Litigation and Stress Part 1

Litigation and Stress Part 1

Mel Herbert MD and Gita Pensa MD

 Take Home Points

• Litigation can have a significant impact on your life.
• Physicians may become depressed or suicidal.
• Finding joy in something and taking each day as it comes can help.

• Pensa is an emergency physician and got sued. They wanted $30 million dollars. The patient was a young patient with a bad outcome.
• We work really hard every day and we have made so many sacrifices to get to where we are. Pensa is an expert in litigation stress.
• Pensa works in a community hospital and is affiliated with the Brown University emergency medicine program.
• She won the case but it was Pyrrhic victory. She was wrecked by the process.
• Litigation turns into a long and draining process. You start to feel that it is just so unfair in so many ways. Everything you have done that is good is forgotten and so much attention is placed on one case with the plaintiff’s efforts to make the worst of you. You are frequently receiving negative communications through the year. You need to be prepared for it. It is really painful. We tend to be perfectionists and work so hard. We give a lot to our patients in the pursuit of this honorable calling and then they shoot it to shit.
• It is hard for people outside medicine to understand how much of who you are is tied up in being a physician. It is difficult to view it as the cost of doing business or about money. For most of us, it is not about money.
• Physicians may become acutely suicidal during this process. Although Pensa was not suicidal, she was the closest to truly falling apart in her life. She is married to a physician who was supportive of the process and she could talk to him. She also went to her doctor. She went from a person who never took medications to taking five medications on a daily basis just to stay upright. She took Prilosec, Zantac, Imodium, propanolol and lorazepam.
• She couldn’t sleep. It was rough.
• How do you get back on the horse? It was a long process. The biggest step was showing up and coming back to work. She was close to quitting medicine.
• When she started seeing patients again, she realized she could do it. She didn’t love it. Her husband encouraged her to not leave medicine; that it would be a waste and let them win. She kept putting one foot in front of the other and tried to avoid ordering a bajillion tests on patients. She kept at it. She felt unmoored. There was no meaning or joy.
• Then something fortuitous happened. Her group was acquired and she had to do teaching in an academic program. She loved it. She didn’t want to be miserable. She made a conscious effort to look for the good in her interactions. Not all of the patients were out to get her. Patients have a need and we have skills.
• Then they decided to re-litigate the case. This has been ongoing for twelve years. The second time around, she gave herself permission to care for herself.
• We don’t always do this. We are busy. We work our shifts. We have families. Sometimes we let the self-care go. She gave herself permission to do things that she would like to do. There is a non-profit in Rhode Island called Dancing with the Doctors. A colleague had done it and encouraged her to do it. The gala of the event was two days before the start of the trial. Maybe this was thing that would keep her mind off the trial.
• It realigned her personality and focused her on something other than medicine and the trial.
• Now Pensa is helping others. She is creating a podcast about litigation stress. She is a wounded healer.

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