Law and Medicine
Medical Malpractice Stress Syndrome
S. Sandy Sanbar, MD, PhD, JD, FCLM
Chairman, American Board of Legal Medicine
Adjunct Professor Medical Jurisprudence
Malpractice lawsuits against doctors, nurses, and other health care providers are
extremely stressful. Numerous distinguished authors have addressed the impact of
litigation on doctors and nurses. The allegation of malpractice may be extremely
traumatic to the accused doctor or nurse, resulting in a litigation stress syndrome. The
medical malpractice stress syndrome (MMSS) is a unique variation of the well-accepted
litigation stress syndrome. Some refer to MMSS simply as post-traumatic stress disorder,
the trauma being the malpractice lawsuit.
MMSS MANIFESTATIONS
Most physicians and nurses are ill-prepared to deal with the devastating
psychological effects of medical malpractice litigation on themselves, their families, and
their medical and nursing practices. The stress of medical malpractice litigation may
directly contribute to physical illness of the physician and nurse, dissatisfaction with
medical practice leading to burnout and early retirement, and if the reaction of the
professional is extreme, depression may lead to suicide. The accused professional often
resorts to alcohol, or self-medication, in an attempt to alleviate many of the
uncomfortable symptoms. The primary symptoms of the medical malpractice stress
syndrome are psychological symptoms (e.g., acute or chronic (>6 months) anxiety and
depression), and the secondary manifestations are physical symptoms, including
exacerbation of cardiovascular, gastro-intestinal, pulmonary and other disorders.
The accused physician or nurse must first realize and acknowledge that he or she
may be suffering from the medical malpractice stress syndrome. Then the distressed
physician or nurse should seek support, understanding and comfort from immediate
family members, close friends, defense counsel and professional colleagues. The
physician and nurse need help to acknowledge and address the fears of medical
malpractice stress. They must continually be reminded that being sued for medical
negligence is a predictable hazard of medical and nursing practice.
EDUCATION ABOUT MMSS
Education of the sued physician and nurse about the medical malpractice litigation and
physician stress is the key to dealing with the fear of litigation. Physicians and nurses
should learn to:
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1. Practice immaculate risk management and quality assurance;
2. Have faith in themselves, their families and all others who help them during the
stressful period of medical malpractice litigation;
3. Avoid the element of surprise by preparing for possible malpractice litigation before
it occurs;
4. Build malpractice-proof shelters to survive the most predictable, yet least anticipated
events in the life of any physician or nurse; and
5. Shelter and protect personal assets long before being sued for malpractice.
THERAPEUTIC BENEFITS
The physician or nurse defendant in a malpractice lawsuit can derive therapeutic benefit
by implementing some or all of the following:
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2.
3.
4.
Being actively involved with the defense attorney team;
Participating in official discovery requests;
Assisting in identifying, but not contacting, qualified experts;
Performing medical and nursing literature research to determine nuances of medical
and nursing care;
5. Attending as many depositions and as much of the trial as feasible;
6. Preparing diligently for appearances by thoroughly knowing the medical records and
the medical literature;
7. Attending or personally experiencing a malpractice mock trial to become familiar
with the direct and cross examination process;
8. Becoming educated and comfortable in dealing with the tactics of the plaintiff’s
attorney and the time and scheduling difficulties required by legal proceedings;
9. Becoming educated about medical malpractice stress and its effects on the doctor and
nurse;
10. Recognizing that there are inherent conflicts of interest between the insurer and the
defendant physician and nurse; and,
11. Seeking counsel by a private attorney if conflicts are perceived with the insurance
company appointed attorney, or if claims are not fully covered by malpractice
insurance.
State medical societies and professional liability insurers generally provide group
support mechanisms to anonymously assist sufferers of the medical malpractice stress
syndrome.
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