Even the best doctors make mistakes; even the best care can result in an adverse outcome; sometimes nature wins despite our best efforts. In this blog, we will explore the intricate links between medical malpractice litigation, physician burnout, mental illness, and suicide. Understanding these connections is crucial for developing comprehensive support systems and interventions that promote the well-being of healthcare professionals.
Medical malpractice litigation is a complex and distressing reality for physicians, with potential far-reaching consequences for their mental health and overall well-being.
The fear of facing a medical malpractice lawsuit, coupled with the emotional toll of litigation, can contribute to increased stress, burnout, and even mental illness among healthcare professionals.
Tragically, some physicians may feel so overwhelmed by the burden of malpractice claims and the fear of professional consequences, leading to an elevated risk of suicide.
Humans make mistakes. Yet when doctors make mistakes, they're publicly shamed in court, on TV and in newspapers (that live online forever). Many continue to suffer the agony of harming someone else -- unintentionally -- for the rest of our lives." - Pamela Wible, MD
Medical malpractice litigation occurs when healthcare providers are accused of failing to meet the expected standard of care, resulting in patient harm.
The American Medical Association estimates that 31% of physicians will be sued over their careers, or around 2% per year. This varies by specialty, practice state, years of practice, and other factors. In 2021, medical malpractice payouts totaled more than $3.1 billion, representing over 9,000 payment reports, according to data generated from the National Practitioner Data Bank’s Data Analysis Tool.
The legal process can be arduous and emotionally taxing for physicians, regardless of the claim’s outcome. Even when cases are ultimately dismissed or settled in favor of the physician, the experience of litigation can leave lasting psychological scars.
The stress associated with medical malpractice litigation stems from various factors:
The constant fear of being sued for malpractice creates a state of anxiety among physicians.
This fear often leads to defensive medicine practices, where physicians order unnecessary tests or procedures to protect themselves from potential legal action.
The pervasive fear of litigation can impact clinical decision-making and definitely contributes to physician burnout.
Medical malpractice claims can have a profound emotional impact on physicians, particularly when cases involve adverse patient outcomes.
Physicians may experience intense feelings of guilt, shame, and self-doubt, even if they believe they provided the best possible care.
These emotions can lead to feelings of inadequacy and emotional distress.
As we’ve written recently, while not wishing to detract from the suffering of the patient, let us not ignore the suffering of the physician and other involved healthcare staff — what we have termed second victim trauma in medicine.
The stigma surrounding medical errors and malpractice claims can lead to physicians feeling isolated and unsupported. We are not great at communicating vulnerability, failure (or even perceived failure), or indeed many emotions with our colleagues.
The fear of judgment from peers, colleagues, and patients can deter physicians from seeking help or discussing their experiences, which can further exacerbate mental health challenges.
Physician burnout is a complex and multifaceted phenomenon resulting from chronic workplace stress. Medical malpractice litigation is one of the stressors that significantly contribute to burnout among healthcare professionals:
The fear of litigation can lead physicians to practice defensive medicine, which involves ordering unnecessary tests and procedures to avoid potential lawsuits. These practices can increase physicians’ workload and time pressure, as they try to protect themselves from malpractice claims. The resultant heightened stress and exhaustion contribute to burnout.
The emotional toll of medical malpractice litigation can lead to emotional exhaustion, a core component of burnout. Physicians may feel emotionally drained as they navigate the legal process and cope with the psychological impact of the claims.
Experiencing a malpractice claim can undermine physicians’ sense of professional accomplishment and satisfaction. The process of litigation can erode physicians’ confidence and pride in their work, further contributing to feelings of burnout.
The ongoing stress and emotional distress associated with medical malpractice litigation can increase the risk of mental illness among physicians:
Physicians involved in malpractice claims are at a heightened risk of experiencing symptoms of anxiety and depression. The fear of facing legal consequences and the uncertainty surrounding the outcome of the claim can create a persistent state of worry and distress.
For physicians who experience adverse patient outcomes leading to malpractice claims, the psychological impact can resemble symptoms of PTSD. Flashbacks, intrusive thoughts, and hypervigilance related to the claim can disrupt daily functioning and exacerbate stress.
Furthermore, “Medical Malpractice Stress Syndrome” (MMSS) has been unofficially coined as a form of PTSD resulting from malpractice litigation.
