Always…

 grass blade against a lake at sunset 
There is a topic I have avoided talking about on this blog.

It is constantly on my mind, though: 

At the zoo with my daughter. Camping. Staring at the moon through a telescope. In the midst of mind blowing sex. 

It is always there.

Is this the moment when my world starts to unravel?

It is worse, much worse when I am away from the office, as if being away creates some sort of anxiety vortex. The only time I can be away during office hours and NOT have anxiety is when I am out of the country, overseas. 

I worry how it will affect my family. My staff. My friends. My colleagues. My reputation. Me.

Because even though I have been threatened repeatedly, nothing has happened officially in over eleven years of practice. Still, it is not a question of if. 

It is a question of when.

The stages of grief include anger. That puts physicians and other healthcare providers within the cross hairs. I accept and understand that often, no matter whether things were done perfectly or not, I will be the target of that anger. And yet I cannot let go of the anxiety. I carry it with me, waiting for someone to take that anger to the next level.

I will sue the clothes off your back.

I don’t write about getting sued because if I acknowledge it, it feels that I am inviting it. Call it superstition. Paranoia. 

*knocks on wood*

Someday it will happen, though. When it does, I fear that I will walk away from medicine. I am tough but I am not sure I am tough enough to weather that onslaught without crumbling under the enormity of it. 

So every day I wait and I worry.

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123 thoughts on “Always…

  1. Oh boy. I’ve obviously never been in your shoes, but I do know what it feels like to be threatened, and to have the threat of that threat hanging over you no matter what you’re doing. When is he going to come back and make good on that threat?

    I at least had the advantage of feeling like I could grab the one child I had at the time and disappear, disengaging physically and emotionally from the situation. But if something similar happened to me today I don’t know what I would do – the stability of roots and emotional connection (whether because of logistics or because where you are is your calling) is a strength when things are going well but it also strangles you when your world gets turned upside down.

    Liked by 1 person

  2. I hope that doesn’t happen to you. Because it does suck. but if it is any comfort, I think that it is far easier to sue folks who lack compassion and empathy. And I don’t see that in you at all. But it is much harder to sue someone with a face, whose hand you shook. It’s harder to look someone in the eye and say “I’ll sue.” That’ (in part) is why they go for the faceless drug companies.

    Liked by 4 people

  3. I can relate completely to the fear and anxiety building, crushing you most when you’re happy, wondering how long happiness can stay. I cannot relate to such a threat, although I did work at a civil law firm and am aware that malpractice suits are common enough. I can assure you, just on the basis of reading intake sheets, proving medical malpractice is very, very hard, and we turned away most cases. Feelings do not take the stand in malpractice lawsuits.
    I’d say your pants are safe and I wish that was enough to put your mind at ease.

    Liked by 1 person

  4. That’s interesting Victo – in a negative way. I’m not a lawyer but I have had considerable training in what conditions permit suing a professional. And I can assure you it is not failure that is the determining criteria. It is lack of engagement and deliberate incompetence. I cannot see you meeting either of those criteria Victo. You can rest easy – as long as you care and do your best, it is not possible to win a lawsuit against you. πŸ˜€

    Liked by 1 person

      • Here’s one for you Victo. When I was transportation Manager of a large retail organization we leased our tractor-trailers from Ryder. One sunny Sunday afternoon, we had a driver returning home empty after delivering on a two lane rural highway. He was driving very defensively within the speed limit. A half-ton coming towards him slowed to turn right into a dirt road and a car with two elderly women in it darted out from behind the half-ton and into our driver’s lane head-on. Our driver jerked the steering wheel to the right and drove off the road into the ditch. But the car was too close and he caught a part of it and spun it around in the lane, crushing it. They air-lifted the two women out by medical helicopter. We sent a wrecker and a recovery crew to get our equipment which had to be trailered out as the wheels were so severely damaged.

