Managing the Stress of Medico Legal Matters

A complaint or claim against a medical practitioner causes emotional and physical stress, regardless of the outcome. It is not uncommon for medical practitioners to experience a range of differing emotions as a medico-legal matter proceeds. Symptoms may last for only a short period, recur with each step in the process or persist throughout the entire medico-legal process.

Reactions after an adverse event, complaint or claim include:

• distress
• anger
• fear
• guilt
• depressed mood
• loss of confidence
• feeling ashamed
• insomnia and nightmares
• loss of reputation
• wanting to give up medicine.^1,2

An Australian study found that GPs with a current medico-legal matter reported increased levels of disability in work, social or family life, as well as higher prevalence of psychiatric morbidity, compared to those GPs with no current matter.³ GPs with a history of past medico-legal matters reported increased levels of disability and depression sub-scores. Male GPs with a current or past medico-legal matter had significantly higher levels of alcohol use than GPs with no experience of medico-legal matters.

Further research has shown that medical practitioners who were the subject of a medical negligence claim described the following reactions:

• 96% acknowledged an emotional reaction for at least a limited period of time
• 39% experienced depression, including symptoms such as depressed mood, insomnia, loss of appetite and loss of energy
• 20% experienced anger, accompanied by feelings such as frustration, inability to concentrate, irritability and insomnia
• 16% described the onset or exacerbation of a previously diagnosed physical illness
• 2% engaged in excessive alcohol consumption
• 2% experienced feelings of suicidal ideation.⁴

Coping strategies

The ability to cope with stress is highly individual and medical practitioners need to reflect on their own means of coping. There are a number of strategies medical practitioners can use to deal with the stressful nature of a complaint or claim. Effective coping responses include both problem solving and emotionally-focused coping. Practitioners need to learn to switch, when appropriate, between coping responses. Difficulty can arise if medical practitioners try to apply the wrong response in a given situation, for example, trying to solve an unsolvable problem.

One of the first steps in coping is to obtain sufficient information about the process in which the medical practitioner is now a participant, albeit an unwilling one. MDA National’s Claims and Advisory Services team can provide detailed information about the particular medico-legal process in which a Member is involved.

Additionally, medical practitioners need to understand what can be expected psychologically and also observe their emotional and physical reactions throughout the process. Members should consult their GP if any symptoms develop, e.g. depression, physical illness or substance abuse. Self-medication should be avoided, even if faced with the common symptom of insomnia.

For most medical practitioners, a feeling of being “out of control” pervades the onset of a complaint or claim process. Medical practitioners may feel like they are on a rollercoaster ride, with alternating feelings of confidence and loss of self-esteem, of assurance and self-doubt. Regaining a sense of mastery and control is important.

Medical practitioners often have difficulty identifying their strengths, but are well practised in identifying their weaknesses. By identifying strengths, medical practitioners are in a position to develop them, and to look at shaping their life and working to feed those strengths. Engaging in activities that make the practitioner feel in better control of their personal and professional lives will assist in restoring a sense of balance (see Table 1).

Table 1 – Strategies for coping with complaints and claims⁵

Social support

• Discuss your feelings with a trusted person – a colleague, family member, friend, GP and/or your claims manager.

Restore mastery and self-esteem

• Ask your claims manager to describe each step of the medico-legal process.
• Clarify the anticipated length of time required to conclude the matter.
• Take an active role in the preparation of the case, including participating in the choice of any medical experts.
• Put aside the necessary time to deal with the case.
• Prepare yourself for the unpredictability of the process.
• Identify areas of your practice that cause anxiety or feelings of “loss of control” and find ways to diminish them.
• Engage in activities that increase your sense of competence, e.g. teaching, CPD activities.
• Review the amount of time spent on professional and family activities, and make appropriate changes.
• Participate regularly in physical and other leisure activities.

Change the meaning of the event

• Review your career objectively and reinforce your sense of competence.
• Seek the advice of trusted family members, colleagues, friends and professionals about your feelings and the progress of the case.

Barriers to seeking support

Medical practitioners describe a number of barriers to seeking help:

• lack of time (89%)
• uncertainty or difficulty with access (69%)
• concerns about lack of confidentiality (68%)
• negative impact on career (68%)
• stigma (62%).⁶

How we can help

When dealing with a medico-legal issue, MDA National’s aim is to obtain the best possible outcome for our Member. Unless the Member is well and able to cope with the process, the best result for that Member cannot be achieved. Therefore, providing support is an integral part of MDA National’s role. Our Claims and Advisory Services staff have extensive experience in supporting Members throughout the course of a complaint, claim or other medico-legal process.

Every Member has individual needs, depending on their personality and the nature of the matter they are dealing with. Some Members find it relatively easy to implement strategies to cope with the stressful nature of the process, while others may be reluctant or unable to obtain the support they need.

To ensure that our Members are provided with an appropriate level of support when dealing with a medico-legal issue, we have two additional support programs:

Doctors for Doctors Program

• This program aims to provide understanding and support by enabling the Member to share their experience with another doctor during the course of a medico-legal matter.
• The claims manager will discuss the program with the Member and provide a prompt referral if the Member would like to use this service at any stage during the case.
• The program complements the role of the claims manager and offers the Member additional support from a colleague throughout a medico-legal matter.

Professional Support Service

• This service aims to provide a Member with direct access to an independent psychiatrist who can provide professional support during the course of a medico-legal matter.
• The service is completely confidential and details of any discussions between the psychiatrist and Member will not be disclosed to MDA National.
• MDA National covers the cost of up to 10 consultations per Membership year.

If you are faced with a complaint or claim, please take the opportunity to discuss these additional support programs with your claims manager. We are here to assist, advise and support you throughout the process, to ensure that the best possible result is achieved for you.

Sources of further assistance

• Doctors’ Health Advisory Service (DHAS):
  -  ACT 0407 265 414
  -  NSW 02 9437 6552
  -  NT call the NSW DHAS hotline
  -  QLD 07 3833 4352
  -  SA 08 8366 0250
  -  VIC 03 9495 6011
  -  WA 08 9321 3098
• Australian Medical Association Peer Support Service: TAS and VIC call 1300 853 338
• Employee assistance programs (hospital based employees)
• MDA National Doctors for Doctors Program: 1800 011 255
• beyondblue: call 1300 224 636 or visit beyondblue.org.au/get-support/

Dr Sara Bird
Manager, Medico-legal and Advisory Services
MDA National

References
1. Bark P, Vincent C, Olivieri L, Jones A. Impact of Litigation on Senior Clinicians: Implications for Risk Management. Quality in Health Care 1997;6:7-13.
2. Seys D, Wu A, Van Gerven E, et al. Health Care Professionals as Second Victims after Adverse Events: A Systematic Review. Eval Health Prof 2013;36(2):135-162.
3. Nash L, Daly M, Johnson M, at al. Psychological Morbidity in Australian Doctors Who Have and Have Not Experienced a Medico-legal Matter: cross Sectional Survey. Aust N Z J Psychiatry 2007;41:917–925.
4. Charles SC, Wilbert JR, Kennedy EC. Physicians’ Self Reports of Reactions to Malpractice Litigation. Am J Psychiatry 1984;141:563-565.
5. Charles SC. Coping with a Malpractice Suit. West J Med 2001; 174:55-58.
6. Hu Y, Fix M, Hevelone N, et al. Physicians’ Needs in Coping With Emotional Stressors: The Case for Peer Support. Arch Surg 2011:E1-E6.