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Legal - Facing the stress of litigation and complaints |
For many practitioners, the prospect of facing an allegation of malpractice is placing a significant stress on their practice of medicine.
In a recent Australian study examining the sources, frequency and severity of work stress experienced by GPs, the GPs in the study perceived that the most severe source of stress in their working life was the threat of litigation. This was despite the finding that for these same practitioners, litigation was the least frequent event that led to work stress.
The threat of litigation and complaints
Based on our experience at United, at least one in 60 GPs in Australia can now expect to face a civil malpractice claim each year. For other specialties, these figures are much higher. However, in our experience only 6% of the litigated claims progress to trial. Of the remainder, about 28% are discontinued and 66% are settled out of court.
In addition to legal action started against doctors, each year in NSW one doctor in every 20 is the subject of a written complaint to the Health Care Complaints Commission with 1,065 complaints being lodged with the commission in 1998-99. These figures do not include complaints made directly to doctors, their employers and other bodies such as the AMA or the coroner.
Again, when viewed in context of the number of services provided during this period, very few resulted in a formal complaint, with less than 10% of complaints lodged with the HCCC progressing to disciplinary action. In 1998/9, a total of 92 medical practitioners in NSW were referred for disciplinary action at the conclusion of an investigation by the HCCC. Eight medical practitioners were de-registered following a finding of professional misconduct. These figures emphasise that, while complaints against medical practitioners are relatively frequent, formal disciplinary action against medical practitioners is uncommon.
The stressful nature of litigation and complaints
Why do litigation and complaints cause such stress? Four main characteristics of the process are the source of practitioners' concerns.
Unpredictability
The operations of the legal and complaints systems are in themselves unpredictable, particularly for those who do not work in the system or are not familiar with the rules, terminology and processes. Added to this is the uncertainty at any stage that a case will proceed to the next step, and if so, then when, and what will be the outcome? What will be the impact on the practitioner's career?
Loss of control
This unpredictability is a significant factor contributing to the practitioner's sense that they have no control over the events or process they are facing. This is compounded by a lack of knowledge about the process in which they are engaged, and the fact that in many instances, others may make decisions that could significantly influence the outcome of their case.
Personal meaning
For most practitioners, an allegation of negligence or incompetence is a direct assault on their personal sense of self, and engenders feelings of shame and guilt. The time which must be taken dealing with the case is likely to be time consuming. It will impact on how they lead their personal and work lives, as well as their relationships with family, friends and colleagues. It is also likely to affect a practitioner's self perception of their standing in the medical community.
Individual coping mechanisms and social support
Many practitioners feel alone and isolated from their peers, family and friends because of allegations of malpractice. At a time when they most need close personal and social support, they may feel unworthy of it. A sense of failure and having “let the side down” will lead them to withdraw and deny themselves a source of support and relief from stress.
The nature of the medical professional
Medical professionals are trained and rewarded for being careful, responsible, conscientious and prepared to consider a wide range of options for diagnosis and treatment. They also tend to have high expectations of themselves and are self-critical. An allegation of malpractice attacks their confidence in these traits and can therefore cause enormous emotional disturbance.
Coping with the stress
There are a number of coping strategies that medical practitioners can use to counteract the stressful characteristics of litigation and complaints.
Gaining understanding and control of the process
To cope with the sense of loss of control, practitioners need to recognise and accept that the legal process is unpredictable in terms of its rules and outcome. Practitioners should familiarise themselves with every aspect of the process; for instance asking their medical defence organisation to explain the legal process, participating in the selection of experts and studying the relevant literature.
Making sense of the personal meaning
Secondly, practitioners need to make sense of the personal meaning of the event.
Practitioners should reflect on their own feelings in this regard and examine how the event has impacted on their relationship with patients, colleagues and family. In addition, reflecting on issues of competence and taking steps to solidify them is important. This is best achieved by participation in continuing medical education and interaction with peers.
Gathering together the resources to cope
Another factor is an assessment of one's means of coping. Self-observation is vital and medical help should be sought if somatic symptoms do not promptly resolve. Using available social supports is also essential. Most practitioners involved in litigation need to share their reactions to the experience.
Practitioners should identify those who they feel most comfortable in sharing their reactions, including their medico-legal adviser, colleagues and family. Practitioners should avoid the 'conspiracy of silence' and consequent feelings of isolation that surround the issues of litigation and complaints.
How to minimise the stress of litigation and complaints
- Find out about the legal/complaints process. Knowledge is power.
- Continue to participate in continuing medical education and other interactions with your peers.
- Examine how you can re-order your practice to reduce anxiety and make it more manageable.
- Seek medical help if somatic symptoms do not resolve promptly.
- Talk openly about how you are feeling with your colleagues, family and medico-legal advisors; seek professional counselling if you need more support.
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