A couple of years ago, I wrote a post entitled "The Shame of Malpractice Lawsuits," in which I tried to evince some sympathy for how doctors feel when they are sued. I wrote about a friend, saying:
Even though she knew that she had done nothing wrong, my friend's main emotional response to the lawsuit was that she was ashamed. She did not want anyone to know about the case -- whether colleagues in the hospital or social friends. . . . As I talked to other doctors, I learned that this was a common reaction to such lawsuits. Another friend talked of the scars left from a case 20 years ago. He was found not to be at fault, but he could still vividly recall the weeks of shame he felt while the case proceeded.
There was a large response from readers but, in my mind, they sometimes missed the point. The post was simply to express empathy for the suffering felt by doctors who are accused of mistreating their patients.
Today, I learned about an approach being taken and Brigham and Women's Hospital that is meant to help address this in a simple and elegant fashion. There is a group of a dozen BWH doctors who have faced malpractice lawsuits during their career. When they learn that a fellow member of the staff has been served with a lawsuit, they simply write the person a letter saying that s/he should feel welcome to contact any of them to talk about how they feel. The idea is just to let the accused person know that there are others who have gone through the process who are there to help. Of course, they are careful never to talk about the merits of the case or other matters that would jeopardize its legal standing.
I think this is an excellent and thoughtful idea that could easily be copied by others and am pleased to share it for that purpose.
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ReplyDeleteAgreed. Doctors should receive supprrt from their community, even when their professional judgment is being questioned.
Ironically, I found (and continue to find) shame and alienation a similar experience for those who have sued. Friends and family alienate someone who has questioned a physician,"What happened?"
I am not alone in saying I have felt great shame and been shamed. At the time, it was the only way to find out "what happened" to my baby.
Physicians and their patients/families need an opportunity to have a conversation within the framework of a supportive, understanding community when outcomes are adverse, unplanned, or even preventable. It is possible. And it can provide healing for all involved.
Thanks for continuing to share your earlier posts.
When I worked for a publicly traded hospital company we had an agreed to arbitration that patients and or families signed at the time of admission.
ReplyDeleteSome 80 plus percent of patients agreed, this dramatically reduced lawsuits.
And the Nurses should do the same.
ReplyDeleteI agree with Pat. Let us not forget the nurses who are often named as part of the physician suit.
ReplyDeletePhysicians absolutely need a place that feels safe to discuss what he/she may be experiencing. If left to manage their emotions or experiences in isolation the greater the risk of suffering from post traumatic stress disorder (PTSD).
ReplyDeleteAdverse medical events take place every day. As long as there are humans there will be errors and mistakes. Some are minor but some devastating. No matter the size of the adverse event, the impact on both provider and patient can be everlasting. I do not agree with 99.9% of lawsuits toward physicians from their patients; but I have come to understand why they occur.
The problem as I see it is when a provider’s reaction is to ignore, or provide inadequate information about the adverse event, the patient feels invalidated and is overcome with anger. All patients want is the truth from the provider involved. They also want to make certain a system is in place to avoid another patient from experiencing the same thing. Additionally, patients want those involved to recognize and truly grasp not just the physical but the emotional impact.
Although I am certain in this day and age every hospital has a system in place to address these issues, at times these systems hinder the process because it doesn’t allow responding to the patient in a timely fashion or they do not follow-up with final outcomes. These systems also prevent the physicians from communicating directly with patients.
Patients do NOT expect physicians to be infallible but they DO expect humanness and honesty.
Again, physicians do not sit in isolation with what you are experiencing; if you find yourself with a lawsuit.
Hi Paul,
ReplyDeleteGreat post. Thanks for highlighting the work of Dr. Jo Shapiro's group at Brigham & Women's Hospital. Dr. Shapiro offered some excellent tips on how physicians can translate the work they have done at BWH to their own organizations: http://www.theschwartzcenterblog.com/2010/09/healing-healer.html
Julie Rosen
Executive Director, Kenneth B. Schwartz Center
Hear hear!
ReplyDeleteDoctors work their whole lives for the benefit of others, so they deserve some support when their judgement is questioned and should not be vilified.
This is a very interesting issue; very central to some of the defensive and harmful practices occurring now in obstetrics (31% Csection rates) -- I learned a lot about this by reading the story of an obstetrician and her journey through self-discovery and healing after she is sued. Delivering Doctor Amelia The Story of a Gifted Young Obstetrician's Error and the Psychologist Who Helped Her (Vintage 2004). Dr. Amelia Sorvino is a well liked obstetrician who has been in practice a few years when, in order to respect her patient’s desires for a vaginal birth, delays a cesarean section. Subsequently, her patient’s baby is diagnosed with cerebral palsy; she loses her nerve, stops practicing and faces a lawsuit. The narrative structure centers around the therapy sessions with the author Dan Shapiro and Dr. Amelia, and the story is told through the psychologists’ lens. So many issues emerge that struck me as very illuminating in terms of how current medical training and clinical practice gets in the way of self-knowledge and personal growth of these young, hard working men/women. The psychologist admits at one point he had difficult sympathizing with Dr Amelia's view of herself as a 'victim', as 'traumatized' and the subsequent work they both do in therapy is very moving.
