PHysician Support Resources

---

The Aftermath of Litigation - Distress

---

Distress is characterized by a wide variety of disruptive feelings and reactions following a significant traumatic event. (Please see the Stress Assessment Checklist.) It is not a diagnosis but a normal response to abnormal events such as significant clinical adverse events and lawsuits. Manifestations include:

• Anger – Sued physicians, for example, often feel that the suit is not only unfair but totally unjustified. These feelings can translate into intense anger that can result either outbursts toward others or simmering inward rage that can contribute to the development of guilty feelings and/or significant stress-related symptoms such as headache, hypertension, coronary artery or gastrointestinal disturbances.
  
  
• Intrusive recollections such as nightmares and upsetting recollections
  
  
• Insomnia and jumpiness
  
  
• Anxiety, irritability and restlessness – These can contribute to our being impatient, preoccupied, and distracted.
  
  
• Feelings of vulnerability and loss of control – Physicians commonly share perfectionistic tendencies and a need to control. Suddenly, we are subject to a schedule not of our making and a process that seems estranged from the medical world—a process fraught with delays and frustrations. We become dependant on a variety of other players – the judge, the lawyers and the jury – especially when we go to trial.
  
  
• Feelings of isolation and withdrawal – Because of the stigma that may be associated with being the subject of a malpractice suit, some physicians feel isolated and "different" from those who have not been sued. The latter may not always be empathic – in fact non-sued doctors may feel awkward with, and avoid, associates who are in the midst of a malpractice suit.
  
  
• Disturbances in our relationship with our associates, staff, family members and those closest to us. We are often impatient, critical, and displace our anger on others, complicating our relationships and causing untold misunderstandings.

Physicians need reassurance that, in most instances, these are commonly shared reactions that will dissipate spontaneously in time. If they persist and do not resolve within a reasonable period, consultation is warranted. We need to observe whether or not we are engaging in counterproductive or self-defeating behaviors such as being hostile and non-cooperative with our attorneys or exhibiting dysfunctional behaviors. Suggestions for helping doctors help themselves respond more effectively during this period are outlined in this section on Physician Support Resources and the "Coping" article on the homepage and include:

• Social support – Most of us find that talking with a trusted confidant and sharing our experience with others is a natural coping mechanism that helps us regain feelings of equilibrium and puts our experience into perspective.
  
  
• Restoring mastery and enhancing self-esteem – We do this by engaging in activities that restore our feelings of control over our lives such as seeking information about the legal process, cooperating actively in our defense, engaging in physical exercise, scheduling our leisure and work time more reasonably, reading and listening to music, and by active participation in relevant hospital committees, medical and specialty society activities.
  
  
• Changing the meaning of the event – The implication of a lawsuit is that we have made a mistake and therefore are incompetent or careless. We can counter such feelings by looking objectively at the successes in our clinical work and personal lives and by seeking to achieve an objective view of the incident in question.

Please see the Stress Assessment Checklist.