FIG1 While many physicians are aware of the legal implications of being sued for medical malpractice, they are often unprepared for the emotional distress associated with such suits.

Few people know this better than Sara Charles, M.D. As a psychiatrist in private practice in Chicago in the mid-1970s, she was named in a malpractice suit and since that time has dedicated a substantial amount of her work time to helping physicians cope with the emotional turmoil that can result from being sued for malpractice.

When Charles was sued for malpractice in 1975 over the attempted suicide of one of her patients, she told Psychiatric News, "I was outraged, because I felt I had provided good care for this patient." She also felt that she was alone in her predicament, she said.

It was not until she consulted the Cook County Jury Verdict Reporter, a publication that included a list of the claims, names, and trial information of all civil litigation in the Chicago area, that Charles realized she was not alone.

"I found the names of a number of physicians I'd been working with on a daily basis" who had been sued for malpractice, "yet no one talked openly about it," she noted.

According to Charles, it took five years from the time she received notification that she was being sued to the time she went to trial—a lengthy period of emotional ups and downs for her. Once she went to trial, a jury ruled in her favor after 30 minutes of deliberation.

In the mid-1980s, Charles decided to investigate one aspect of malpractice litigation that was seldom discussed, much less studied—the emotional impact of malpractice litigation on physicians.

In 1985 she surveyed a random sample of 346 physicians in different specialties who were members of the Chicago Medical Society. Her findings were published in the April 1985 American Journal of Psychiatry.

Charles found that 56 percent of the sample, or 194 physicians, reported that they had been sued for malpractice during the course of their careers.

In one survey section, physicians who had been sued for malpractice or were threatened with a malpractice suit were asked if several emotional symptoms related to the case were present and, if so, to rate their severity.

When she compared the two groups, Charles found that many more of the physicians who had been sued for malpractice experienced anger than physicians who had never been sued (86 percent versus 46 percent).

In addition, 79 percent of the physicians who had been sued said they experienced depressed mood, compared with only 50 percent of those who had never been sued. In addition, sued respondents experienced these feelings to a greater degree than the respondents who were not sued.

Symptoms such as insomnia, irritability, and frustration were also more common among the sued physicians.

In addition to researching the topic, Charles began evaluating, and sometimes treating, physicians who had been sued for malpractice and helping them cope with the emotions they were experiencing.FIG2

Among the problems commonly experienced by physician malpractice defendants are disruptions in personal and professional relationships due to stress over the lawsuits, she noted.

Some physicians may stop performing a certain medical procedure "for fear that it is too risky," she said, and some may lose their confidence and stop practicing altogether. Others may cope with the stress by drinking alcohol or self-medicating.

Since unchecked emotional distress can evolve into depression and anxiety disorders, "Physicians should monitor their symptoms as much as possible and seek treatment when necessary."

Charles is the co-author of the book Adverse Events, Stress, and Litigation: A Physician's Guide with Paul Frisch, J.D., an attorney. The book, published by Oxford University Press earlier this year, discusses the emotions often experienced by physicians who have been sued and includes comments from these physicians about their experiences.

Charles, along with an advisory group, recently established the Physician Litigation Stress Resource Center, which is an online guide for physicians facing malpractice litigation.

The site directs clinicians to articles, books, and Web sites that address the emotional aspects of malpractice litigation. In addition, it includes strategies for coping with litigation-related stress.

Charles said that if physicians can anticipate the range of emotions they may experience during the months or even years leading up to a trial—shock, intense anger, and dread, for instance—"that gives them some sense of mastery over the experience."

She pointed out that physicians involved in malpractice litigation—just as they would when hit by any traumatic event—need emotional support. However, their attorneys often advise them not to speak with anyone about their case.

Said Charles, "There are ways to respect this legal admonition while still giving yourself the opportunity to talk about the emotional experience of being sued" with friends, family, or a colleague.

It can also be helpful for physicians to see the lawsuit in its proper context, Charles suggested.

"Being sued for malpractice implies that you are incompetent or a bad doctor," she said, but it can be helpful to realize that the U.S. legal system in which malpractice suits are filed is about "compensation, not competence."

She also pointed out that those who are sued "are often the best at working with the sick and high-risk patients," and most are eventually exonerated (see box).

Psychiatrists, she added, "are in a unique position to assist their colleagues from other specialties who may be experiencing emotional distress due to malpractice."

The Physician Litigation Stress Resource Center can be accessed online at<www.physicianlitigationstress.org>.▪