A patient is accusing you of bodily harm—and already has an attorney on retainer. Your blood pressure is elevated and you are hesitant to share this problem with colleagues or family members. “I’ll just put my head down, concentrate on my work, and I can tough this out alone, ” you tell yourself.
This, says, Dr. John Kelly IV, Associate Professor of Clinical Orthopaedic Surgery at the University of Pennsylvania, is an enormous, common mistake. His resounding, often unheard message? “You are not in this alone…lawsuits are common for orthopedists…and there is help.”
Dr. Kelly describes how he became a champion of peer support for orthopedists undergoing a lawsuit: “When I served on the AAOS [American Academy of Orthopaedic Surgeons] Board of Councilors several of us got together and discussed what it was like to go through a lawsuit, and how alone you feel. I proposed the idea of a peer counseling service, we signed on 12 volunteers, and secured funding from AAOS. Wayne Sotile, Ph.D., who is with the Department of Orthopaedics at Tulane University, and is a consultant regarding physicians and resiliency, advised us as to how we could help our fellow orthopedists.”
Digging into the emotional fundamentals of a lawsuit, Dr. Kelly states,
It is hurtful when a patient turns on you. We are human…we take it personally. You begin doubting yourself, start to look at patients as adversaries, and often develop the symptoms of post traumatic stress disorder. You may get paralyzed with fear, and may even hang up your OR privileges.
“I have a friend who was sued and ended up quitting surgery. He said the experience robbed him of his dignity because the patient was saying things that were not true.”
Walking the walk, Dr. Kelly is open when it comes to his experience with lawsuits. “I had a patient who developed a sexual dysfunction after surgery, but he didn’t take his prescription as directed. His lawyer sent a letter to my wife saying her assets were in danger; this on top of the fact that I had just lost my father. After years of training and experience to have to stand before a jury like a criminal and have people make you feel like you are Charles Manson—it’s a traumatic experience.”
Given the frequency of lawsuits and the psychological damage they can cause, one would think that Dr. Kelly’s peer counseling appointment book would have few openings. But alas, says Dr. Kelly, it is nearly blank. “Despite our attempts to publicize this program, not many orthopedists reach out to us for assistance. After lectures on this topic sometimes people will approach me and say, ‘May I call you?’ This underuse of our program must be because these physicians are ashamed to be in this difficult situation. When someone does call me I am very open, even revealing that I took antidepressant medications for awhile. I am hoping for a shift in thinking because we all need some help getting through the sleepless nights that inevitably come with being sued.”
“Approximately 50% of orthopedists are sued during our careers. Where I am, however, Philadelphia, most orthopedists are sued at least twice. I have partners who have been sued 20 times. With regard to my own situation, I couldn’t help but think, ‘Here I received the patient relations award in medical school and other awards for communication…and I’m being sued by people I have never even met…my name was just on a chart.’ I saw that being sued was either going to make me cynical or it was going to make me better. I took a deep breath and strengthened my commitment to being the best doctor I could be. I was not going to let the lawyers get to me.”
One thing Dr. Kelly learned during his own lawsuit experiences was that not discussing things with one’s spouse aggravates the situation. “Most orthopedists want to shield their loved ones from the pain so they withdraw and get more distant. But with less connection and more stress there is more irritability and strife in one’s relationships. I isolated myself at first and it strained the relationship with my wife. Most recently when I was sued, however, we were sending text messages back and forth during the day—her support turned out to be invaluable.”
Dr. Frank Kelly, a practicing orthopedist for over 30 years, has served as Chair of the AAOS Communications Cabinet. He states, “When ‘the other Dr. Kelly’ raised this issue several years ago I began to contact academic chairs and learned that there was no program to address the issue of handling lawsuits. There was the occasional course lecture dealing with stress, but overall we didn’t find much out there.”
Now, with several years of helping peers under his belt, what does he routinely tell them?
I let them know that the number one mistake they can make is to not be open with family and colleagues. I understand that it is difficult…and we’re embarrassed and think that we have let people down. But we need to get better at opening up.
