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
Sara Charles, M.D.: The stress that often accompanies malpractice suits
can disrupt the personal and professional lives of physician defendants in a
number of ways.
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
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
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
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
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