• Dealing with the stress of a claim or complaint

    Facing a complaint, litigation or a disciplinary hearing is one of the most stressful events a doctor will face and it carries significant professional and personal impacts. Research looking at the psychological wellbeing of doctors (undertaken by psychiatrist Dr Louise Nash from the NSW Institute of Psychiatry) has shown that many doctors describe having a medico-legal complaint as the most traumatic experience in their lives, even when the matter is resolved in their favour[1].

    One US study found nearly 40% of doctors who had been sued experienced serious depression after the event, and in another study doctors negotiating the medico-legal process were found to be more prone to the onset of physical illness such as a myocardial infarction or the exacerbation of an existing illness[1]

    Other international research has shown that medico-legal actions have potentially negative long-term effects including self-doubt, a loss of confidence and negative impacts on their professional identity[1]

    Such events are traumatic partly because they strike at the heart of a doctor’s sense of identity and credibility. If pre-existing psychiatric morbidity exists there is a chance it may worsen, which can compromise the wellbeing of at-risk doctors.

    Exposure to a complaint or negligence claim often involves a traumatic pattern of shock, initial panic, indignation, difficulties with work and home life and often anger or suicidal ideation.[1]

    So what can a doctor do when faced with the stress of medico-legal action? We outline five areas that you should focus on in an effort to optimise your wellness during such a difficult time.

    Accept the unpredictability of the legal environment

    An important first step is to recognise that the legal process is unpredictable. Key strategies to manage the unpredictability include:

    • Familiarising yourself with the legal process
    • Gathering together any relevant documentation
    • Asking your lawyer to explain points of law and what to anticipate throughout the process
    • Participating in the process of choosing your experts
    • Where possible, be engaged and check everything yourself

    Exercise control where you can – make adjustments

    Being at the mercy of ‘the system’ can be distressing. Lack of control during the protracted course of a legal matter presents real challenges for doctors who are used to a high degree of professional autonomy. One way of dealing with this issue is to actively engage in the process as much as possible. Some ways to achieve this include:

    • Actively involve yourself in the defence of your case
    • If some aspect of the case particularly stresses you, such as preparing for a hearing, consider rearranging your office visits or cancel surgery or other clinical procedures
    • Attend and review conferences and actively study the literature that relates to your case
    • Examine your office and practice procedures and your time management with a view to making changes where needed
    • Avoid situations that might demand compromises in your own professional standards
    • Participate in medico-legal education programs, especially those that cover how to keep proper records, improve communication skills and enhance the informed consent process

    Get to grips with what it all means

    It is important to take stock and consider the big picture in complex situations like legal action and disciplinary matters. Take time to think about the meaning of your profession and career.

    • Reflect on your own feelings of competence and take whatever measures necessary to solidify them
    • Examine how this event impacts on your relationships with patients, especially if the plaintiff is a long-term patient or friend
    • Work to neutralise negative feelings
    • Consultations on family finances and financial planning can help reduce anxiety

    Focus on coping strategies that enhance wellbeing

    Examine how you manage stress. Look for gaps or less healthy strategies and replace these with new ones – get support to do this if you need it. Re-examine your life and restructure it as necessary - this can be an opportunity to put life in perspective and reprioritise. Some of the things to look out for include:

    • Consider your historical coping strategies and question whether they continue to be effective - do they need to change?
    • Consult your general practitioner if you have symptoms that do not diminish - research shows this is a risky time for your physical wellbeing
    • Consult a specialist if persistent psychological symptoms and or drug and alcohol abuse develops
    • Enhance your leisure time, sporting activity, holidays and family time which are all effective diversions
    • Make changes in your practice so that it generates less anxiety and is more manageable

    Jump the support barriers

    Research tells us that doctors are reluctant to seek support when they need it and there are many barriers (both real and imagined) to receiving the care they need. [2] Faced with the extraordinary stress of litigation or a disciplinary hearing is a time to jump the barriers and make the connections with support required.

    • It is extremely important to seek help for stress related to litigation or a disciplinary hearing so you will be at your best when participating in your own defence
    • Identify those with whom you feel most comfortable to share your reactions and recognise that most practitioners need to share their reactions to the experience with someone
    • For different practitioners, it will be another practitioner, a spouse, a family member, friend, office staff, medico-legal adviser, claims manager or solicitor
    • Most people are willing to hear you out and sometimes that needs to be a mental health professional

    Cautionary Tale

    Member Story

     

    Keeping well while facing a medico-legal complaint - a personal story

    Dr Emmanuel Varipatis, a 59-year-old GP from Manly, NSW, was sued for $350,000 after a judge found that he had been negligent in not referring a morbidly obese patient for gastric band surgery. Here, he explains what self-care measures he employed throughout the ordeal.

    The story begins

    It was just a normal day. I was standing at reception and picking up a file when I got served. I opened the envelope and saw it was a Supreme Court document; I was being sued by a patient who I thought I’d looked after quite well for a long time and who I’d gone out of my way to take care of.

    Stress symptoms

    I found that my mind was obsessing on the case 24/7 and it was too easy to let this take over. I started suffering the basic symptoms of anxiety with even occasional moments of panic, and found myself waking up in the middle of the night with the case on my mind. When it became evident that this case wasn’t going away, I decided I needed a strategy to deal with it so it wouldn’t affect my work, family life or health. To achieve this, I needed a plan to manage my cortisol levels as best I could.

    A plan of action

    I followed my own advice and engaged in the same type of stress management techniques that I would recommend to my patients. The first thing I decided to do was to change my attitude around this case. It was self-evident that worrying and obsessing wasn’t going to change anything; so I made a deliberate decision that, as much as I could, I would stop worrying and just take whatever actions were necessary, as necessary.

    Relationships and lifestyle

    I kept my wife involved and found that being able to ‘share’ the stresses made it easier for both of us. I made sure to keep up a nutritious diet and stuck to the rule of ‘early to bed, and enough sleep’.

    Full steam ahead

    I increased my exercise from two hours to five hours a week with sessions of Pilates, walking and body surfing. I did lots of early morning walking sessions with mates around the headlands, followed by outdoor gym exercising, then body surfing and finally breakfast. This combination of social ‘guy time’ plus exercise was probably the best help of all in keeping me sane.

    Meditation

    I restarted the regular practice of meditation. I find it easier to do if it’s ‘directed’, so would generally use phone apps that allow me to just put on headphones and listen to guided meditation and self-hypnosis sessions.

    A set back with health implications

    When the judge found against me, the case received nationwide media coverage and I received lots of unwanted publicity. So even though I still felt I was coping well; it was at this point that my blood pressure went up and I had to commence medication for it.

    It has proven to be a high-publicity case with unusual longevity; a marathon case that just keeps on going. As life stressors go, this case for me has ended up rating right up there with bad marital or financial stress; and I am certain that I would be ‘a mess’ now if I hadn’t worked out an action plan early on for managing the stress of this case.

    A good outcome

    The Court of Appeal found in favour of Dr Varipatis, overturning the NSW Supreme Court’s earlier decision. The High Court of Australia has subsequently rejected the patient’s application for special leave to appeal the Court of Appeal’s decision, effectively closing the door to further appeal and bringing this stressful event to its conclusion.


    References

    1. Nash L, et al. The psychological impact of complaints and negligence suites on doctors. Australasian Psychiatry 2004; 12(3): 278-281.
    2. National Mental Health Survey of Doctors and Medical Students, beyondblue, October 2013.