The stress of medical malpractice litigation can lead some physicians to resort to maladaptive coping mechanisms, such as substance abuse. Self-medicating with alcohol or drugs may temporarily alleviate stress but can exacerbate mental health challenges.
A 2020 study of suicide risk factors published in JAMA Surgery revealed that civil legal problems increase suicide risk by 61% in surgeons and 80% in non-surgeons.
Undoubtedly the most alarming and devastating consequence of medical malpractice litigation is the increased risk of physician suicide.
As physicians, our suicide rate is around double that of the general population. The reasons are complex and explored in previous articles.
For many physicians, medicine is more than just a job; it is a fundamental part of their identity.
Medical malpractice litigation can shatter this professional identity leaving physicians feeling lost and questioning their purpose, further contributing to suicidal ideation.
Physicians experiencing malpractice claims are at a higher risk of suicide compared to the general population.
A 2020 study of suicide risk factors published in JAMA Surgery revealed that civil legal problems increase suicide risk by 61% (1.61 odds ratio) in surgeons and 80% in non-surgeons. In comparison, suicide risk increased with physical health problems (1.40 odds ratio), and treatment for mental illness (1.45 odds ratio).
The fear of potential career consequences, coupled with feelings of shame and despair, can lead to a sense of hopelessness and thoughts of suicide.
The stress of medical malpractice processes — which may also affect licensing and credentialing if found against the physician — is strongly linked to mental illness.
The resulting problem is two-fold: Firstly, physicians are fearful of disclosing mental illness diagnoses or treatment. In many US states, a psychiatric history can be discovered during litigation and then held against the physician — with lawyers arguing, in effect, that the doctor was mentally ill and unable to do their job. Secondly, untreated mental illness is a risk factor for suicide.
Mental illness is common. We should all have access to treatment. Untreated mental illness makes us more likely to make errors, therefore treatment should be easy and encouraged.
Yet the current legal system in the US creates barriers for doctors getting help, a fundamental human right.
This has got to change for the welfare of physicians, patients, and healthcare systems.
Mental illness is common. We should all have access to treatment. Untreated mental illness makes us more likely to make errors, therefore treatment should be easy and encouraged. Yet the current legal system in the US creates barriers for doctors getting help, a fundamental human right.
Addressing the mental health challenges resulting from medical malpractice litigation requires a multifaceted approach:
1. Peer Support and Counseling
Peer support programs that allow physicians to connect with colleagues who have experienced similar challenges can be invaluable. Professional counseling services can provide physicians with a safe space to discuss their experiences and emotions openly.
2. Legal Assistance
Providing physicians with access to legal representation during malpractice claims can alleviate some of the stress associated with the litigation process. This support can help physicians navigate the legal challenges and protect their human rights.
3. Promote a Culture of Psychological Safety
Creating a culture that encourages open communication, destigmatizes mental health challenges, and supports physicians during difficult times is vital. Encouraging discussions about mental health and the impact of malpractice litigation can facilitate early intervention and support.
4. Comprehensive Well-Being Programs
Healthcare organizations should invest in comprehensive well-being programs that prioritize physician mental health. These programs can include stress reduction workshops, resilience training, and resources for coping with the emotional toll of medical malpractice litigation.
5. Tort reform
While beyond the scope of this article, only cases where there is medical validity to the claim should make it to court. Spurious claims should be blocked and even discouraged using economic and other means. Consideration of damage limitation or third-party no-blame insurance schemes may help reduce the litigation pressure on physicians, and improve their well-being.
Medical malpractice litigation is a common (31% of a lifetime) and challenging aspect of the healthcare profession, with significant implications for physician well-being.
The fear of facing malpractice claims, emotional toll of litigation, and potential impact on career and reputation create a perfect storm that contributes to burnout, mental illness, and even suicide among physicians.
The current US malpractice system creates barriers to physicians getting their own mental health support which further increases our suicide risk during the awful stress of litigation.
It is imperative for healthcare organizations, medical societies, and policymakers to recognize the links between medical malpractice litigation and physician well-being and implement comprehensive support systems and interventions.
By prioritizing physician mental health and fostering a culture of empathy and psychological safety, we can better protect the well-being of our healthcare professionals and, in turn, ensure the delivery of high-quality patient care.