        A few days later the driver called me from home and he was panicking. The women had engaged the services of a lawyer and were suing him and our company for damages. We had deep pockets and they figured we would pay rather than go to court. What they did not realize was that Ryder held the insurance policy and with a fleet of 10’s of thousands of trucks, a part of their sales pitch was their ability to provide fleet insurance at a competitive rate. They fought every single lawsuit even as small as a ticket,and they often counter sued to get their money back. The last I heard they had destroyed the ladies suit and had counter-sued for not only the damage but for suffering and costs as well.

        Like I said the problem is systemic and the only way to stop it is to carry every suit out to the end.

        Liked by 2 people

  5. I never thought of that, and I’m so sorry for the nagging anxiety. We live in a litigious society where good intentions and our very best efforts aren’t always understood or appreciated, especially in the light of misfortune. I imagine it’s necessary to find a way to accept that another’s anger and grief are beyond your control, that this is a burden of your profession in this day and age, and to believe that you’ve done your very best with your talents and intention.

    Having followed your blog for a bit now, I can attest that your efforts are full of successes, of instances of human connection and healing. That too is part of the legacy, and must be weighed against the challenges. What you and others in your profession do is important, and appreciated.

    Liked by 1 person

  6. Sad to say that you probably will get sued at some point – I think most doctors do get sued these days. But that’s what malpractice insurance is for, and the insurer and its attorneys will try to keep as much of the stress off you as possible.

    I don’t know if the lawyer I work for has ever been sued over something I’ve done, but since I’ve never been called as a witness, I would assume not. I have, however, been physically threatened – both by a client and by a co-worker (who was subsequently fired).

    You need to let the anxiety go if you can. If it happens, it happens. I know you do everything in your power to keep your patients happy – worrying too much about everything you’ve said or done could result in errors you wouldn’t have made otherwise.

    Sorry I can’t be more supportive on this one – but unfortunately, it’s an aggressive, self-involved world out there (unlike the peaceful, comforting blogosphere we’re in at the moment).

    Liked by 2 people

  7. Isn’t it something like 60-75% of physicians will be sued at least once in their lifetime? Perhaps thinking of it as inevitable could lessen the stress a little. Neurosurgeons always have at least one case going on (from what I’ve heard). They learn to live with it. Doesn’t make it any easier for the rest of us though, I know. That was a constant fear for me too. But the biggest thing that’s been shown to lessen the chance of being sued is showing empathy and compassion to your patients and listening to them. I have no doubt you do that every day.

    Liked by 1 person

  8. Years ago I do not think that anyone thought about suing the doctors. We all believed that they did their best to help and if it turned out that a life was lost or we couldn’t be helped, then so be it.
    Doctors did their best, they made house calls, they treated their patients well. If you could not afford to pay them you were told not to worry about it.
    Times have changed, I don’t know when exactly, but boy the law suits are flowing. Not only In the medical arena but in every industry. Greed has taken a front seat and is now driving.
    If it is going to happen to you doc there is nothing you can do to stop it. You have insurance and as I understand the cost is astronomical now. From reading your blog I get the impression that you are a caring doctor. “A real human heart beats behind the white coat.” Exhale doctor, you are doing a great job and your record will speak for itself. :o)….

    Liked by 1 person

  9. Oh, I am so sorry. It sounds like a terrible burden to carry daily. It also seems like a very important issue to be openly discussing. If all the doctors who care (have anxiety) leave the profession, we will be left with only those who don’t care, and the ultimate loss will be to patients. That said, you have to take care of yourself, and if your profession is wrecking your life, you have ever right to leave it……and possibly move to Europe!
    Reading this makes me, and I am certain many other people, wish you were my doctor. I want my doctor to have some anxiety about my welfare, and I want my doctor to be fully human. This is why I think this issue is so important to discuss. If other physicians were as brave as you and came forward, a dialogue could start about the reciprocal obligations of physicians and patients, and patients could start to view their physicians as the human beings they are. This dialogue couldn’t help but improve medical care delivery.
    I admire your bravery. Bravo! I wish other physicians would step up to the plate and back you up.

