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AAOS Now

Published 4/1/2008
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John D. Kelly IV, MD

Coping with malpractice stress

How to come back from a crisis in confidence

Even the best and most innocent orthopaedic surgeons have been the targets of medical liability litigation that can result in anguish, a loss of self-esteem, a fear of treating future patients, and a shift to seeing each patient as a potential litigant. Coping with these feelings isn’t easy, but it is possible. My personal story may provide an example and roadmap for others.

The surgery was successful—and so was the suit
Approximately 10 years ago, I performed an anterior cruciate ligament reconstruction on an anxious young man. The surgery went splendidly, and the only postoperative complication was hiccups, which were successfully treated before the patient was discharged.

Later that day, however, the patient called and reported that the hiccups had returned. I called in a prescription for the same medication he’d been given in the hospital, but that evening, the patient called again. At this point, I recommended that he report to the emergency department. He refused and begged for an additional prescription. After consulting a pharmacology reference, I agreed, provided that the patient adhere to the prescription.

Fortunately, the hiccups dissipated but the patient awoke the next day with priapism, the medical term for a sustained erection. He did not seek immediate medical attention and ultimately underwent a successful ‘decompression’ one week later. Claiming ‘sexual dysfunction,’ he sued me for calling in the second prescription. At the advice of my institution’s attorneys, we settled out-of-court for more than $3 million total (myself and the pharmacy that filled the prescription).

This bombshell sent me into a real emotional tailspin. I had spent my life trying to do the right thing, and I was overcome with guilt, rejection, and remorse. I felt betrayed by the patient and by the system. I became depressed and was unable to sleep. I withdrew from my family and friends. I approached every patient and surgery with a heightened sense of excessive carefulness and obsession with detail.

Coming back from the brink
My recovery began when I realized that I had a problem. I sought help and returned to the fundamentals of self-nurturance and well-being.

Whether you realize it or not, malpractice stress affects your loved ones. I did not realize the contagion of stress I had spread to my family. A rich family life, especially a sound marriage, is central to the ability to bounce back from a crisis. After taking inventory of the impact the suit had on my marriage, I took steps to promote intimacy with my wife. I made my marriage a priority and rekindled the closeness we shared.

I discussed the case with my children and told them of the stressors that I had been feeling. I found that honest disclosure saved me the energy from living the lie that ‘everything is OK.’ Your loved ones will embrace and support you if you are truthful.

I prayed and received solace in feeling that a loving presence was with me. I looked for the ‘gift’ in my distress and found a heightened empathy for others experiencing malpractice stress.

Turning stress into strength
Just as a stressful time can make or break a relationship, so too can malpractice strife cause one to become broken and cynical or better and stronger. I slowly recognized that I was wasting energy on things over which I had no control. I couldn’t prevent frivolous suits being levied, I couldn’t avert every surgical ‘adverse event,’ nor could I control the whims of a jury. I could, however, control my behavior, act on my values, and not feel like I was at the mercy of the judicial system.

I derived confidence in knowing that the one thing the world could never take away from me was my sense of honor and values. I resolved never to compromise my integrity.

I realized that I needed to take better care of myself. I couldn’t give to my family and my patients what I didn’t have. I made sleep a priority and realized that regular workouts greatly increased my productivity. I sought wisdom daily by reading scripture and tried to spend some quiet time every day in prayer. I ate properly, limited sugar, and found my energy level slowly rising.

I endeavored to look at each patient as someone who was essentially good and needed help. Any obnoxious or offensive behaviors patients demonstrate are essentially reactions to pain, stress, or internal strife. By focusing on what we can do instead of judging them, we surround ourselves with positive energy. We can help patients and lessen their suffering.

Friends and colleagues
Throughout my ordeal, I was blessed with friends with whom I communicated regularly. The gift of friendship truly nourishes resiliency. Two of my partners were helpful in preparing me for the trial and in reassuring me that I was still a good doctor. A nonmedical friend provided insight and perspective. Don’t neglect the caring connection that friendships provide.

The AAOS is also a resource. In response to member needs, the AAOS has spearheaded several efforts to enact medical liability reform. More importantly, it has assembled and trained a cadre of experienced orthopaedists who have been through malpractice proceedings and can help ease your burden. This network of counselors assures us that we are not alone, but are all in this together. They know that a lawsuit does not reflect on your abilities as a surgeon, and that the sun will shine tomorrow.

A medical liability lawsuit need not be a disaster. In my case, it resulted in strengthening my marriage, my values, my faith, my self-awareness, and my empathy for others. It gave me the desire to share with others possible paths to recovery. I sincerely hope that if you are beset with the scourge of malpractice, you allow the AAOS to help. Use the peer counseling service, and let the healing begin. We have many more patients who need us!

John D. Kelly IV, MD, is a member of the AAOS peer counseling service. He can be reached at johndkellyiv@aol.com

The ABCs of positive thinking
Focusing on what is good and useful cultivates resiliency. But before we can focus on the good, we need to neutralize negative thinking. I found that taking a step back and practicing a cognitive restructuring approach to negative ‘voices’ was helpful—what I called the ‘ABCDE’ approach.

A—Accept the ‘voice’ of self reproach. Don’t fight it or you will give it more energy. What you resist persists.

B—Break away from your thoughts and watch them from a distance. Look at your thoughts as an impartial spectator and realize that you are not your thoughts. When you are anxious or depressed, do not believe what your mind tells you.

C—Connect to your higher power and sense of values. Look inward for guidance so that you may…

D—Do what you need to do according to your values, whether you feel like it or not. Treat patients kindly, tell the truth, and forgive. These behaviors and choices will sustain you. Positive actions and emotions spread like wildfire.

E—Embrace the truth about yourself and recognize that beating yourself up with criticism will do nothing to help you serve your next patient.