Op-Ed: This Doc Has ‘Post-Litigation Stress Disorder’

I am sure that I have “post-litigation stress disorder.” It does not actually exist yet as a recognized disorder, but I definitely have it.

You know what else? Countless other physicians have it too.

We don’t talk about it. Besides the fact that lawyers forbid you to speak of ongoing litigation to anyone, especially colleagues, there is such a culture of shame surrounding this subject. Although we now live in a world where “it’s not if, but when,” we still tell ourselves and each other, subliminally, that being sued means you are a terrible doctor. So we accept this ugly lie as absolute truth, and we bury and internalize the shame.

This is about to get very vulnerable. I will not bury it any longer. It’s not just hurting me, it is yet another institutional barrier between my patients and me, so it is also damaging the doctor-patient relationship.

I want to share my experience with both my physician colleagues and patients, precisely those from whom we hide this insidious shame.

When I was in medical school, I recall the fear of litigation being a deterrent to doctors entering the field of OB/GYN. As I progressed through OB/GYN residency, I told myself that I didn’t need to worry about that. I was passionate about the field, I was very good at my craft, I was a hard worker who always brought my A-game, and I had a very kind and compassionate bedside manner. I thought I had all the protection I needed against litigation.

Fast forward to a few months shy of 10 years of private practice, and I was served my first summons.

I was in my office (that’s right, the plaintiff’s attorney had it delivered to my office while I took care of my patients) when my manager led a gentleman from the waiting room to my desk because he was “required by law” to speak to me.

At least he was a civilian — I know some colleagues have been served in this same manner by uniformed police. This is the process of demoralization, step one. When I realized what was happening, I truly had an out-of-body experience. Thank god for the meditation practice I had started a few years prior. Otherwise, I am not sure how I would have made it through the next few hours and the end of my clinic day.

Demoralization, step two is an inch-thick pile of blithering legalese, cut and pasted from an out-of-date law school template that is peppered with deeply personal and professional gut punches like “negligence.” My advice: Do not read this. Besides the fact that it is a giant waste of a doctor’s valuable time, in my experience, there is a very vague complaint, very little substance, and a great deal of emotional abuse in it — as I said, demoralization, step number two. Let your attorney read it and ask them for the cliff notes. Save your emotional energy for believing in yourself and defending your good practice of medicine.

Demoralization, step three comes from all directions but sadly may even come from the defense team when they tell you, “This isn’t personal.”

Correction, it is not personal to attorneys. To the doctors who have sacrificed and poured themselves, mind, body, and soul into the lifelong pursuit of their craft and the care of their patients, it is deeply, profoundly personal. To the patient who had a bad outcome and has now been convinced by some greedy ambulance-chaser that their trusted, compassionate doctor maliciously injured them, it is deeply, profoundly personal.

This brings me to pain and suffering. Of course, we all know that for lawyers, pain and suffering are ways to pad a settlement or judgment.

But what of the pain and suffering that the patient and their family endure over years of legal back and forth, having their personal medical history become public record through depositions and court proceedings, reliving and retelling their tragedy over and over again?

At the end of the painful years-long legal process, when they get a settlement or judgment, and their attorney takes 40% (after expenses), maybe more, is their lot improved or their pain and suffering alleviated?

And what if they get no settlement or judgment? What about the pain and suffering of physicians who are emotionally broken by the trauma of this process and the impact that this has on their families and their other patients? Or the suffering of patients who cannot find a caring, compassionate physician because of this malignant legal climate?

The demoralization ripples outward.

I am not suggesting that there should be no legal recourse for true medical malpractice.

What I am saying is that not every bad outcome can be predicted or prevented, and not every bad outcome is the result of malpractice.

Launching this malicious, formulaic, yet highly personal attack on doctors and emotionally manipulating patients at a very fragile time in their lives is a perversion. A bad outcome can be investigated without demoralizing doctors and emotionally traumatizing patients. Litigation in this country does not serve to protect patients but, rather, has become yet another billion-dollar industry that commoditizes the doctor-patient relationship.

Concerning my own painful malpractice experience, my conscience is crystal clear with respect to the care I delivered, but I still carry the trauma and the shame heaped upon me by this vile industry. Like most doctors, I think that I have a reasonably iron constitution, but I know that it has affected my family and my relationships with my other patients, which gives me both tremendous sorrow and rage all at once.

The doctor-patient relationship is not served by our current litigation system, and in fact, is deeply wounded by it. Anything that does not serve the patient and supports the doctor-patient relationship has no place in healthcare. There may be a plaintiff’s attorney on every billboard you pass, but doctors are fleeing this hostile system in droves. Who do you want to deliver your baby’s baby?

Maryanna Barrett, MD, is an obstetrician-gynecologist.

This post appeared on KevinMD.