    Liked by 4 people

    • It is a taboo subject even among physicians. Very few want to admit they have been sued. Talking about it while in litigation makes that discoverable and so talking through the process with someone for emotional support is a no can do. Trapped. Shamed. It just gets worse…

      Liked by 1 person

      • Victo….I totally hear you on this one. (both the obsessiveness of the thoughts as well as the very real possibility just because of the world in which we live….I am really glad you brought this specific obsessive thought out into the open!~ I did have a thought…(I’ve been trapped by thought patterns and the only thing that works for me is to open it up to someone else…what if you did that with counselor (who is them selves bound by law NOT to divulge what you would share in confidence of a counseling room. (not just a medical peer) That way maybe you can be set free from the torment. dinner bell just rang..better go before I wind up in the dog house πŸ™‚ DM

        Liked by 1 person

      • Dinner…. Mmmmm! I would probably benefit from counseling. First, is an issue of time. (I roll my eyes at patients over that one so I realize it is a lame excuse.) The other issue is pride. (I tell people they don’t get to complain if they are not trying to help themselves so I guess that is a lame excuse, too!) πŸ™‚

        Liked by 1 person

      • this is what living with domestic violence feels like…but it is even worse because people feel you are stupid if you don’t get out…..”you should be able to just get out”

        Liked by 1 person

  10. PS- My brother is now a superior court judge, but he was a medical malpractice defense attorney for many years, i.e., he defended doctors and hospitals. He found his practice highly stressful so he would fully understand your feelings. I remember him mentioning two points, you will inevitably make a mistake and people are much less likely to sue people they like. I used both these caveats to guide me in my stressful career as a psychotherapist and mental health program director. Lawsuits against mental health providers have gone through the roof in the last 20 years, many times for good reason, i.e., ridiculously severe malpractice or incompetence. That said, I did retire early, at age 50, and I now spend a lot of time in Europe! πŸ˜‰

    Liked by 1 person

  11. Every profession is at risk today. I’ve seen people shopping for a lawsuit as much as the house they were buying. I recommend a pro-active approach. Find out what kind of documentation might help you if/when this happens. It might be above and beyond the required documentation, but well worth it. There are likely classes taught with this approach. Find a decent attorney before you need one. Maybe some of the corporate laws can protect your assets. It is terrifying for anyone who runs a business of any kind.

    Liked by 1 person

  12. I’m a nurse. I’ve had patients threaten to sue, I think to keep people on their toes. I think there is a small fraction of people out there who have a certain personality type that like to sue, or threaten to do so anyway.
    I had been working in my first nursing job for just a few days, when a patient on our unit fell. The patient later passed away. I don’t think anything could have been done to stop the patient from falling. His family sued the facility I worked for. I had a few phone calls from the lawyers but that was the extent of my involvement. It seemed from looking at the depositions of my other coworkers though, the lawyers seemed to want to make their case by doing everything they could to tear people down, in ways that had nothing to do with anything happening at the time of the fall.

    Liked by 2 people

  13. I will admit that this same anxiety and fear played a part in my decision to pursue a PhD (in microbiology) and not an MD. Bacteria in a test tube are much less likely to sue you…
    Other comments have touched on how common it is now in so many professions to be sued, so thank you for writing about this – I think it will help a lot of people!

    Liked by 1 person

  14. I am deeply sorry that you must deal with this threat while trying to do a job you enjoy. Being fortunate enough to have a meaningful job, then being faced with anxiety over doing that job, and then being judged for it, truly sucks.

    Liked by 1 person

  15. I do understand, I have family who work in the health service and they too have just the same fears. It works both ways too, as patient I have noticed over the years that staff no longer say they are sorry if a minor mistake occurs, they use all manner of words, and even become very evasive, because they fear they’ll be admitting culpability, and this nice patient they’re talking to, might go away, and then come back all angry and sue them, stating they admitted they did something wrong. It’s awful all round, and I hate that people who are kind, and good such as yourself, who actually give a crap, are worried in such a way. *throws a hug her way*

    – sonmi.u.t.C

    Liked by 1 person

  16. Similar to my frustration when things go well, God intervened. When things don’t go well, we screwed up.
    It is so scary and it wakes me up at night. I truly wonder if people have any idea how horrifying this career is.
    We are responsible for others outcomes regardless of the situation. We are expected to be omnipotent and still retain our ability to relate to everyone on a personal level.
    We have to be the consumate professional- yet approachable.
    It’s difficult at best.