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Another resource I discovered What do I say?: Communicating Intended or Unanticipated Outcomes in Obstetrics by James R Woods and Fay A Rozovsky — an obstetrician and a lawyer, respectively. Their book (Jossey-Bass 2003) is designed to help obstetricians improve communication about bad outcomes while avoiding liability. It’s an interesting, if ultimately unsatisfying, book because it is very narrowly construed along those lines. While it fulfills its own goals admirably, for me it doesn’t take the issues further by examining the lack of communications and teamwork skills in medical school curricula or the real patient safety issues that emerge with some standard obstetric practices that are not evidence based.
The social shaming that emerges around a lawsuit is very powerful and deserves attention. Would love to hear stories from participants in this approach how it works for them...
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ReplyDeleteYou are right on the money. So far I have escaped but it will happen. My closest encounter was when a patient complained to the board after his attorney advised him, His complaint was that I kept him as a prisoner in the hospital when he was actually going through alcohol withdrawals. I will never forget how painful the whole process was to clear my name. But when you get a letter from the board that "we are evaluating your capability to practice medicine" you almost get a heart attack.
It’s a real thing – like post-traumatic stress syndrome. Most of us really do care about what we do and how well we do it and are devastated when listening to the lawyers characterize us as monsters in the court room.
ReplyDeleteAs a plaintiff's lawyer, I have seen that there is a great deal of shame that patients also unfortunately feel when they come to me to explore a lawsuit -- almost apologizing for doing so saying "I'm not one of those people who sue." I regret that the legal system causes people to feel ashamed when the the true goal of the system is truth seeking, and to compensate those who have been injured while allowing the health care system to search for means to improve safety. According to a recent Wall Street Journal article, “medical professionals are finding lessons in . . . malpractice cases. By analyzing the breakdowns in care that led to missed, delayed or incorrect diagnoses, insurers and health care providers are developing programs to avert mistakes." Gordon Shiff, associate director of patient-safety research at Brigham and Women’s Hospital, added that malpractice cases “let us drill down and learn deeper lessons.”
ReplyDeleteAlthough litigation is by nature adversarial and therefore very unpleasant for both sides, it can serve a very useful roll in preventing future patients and physicians from having to endure it.
Although doctors are humans and they deserve support even if they make mistakes, I do not consider on an equal footing all of them. It is a fact that many doctors involved in such lawsuits are at fault, so they should feel ashamed. On the other hand, if you truly believe you did not do anything wrong, why should you first, be ashamed and second, seek for a support? Being ashamed is the consequence and not the cause. For example, I would not care less if somebody is accusing me of doing something wrong when I am personally 100% certain I didn't. Why would I need support and why would I feel ashamed of something that I have never done?
ReplyDeleteThe comment above "Most of us really do care about ...." is actually a shame. Shouldn't it be "All of us ..." instead? Until all of the doctors understand that it is their responsibility to perform their job professionally up to the expectations of their patients, I would not have any incentive to support groups intended to support doctors involved in malpractice cases. If one is guilty, they deserve to carry all negatives and go through hard times. Otherwise, it is a personal problem of the doctor carrying more about his ego and social reputation as opposed to what the real facts and truth are.
Moreover, I cannot see the need of such groups bearing in mind that as a teacher I have encountered numerous cases of premed college students interested in becoming MDs only because of the financial incentive without having any passion whatsoever with respect to helping people's well-being. Do I think these students would deserve any support when they become doctors and "naturally" ruin the lives of a N number of people? Obviously, no.
A real culprit here is medical tradition and medical education. Yes, of course, I know that medicine is different - but do other craftspeople, businesses, religious leaders flog themselves over a job poorly done? Guilty and bad, perhaps. But PTSD? The care of a human being is sacred, true, but I argue that that is not the root of shame in medical error. Most descriptors of pain are the revelation that they are discovered by peers (and employers!) to be fallible and possibly not as competent at their job as the system would like everyone to think so. Patients, as passive players so far in all of this, are expected to receive and be grateful. When they respond with real anger, it questions the reification of medicine as a priesthood. Much of the physician pain, however, appears to stem from exposure to colleagues and superiors, not from sharing the actual harm of an event with the patient. I'm sympathetic, but not sold. Medical education should teach doctors that they have a duty, but that they are not sacred.
ReplyDeleteI'm a doctor (ok a dentist, which many people think we are not real doctors... Anti-dentites!) and what I have found that it comes down to managing patients expectations. They expect a certain level of care, but they don't always understand the reality of their situation/condition. I believe that patients enter a health care setting and want to transfer ownership of their problems to the provider. They then expect the provider to play by their rules ( ie that poor ob/gyn who had to try to try a vaginal birth and then got sued). When they get a bad result, they assume malpractice. I do not believe that these are the same, and when a person can sue just because they don't like the result, that is a potential problem. The results on the doctor's psyche can be devastating....
ReplyDeleteof course, I know that medicine is different - but do other craftspeople, businesses, religious leaders flog themselves over a job poorly done? Guilty and bad, perhaps. But PTSD? The care of a human being is sacred, true, but I argue that that is not the root of shame in medical error. Most descriptors of pain are the revelation that they are discovered by peers (and employers!) to be fallible and possibly not as competent at their job as the system would like everyone to think so. Patients, as passive players so far in all of this, are expected to receive and be grateful. When they respond with real anger, it questions the reification of medicine as a priesthood. Much of the physician pain, however, appears to stem from exposure to colleagues and superiors, not from sharing the actual harm of an event with the patient
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