Malpractice Experience And Lessons Learned

crispydoc Uncategorized 6 Comments

A reader, Carla, inquired if I might provide some closure to the malpractice lawsuit I've referred to previously (see here and here for the original posts). In addition to wanting to know the ending, there's value in reflecting on where I am now, where I was then, and how I bridged the gap.

Legal Conclusion

The case dragged on for several years. After numerous practice sessions with my attorney, I provided testimony at a pre-trial deposition. Based on the testimony I provided and the facts of the case, the suit was dismissed on the condition that I not counter-sue for defamation.

The formal document dropping the suit listed it as dismissed with prejudice - the language of law remaining malicious and antagonistic to the end.

Legal Lessons Learned

I've since been required to testify in other cases where I was not a defendant, and it has felt significantly less stressful with repeated practice under the tutelage of savvy lawyers.

I can summarize everything I've learned about providing testimony as a doctor in two sentences:

  1. Answer only the question you are asked, as concisely as possible (yes, no, it depends) as if you had to pay a dollar per word.
  2. There is no gold standard reference material; books are out of date the moment they are published, and online resources have not incorporated the most recent developments in the literature.

Everything else is commentary.

Since the time the original case was resolved, I have received a couple of notices that legal action may be pursued in other, unrelated cases. It no longer freaks me out.

I now recognize that it's commonplace prior to the expiration of the statute of limitations for a plaintiff's attorney to file suit against every doctor in the chart and then winnow down the defendants to those most likely to result in a payout and release the rest.

It's an expensive game, but now that I've played a few rounds, I no longer take such legal maneuvers personally, and I don't let them affect my self-esteem.

Lawsuits, like bear markets in investing, need to be part of your expected calculus if you practice medicine.

I used to think "I'm suing you," meant "You harmed me."

Now I know it means "I had a bad outcome regardless of the care you provided, and if I get lucky some of your insurance money could help me pay for the care I need going forward."

Legal action is never personal, it's business.

Cynicism Aborted

I enjoy my patient interactions and feel more hopeful about my role as their advocate, although certain fissures is our very broken health care system (prolonged ED boarding of psychiatric patients awaiting placement to a proper facility, a problem felt by EDs universally) can rob me of some of that hope.

A passion project addressing challenging patients with high rates of ED utilization is playing a small part in stemming the epidemic of controlled substance abuse by standardizing more judicious medication use within the ED.

I combat defeatist thinking by serving on an interdisciplinary committee to provide patients with care guidelines ensuring safe and appropriate treatments tailored to their needs that do not undermine their health.

Compared to before, I feel more engaged with medicine and find myself more inclined to keep up with changes in the literature.

Evolution In Mindset

I still keep the files from the suit in a box in the furthest end of the house away from my regular activities, an attempt to literally and figuratively compartmentalize the feelings associated with being in a lawsuit.

On the rare instances I need to retrieve an unrelated file nearby, I wince reflexively.

At the time of the lawsuit, I was practicing full-time medicine, so (surprise!) a great deal of my sense of self was wrapped up in my identity as a physician.

As I cut back my clinical workload in the ensuing decade, my identity shifted to reflect my reallocation of time.

The analogy of reducing risk by owning a bunch of stocks instead of a single stock comes to mind. As I became a more present husband and father, I bought and held larger shares of those identities, so I was better able to withstand volatility elsewhere.

The result is that both positive and negative fluctuation in self-worth deriving from my physician identity has become less noticeable over time.

When I attended a ceremony to receive an award of appreciation from our hospital foundation a few years ago, I felt grateful for the recognition, but it was out of mind after a couple of days.