    Liked by 1 person

  17. I agree with ‘Glazed’. “…our fears are worse than the reality..” And your constant worrying is understandable in a country that has such a reputation for Torts cases. And does it mean that they are already punishing you for something you haven’t done.

    Liked by 1 person

  18. The world has changed so much in the past twenty years. Litigation is now for the masses. I hope this day never comes for you, but we have to do what we think is right despite the risks.

    Liked by 1 person

  19. I hope that day never comes for you, Victo. You’re obviously a caring and compassionate physician, and the stress and worry must be tremendous. I’m sure you could set up a private practice with just the people who follow your blog. I know I’d sign up in a minute.

    Liked by 1 person

  20. There are bad, incompetent doctors. I have one now. I will find a new primary care doctor as soon as I can, but having (in the past) suffered under the “care” of someone who was careless (to say the least) I’m suspicious, highly critical and paranoid where once I was trusting. But, we live in a world of corporatization and the commodification of the professions. That makes the fear of losing your livelihood real. I am sure for doctors as well as for teachers happening to steal your livelihood is real. As a teacher my job often depended on what my students had to say about me. It was sometimes terrifying.

    Liked by 2 people

  21. Always alert. Sometimes you do not want to be alert.

    I am a temp now. As a full-time temp I am almost always on call and one bad day can cost me my job either due to health issues or due to not performing my work satisfactory.

    That feeling of always being alert must be much worse as a highly skilled professional saving lives. Whatever happens, happens. I think that if you are as sharp in your writing as you are in your medical practice then you should not worry too much.

    Someone once taught me to believe in myself whatever happens and to stay calm and focused.

    Please keep doing your thing. Sometimes unexpected people protect you.

    Liked by 1 person

  22. Dearest Doc, I am going to be blunt, so forgive me if I cross a line. What is it exactly you are afraid of? I am not asking for me, I am asking you examine it and see really what is the worse case scenario. I think if you really dig deep and down, you will see that the reality is not the fear of being sued…. but there is something else lurking….. and only you know what that beast is. Name it and tame it.
    My administrators voice would tell you: “going in, you knew there were risks.” How real are those risks for you and is it worth the anguish? Maybe I am reading more into this than is intended, but I think this is very real for you and very profound. Does this impact your “performance”. I think it does in a good way, but what about balance of life? The fact you need such a large void to put it out of your head is telling.
    I also sit on the board that reviews all incidents for all four agencies. The vast majority are things that were caused by someone not thinking. We have very few sentinel events, but when we do, they are doozies. And again, caused by careless, rushed clinicians who feel immune to the outcome. This is not you in anyway. You are in touch, careful and methodical. Trust yourself.
    Health care is a business. Being a doctor is a vocation. Hold on to this: β€œWhen women enter any vocation, that vocation changes in some way,” – forensic sociologist, Rosemary Erickson

    Liked by 1 person

    • I used to sit on the hospital review board when I was chief of family medicine for a few years. It was sobering, and yet reassuring, to see other’s mistakes. I will give this some further thought. Maybe there is a post lurking here… πŸ˜‰

      Like

  23. My husband was sued once – the lawyers from the malpractice law firm didn’t want to settle because it would have set a precedent that would have opened the barn doors for other lawsuits. Three months on a malpractice diet (he lost 17 pounds and I nearly lost my mind), the case was settled in 15 minutes in his favor. But it changed the way he practiced and looked at patients.

    Liked by 1 person

    • Only three months? How long ago was that? I am so glad you both survived it. I think that change in how I viewed patients is what would drive me out of medicine, no longer being able to trust that people are inherently good (myself included). I am afraid of what I would discover about myself in the process.

