An excerpt from The Healthcare Heist: How Physicians and Patients Can Unite to Transform Healthcare.
Every day, Francine said a little prayer for her doctor, sometimes upon awakening, often before drifting off to sleep at night. Her world had narrowed significantly since Simon, her husband, passed away the year before. With no children or close friends, Francine relied heavily on Doctor G to make sure that her needs were met.
Initially, Francine enjoyed visiting the office and chatting with the receptionist. As Francine’s mobility declined, however, Doctor G began making house calls. It was not just the physical strain; the lingering depression following Simon’s death weighed heavily on her. The antidepressant pills, however, were beginning to take effect. The few colors she could still discern seemed brighter, and there was even talk of her niece visiting from Ohio.
Then came devastating news: Doctor G was retiring from medicine and leaving the practice. Francine had always imagined that because he was much younger than her previous doctor, he would care for her until the end.
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Her last visit to the office was bittersweet. Though her physical condition had improved quite a bit, meeting Doctor G’s replacement left her feeling disheartened. The new doctor appeared hurried and less warm.
A few days later, as Francine experienced a brief bout of chest pain while watching television in her living room on a brisk Chicago day, she hesitated to call her new doctor. Outside, rooftops glistened with a fresh dusting of snow. Doctor G would have stopped by her apartment on the way out of the office and assessed her condition in the comfort of her own home. But with this new doctor, well, who could say?
As Francine drifted off to sleep, she pondered why such a young doctor would be leaving medicine so prematurely, and who would care for all of his elderly patients in the future. In fact, it was likely her last thought before slipping into unconsciousness. Perhaps she felt a fleeting pain or a moment of breathlessness as the massive heart attack overtook her. We will never know. We also will never know if Doctor G would have indeed visited her in the apartment or sent her to the hospital. In any number of alternate realities, she might have received appropriate and timely care and welcomed her niece into town with open arms a week later.
Instead, she died of a broken heart.
A promise to myself
Early in my medical training, a close friend faced unjust accusations of malpractice, enduring a grueling trial marked by self-doubt and eventual vindication. Witnessing her ordeal, I made a solemn vow to myself: If ever sued, guilty or not, justified or not, I would leave medicine without hesitation. The trauma of standing trial would destroy the will to practice medicine again.
The unspoken reality of being named in a lawsuit fundamentally alters how one practices the delicate art of medicine. Objectivity is lost, replaced by an instinct to overcorrect and protect oneself. The focus shifts from delivering the best care for the patient, to avoiding the trauma of being sued again. We become paranoid and overcautious.
The shift is supported by the data. A 2018 study from the National Bureau of Economic Research revealed that doctors’ fear of lawsuits increases the intensity and cost of hospital care by 5 percent, without yielding measurably better outcomes.
In my case, supposition became chilling reality one cold winter night when, at my front door, I was handed a summons to appear before a judge, while my wife and children sat quietly watching television in the adjacent family room. What ensued was a calamity spanning four years, costing my insurance company and me thousands of dollars in missed work and deductibles, ultimately leading to my departure from private practice and clinical medicine altogether.
The conclusion of the story was rather anticlimactic. After years of turmoil, I was dropped from the lawsuit when my deposition testimony finally persuaded the nursing home involved to settle with the deceased patient’s family. I received my own personal reprieve a few months earlier, before the settlement, when the plaintiffs’ attorney openly confessed in court to the judge that he had never intended to pursue the complaint against me. He had used my testimony as leverage to extract a larger settlement from the nursing home and hospital.
I was a connecting puzzle piece. A pawn. A resource to be exploited in the attorney’s high-stakes blame game. The attorney sensed that the roulette wheel of fate was poised to yield a significant payout.
The attorney positioned himself as an advocate for the patient and their family, but everyone involved understood the reality. The nursing home had committed no wrongdoing, an indisputable truth acknowledged by all parties. Economically, settling made more sense than proceeding to court regardless of the outcome, win or lose. The nursing home’s attorney, wise to the financial realities, recognized that prevailing in a protracted legal battle would exceed the costs of a settlement.
For the patient’s family, the settlement provided only modest compensation when compared to the years of anguish and extended grief caused by contentious litigation. No amount of money could replace their loved one. The past could not be undone. Meanwhile, the plaintiff’s attorney walked away with a substantial percentage of the settlement. In fact, he was the only one smiling at the end of this heartbreaking fiasco.
Collateral damage
By the way, I am Doctor G. Francine was one of my patients. My decision to leave medicine undoubtedly contributed to her premature death, as well as that of several other patients who passed away shortly after I closed my practice. It wasn’t just Francine. There was George, battling brittle diabetes for years, who was just barely hanging on before I left, and Sasha, prone to congestive heart failure exacerbations when she traveled out of town. Her new doctor, unfamiliar with her medical history, took a more lenient approach to her restrictions, not having been involved in her last hospital admission.
When doctors leave their practices, they take with them invaluable knowledge and expertise accumulated over years of caring for their patients, most of which has never been formally written down. This issue has been exacerbated even further in this post-pandemic era. According to a 2022 report by Definitive Healthcare, 334,000 health care providers exited the workforce in 2021, including 117,000 doctors. The primary care specialties suffered especially significant losses, with internal medicine seeing a departure of 15,000 MDs and family practice losing 13,000 practitioners.
Patients are not the only ones affected. When I left my practice, the livelihoods of my staff, secretaries, lab techs, and others, were also impacted. Physicians often drive the revenue for medical offices, and without their presence, the financial resources to cover salaries and essential services dwindle.
Attributing the entire great resignation and physician shortage solely to the malpractice crisis would be premature. However, it is undeniable that concerns and anxieties related to malpractice contribute significantly to burnout and frustration among physicians. In fact, psychiatrists recently coined the term medical malpractice stress syndrome, or MMSS, to describe the traumatic aftermath physicians endure following malpractice lawsuits. Those affected by MMSS often suffer through isolation, helplessness, and hopelessness, which can increase the risk of depression and even suicide. It also is a primary driver in the decision to leave medicine.
This essay is cited in the KevinMD records on medical malpractice and physician careers.
Jordan Grumet is an internal medicine physician.
