Litigation Culture Causing Burnout in Physicians

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A Harvard report found that doctor burnout has become a public health crisis. They define doctor burnout as “a state in which doctors lose satisfaction and the feeling of effectiveness in their work”.

This condition is linked to higher rates of depression and other mental health problems. It is estimated that 300 to 400 doctors commit suicide each year, with this group having a higher suicide rate than any other profession. A variety of factors, including long hours of work, contribute to this epidemic. A more recently recognized problem is malpractice litigation.

Eliza (name changed to protect anonymity), a Canada-trained family doctor practicing in the United States, spoke to the Trauma and Mental Health Report (TMHR) about the unexpected challenges she faces in her career:

“Here in the US, I often spend more time jotting down notes about the appointment than I do about the appointment itself. If I don’t, the insurance companies won’t pay our bills. We work for hospitals and other health practices that operate as businesses. They are always concerned about their bottom line, and this means that we must bear the heavy burden that comes with it. If a patient has concerns in the middle of the night in Canada, they go to the emergency room. In the US, you can call me at 3 a.m. It is a constant burden to be on duty 24 hours a day and it makes us constantly stressed and overworked, which ultimately leads to burnout. “

A male doctor wearing scrubs, hairnet and mask sits with folded hands and looks down.

Eliza also commented on fear of misconduct lawsuit:

“I find that a lot of my time is spent ordering additional and often unnecessary tests because we need to be wary of lawsuits and protect ourselves. The constant threat of being sued definitely hangs over your head and affects not only your ability to practice your career but your personal life as well. “

The term Medical Malpractice Stress Syndrome (MMSS) was unofficially coined as a form of PTSD resulting from a lawsuit or the risk of lawsuit. According to KevinMD, a blog platform for doctors:

“After a lawsuit, doctors report feelings of isolation, negative self-image, anxiety, depression, self-doubt, anger and difficulty concentrating. Physical symptoms can either include the development of a new medical disease or the worsening of an existing condition such as high blood pressure, coronary artery disease, or diabetes. “

The American Medical Association reports that one in three physicians has filed a medical misconduct lawsuit against them during their career. Almost half of the doctors aged 55 and over state that they have been sued. And one report found the doctors most likely to be sued are surgeons and obstetrician-gynecologists. This is not surprising as such specialties often deal with complicated and dangerous cases.

A hand signing a name on the signature line of a legal document.

This contentious culture is particularly prevalent in the United States. In other countries like Canada and the UK, it is unusual and difficult to sue doctors for misconduct. Patients must prove that injuries or illnesses were caused directly by the doctor. In the US, the bar to be sued is lower. The Medscape Malpractice Report found that the main causes of complaints were failure of diagnosis, delay in diagnosis, and complications in treatment. Although 68% of lawsuits are dropped or dismissed at some point, these cases are time consuming and have financial and emotional costs.

Nick (name changed), a Michigan physical medicine and rehabilitation doctor, told the TMHR that it can be daunting for doctors entering the field:

“We dream of being able to help people. It’s daunting when you’re constantly nervous and fear that your patients will sue you. It is hurtful to be sued for trying to help your patient as best you can. We are in a job where we often see people who have gone too far and cannot be saved. Sometimes procedures are risky and don’t always work. Losing patients already takes an emotional toll. In addition, it is very difficult to process these complicated feelings when one is accused by the patient or the family. “

There are some organizations and communities that help doctors dealing with burnout or MMSS. It is recommended that clinicians remember their past successes and achievements, allow time for non-medical activities, and consult with peers and mental health professionals.

-Safa Warsi, contributing writer

Feature: Scott Graham at Unsplash, Creative Commons
First: Jonathan Borba at Unsplash, Creative Commons
Second: Pixabay at Pexels, Creative Commons

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