      Like

  24. Hi, If you practice the way you write, then you’re consistently sincere and thoughtful with your decision making and your actions. I have a feeling you’ve made a positive impact on hundreds and hundreds of people.
    Anyone viscous enough to end your career will take a part of you away, but you’re still a mother, a writer, and so much more.
    I also think Jane’s comment is interesting.

    Liked by 1 person

    • You are right that medicine is only a small facet of who I am. It would be interesting to see the other parts of me develop and grow without having to be crowded out by medicine. I think Jane is a good people manager/motivator…. πŸ™‚

      Liked by 2 people

  25. When you say it’s not if but when, does that really mean that EVERY doctor get sued at some point? Aren’t there some that don’t ever get sued? Just curious. I’m wishing and praying for you to have more and more mindful moments – focusing more fully on the present moment, enjoying your family, the rest of your life, and all the beautiful places in the country you live in.

    Liked by 1 person

    • The STATs in 2011 were 61% of physicians over 55 yrs old had been sued at least once. Can you imagine going into a job where that was expected? Family physicians face a 5% annual risk while neurosurgeons face a 19% annual risk. I will work harder on shutting out those intrusive thoughts for my own sanity. :-/

      Like

  26. Pingback: My Article Read (10-6-2015) | My Daily Musing

  27. I’ve seen both sides of this. I used to think all litigation was bogus, having seen people sued for nothing and settle just to avoid the cost of a lawsuit; but recently a friend was crossing the street with the walk sign and was run over by an turning SUV. The guy said he didn’t see her, and that’s probably true, but still…lost wages, insurance companies refusing to pay certain things, unable to even stand for months…how is she to survive without suing someone to get some help with the endless expenses? She herself says she sees all this in a different light, having also been against litigation. Seems like there should be some way to help in this situation without making it a personal vendetta. Humans are, well…human. Accidents happen. Mistakes are made. ClichΓ©s, but it’s true. How do we help those affected without destroying lives?

    Liked by 1 person

    • I agree completely. I don’t think anyone would say that valid lawsuits should not happen. I made a point earlier about also needing to punish bad doctors. It is not a threat that should ever really go away. I wish that myself and other physicians did not have to deal with frivolous suits and the turmoil that accompanies them AND I wish personally that I was wired in such a way that the anxiety was not a constant companion for me.

      Liked by 1 person

      • I really think there needs to be some kind of actual “no fault” (instead of what they label no fault now) method of compensation. The world is not perfect, and there is not always or even maybe ever, a need to assign blame.

        Liked by 1 person

      • Sometimes in medicine there is a need to assign blame. We learn from it as physicians. It helps to prevent future errors. And hopefully removes people from practice who should not be practicing. Drivers who slip on a wet road are one thing but someone driving drunk is entirely another. It will never be perfect, I am afraid. I feel for your friend.

        Liked by 1 person

      • It’s been a hard road but she was determined to walk again…and she is. She hates using a cane, but I think eventually she will be able to get around without that too. But the accident was an eye opener in many ways.
        And you’re right , sometimes there is clearly a fault. But not as often as lawyers would have us think!

        Liked by 1 person

  28. Reading this I thought, Good god she’s in my head. Over late night sushi I shared it with my husband (also an internist) and with seaweed salad dangling from his chop sticks he snorted, ‘Yep, that’s me.’ I’m glad (but also not so glad) we’re not alone…

    Liked by 1 person

  29. I don’t think that if you write about it, you are inviting it. You would just be writing about it, like writing about a snow storm- something else that happens and is not in our control. Having it always on your mind is telling the universe a different message than you would like, I’m afraid. Maybe if you get it out of your head and onto the page you can get some solace and not have to worry about it anymore. You have malpractice insurance for that very reason. You’re fine. If you do choose to walk away from medicine do it because you don’t like it anymore, not because of some money seeking moron. But you worked too hard to worry about hypothetical things. Enjoy it, and maybe take a yoga class to help defer your thoughts.

    Liked by 1 person

  30. Not a great place to be, Vito. I understand it but I don’t like it. I feel the act of writing helps but at times, when there’s too much writing and introspection work, I begin to question everything far too much. And then, anxiety grows.

    Like

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