So how do you know when to seek help? “Many times people aren’t aware of the changes they are undergoing as a result of a lawsuit. Signs of depression begin to emerge…there is a change in your personality, including a withdrawal from one’s social life. One of the more common symptoms I’ve seen is that people begin to drink more alcohol than usual, or even begin to use drugs. They are looking for something to help them get through the day. What I want my colleagues to realize is that it’s not something that can really make a difference during this time…it’s someone.”
It’s pretty basic and we’ve heard it before…it feels good to know you’re not alone. Dr. Kelly: “Open up to someone who has been through this experience and you will be surprised at the positive feelings you will experience. You will see that in fact your identity as a physician can be restored, and that you don’t have to feel worthless because you are still a good doctor and a good human being.”
Dr. Kelly also advises, “Make sure that you feel comfortable with your attorney because this is a long drawn out process. Also, your spouse and children need to know that if you’re in a bad mood or not paying attention to them, that it is not because of them. Lastly, try to maintain a combination of a decent diet and regular exercise. Doing so will help eliminate mental cobwebs so that you can think clearly.”
But what if the orthopedist being sued wasn’t performing his or her best that day and did make a mistake? Dr. Kelly says, “Everyone deserves empathy. These things happen and we all make mistakes at some point.”
Wayne Sotile, Ph.D. is author of The Resilient Physician, and has worked with individual orthopedists, their spouses, and with orthopedic groups concerned about the impact of the medical malpractice stress. He has also worked with malpractice insurance carriers and with both AOA (American Orthopaedic Association) and AAOS, to develop resources for helping surgeons cope with this process. Dr. Sotile notes, “I encourage surgeons to be realistic and discerning regarding what coping strategies will be adaptive (i.e., will yield positive outcomes) versus maladaptive (i.e., will lead to negative outcomes).”
The most frequent maladaptive coping strategies I see are allowing the distress of being named in a malpractice suit to fuel urgency, shame, or obsessive-compulsive coping. I encourage surgeons to accept that no amount of urgency on their part will change the typically slow pace of a lawsuit.
Surrounded by a maelstrom of emotions, says Dr. Sotile, one should seek shelter in the solace of relationships. “It is common to feel a combination of fear, outrage, embarrassment, anxiety, and, sometimes, regret. If you cloak such emotions with a shroud of withdrawal or anger, they will fester into shame. The adaptive solution is to find appropriate, supportive relationships where you can freely express these various emotions; you should also deploy adaptive self-soothing coping strategies.”
Kenn W. Kiser/morgueFile
And, states Dr. Sotile, failing to handle the stress properly can result in obsessive rumination about worst-case scenarios, and can fuel compulsive attempts to ‘cover one’s tracks.’ “Physicians may alter clinical practice patterns, becoming obsessively attuned to details, refusing to treat challenging cases, documenting excessively, and changing the way they communicate with patients.”
While Dr. Sotile isn’t necessarily recommending a Buddhist retreat in the Himalayas, he is a strong advocate of being in the moment. “The antidote to preoccupying anxiety is mindfulness. Most orthopedic surgeons love practicing their profession, and are happiest when they are fully present and mindfully engaged in what they are doing. Resist the tendency to dissociate from interactions with your patients and colleagues (i.e., ‘observing’ yourself interacting, rather than being engaged in the interaction).”
On the all important support front, Dr. Sotile says, “While asking for support from colleagues may sound like heresy to a competitive surgeon, it works far more often than not. Having the self-confidence to admit when you are vulnerable tends to do two things: it deepens others’ respect for you, and it begets support from others who will help you to cope.”
When you find some quiet moments, recommends Dr. Sotile, take a broad view. “Develop philosophies that help you make sense of this experience. Remind yourself that yours is a high-risk profession, and that there are no perfect surgeons, patients or patient families. However, yours is also a noble profession. And, far and away, the majority of patients and family members of patients appreciate what you do for them.”
The refrain of Drs. Kelly? In the end, the sun will rise tomorrow.
For more information, please contact: Dr. Frank Kelly at fkelly@fs-ortho.com; Dr. John Kelly at johndkellyiv@aol.com; or Dr. Wayne Sotile at wsotile@attglobal.net.