Similarly, a grueling shift where I stay after a couple of hours to tuck in my patients is no longer as depleting as it once was because I have so many great things outside of medicine to look forward to after that shift is over:

  • an early morning bicycle ride the next day
  • an upcoming game night with friends
  • a delicious home-cooked lunch with my wife
  • an intellectually satisfying book or a long-form article in the New Yorker to read
  • a concept for a blog post I'm excited to articulate
  • avocados to pick from the tree with my son
  • witnessing concepts of energy my daughter learned in the abstract at school solidify in her mind as we tour home efficiencies like insulation surrounding window sills and  heating ducts

Obviously this lifestyle is a product of many cumulative course corrections undertaken over a long period of time. Reducing my clinical burden, redistributing my time in accordance with values, and improving my wealth-building behaviors and fiscal discipline have reduced my reliance on income derived from work.

I wake up at sunrise on my days off, which are most days, bursting with energy and ideas on how I want to spend my time before the kids return from school.

There is life after a malpractice lawsuit.

Diversification of identity has been a key to reducing my dependence on medicine for self-esteem.

Thanks, Carla, for reminding me to write the conclusion to an otherwise upsetting chapter in any physician's career.

Comments 6

  1. Thanks for sharing CD.

    Like ones salary, this is something that few physicians discuss because of the stigma associated with it.

    The very name, malpractice, connotes you did something bad when most of the time you did not. But it is because of it that you don’t want to advertise to your colleagues that you are in one and thus cut off a great support system from the get go.

    Glad it went well with you and I love the diversification of identity concept.

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  2. Great post CD.

    Like Xrayvsn, I also love the concept of diversification of identity. Unfortunately, after practicing primary care pediatrics for almost 20 years it is one that I very much need to work on as I have forgone many relationships and hobbies outside of medicine due to being “too busy” at work.

    Sometimes it takes a major life event to shake up the status quo and make one reexamine what is truly important in one’s life. I know this to be true in my case. You just articulate it much better than I could.

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      Thanks for the kind words. We lost out home in a fire when I was in high school, and certain trees rose from the ashes that we’d never had in our yard. Turns out certain seeds lay dormant until extremes of temperature provoke them to germinate after a dormant period.

      Perhaps the 20 year of char will allow you to break out and send tendrils in new directions. The good news is there are so many wonderful asset classes (art, music, friendships, literature, service to others outside of medicine) you can diversify into that I’m genuinely excited for you to hit this next stage in your journey.

      Good things ahead, CP. Chin up.

  3. Medicine is a boiling cauldron, not a placid soup bowl. It’s a system that produces eddy currents of chaos which eats ups a ton of kinetic energy compared, to the bland profile of laminar flow. Medicine is coercive and erosive. You might think unnecessarily so, but maybe not. Maybe it runs at the level of chaos that is reduced compared compared to an even worse level of chaos but far more chaos than the expected laminar chaos.

    A summer breeze contains a mild rather pleasant amount of kinetic energy and chaos. A winter gale, a not so pleasant but survivable amount of kinetic energy and chaos. The energy of a cat 5 hurricane or F 5 tornado is virtually not survivable without massive battlements. It turns out the probability relationship between these events is likely a power function not a linear function making the cat 5 more likely than the human brain with it’s linearly predicting point of view would predict. That means from a personal point of view, it’s all about the expectation of an event’s occurrence and the disappointment contained when the occurrence deviates from the expected.

    I find lawyers to be well trained in what passes for law, but poorly trained in what passes for justice, because the “law” operates in an environment of mild risk and expectation, while in reality disease operates somewhere between gale force and cat 5. Waddya mean my leg needs to be cut off??? Just give me a pill damnit! And the family sings: waddya mean his leg needs cut off!! We gonna sue!!

    FIRE operates on the same platform. It bets the future on an expected summer breeze level of risk.

    It is what it is. You can be a victim for just as many minutes as you like while trying to force your “understanding” to become reality. When you’re done being victimized by your understanding, accept reality and go do something else.

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      Explains why I keep burning my tongue each time I take a sip.

      The family chorus, as well as the distinction between law and justice, are pitch perfect in the way you’ve articulated them. I imagine many of us have heard the song and felt very lashed to the mast as the storm raged about us.

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