asked.

She blushed and laughed.

“Ever since I was born, it got much worse in medical school.”

I smiled in knowing agreement.

“Could it be truer that your peers will not judge you?”

“90 percent of radiologists are sued by age 65. Plenty of my colleagues have been through this. I am looking forward to asking them.”

Her perspective on the legal process changed as she questioned the rest of her underlying beliefs. She saw that the opposing lawyers were doing their job: it was not personal. She realized she would not lose her home or medical license. She realized she could stand the stress of a trial and even learn valuable life lessons from it.

More importantly, however, she upended deeply rooted beliefs such as needing to be perfect to be loved or needing people’s approval to be happy. These thoughts had plagued her long before the lawsuit, and she was grateful to unload them. She felt happier than before the summons.

After a few sessions, Dr. Williams gave her deposition with courage and calm. Her kind yet unflappable demeanor paid off: the plaintiffs withdrew her from the case after the deposition, as they felt she was too likable and confident to put on trial.

We are busy people who have had much success; looking at our painful thoughts is not something we have had the need or opportunity to do. We may be a little anxious, neurotic, even, but we are respected, helpful, and successful. We tell ourselves that our anxiety is a small price to pay for all this success. Sometimes it takes a life-changing event to see that the truths we hold so close are not helping us. We are successful despite our anxiety, not because of it.

Opposing counsel desperately hopes we do not question our thinking. They bank on the legal process bringing up so many underlying beliefs that we settle cases early or show up to trial withdrawn, anxious or angry. Our mental clarity, unfettered by stressful thoughts sometimes carried for a lifetime, is our best legal defense.

“Reality is always kinder than the stories we tell about it.”
– Byron Katie

Lara Patriquin is a radiologist and physician coach and speaker. 

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