Definition
Medical malpractice stress syndrome is the term the medical literature has used since the 1980s for the cluster of symptoms physicians experience after being sued. It was first described by Dr. Sara Charles, a psychiatrist at the University of Illinois, after her own suit. It is not a formal diagnosis. It is what reliably happens to a competent, conscientious person when their competence is formally and relentlessly accused.
86% anger. 79% depressed mood.
Among physicians who had been sued, compared with 46% and 50% among physicians who had not. Charles, American Journal of Psychiatry, 1985.
Symptoms
| Domain | What physicians report |
|---|---|
| Emotional | Anger, shame, a sense of betrayal, isolation, loss of confidence, a feeling of being marked |
| Cognitive | Intrusive replaying of the case, difficulty concentrating, second-guessing routine decisions, defensive over-ordering |
| Physical | Insomnia, fatigue, headaches, GI symptoms, new or worsened hypertension, increased alcohol use |
| Behavioral | Withdrawal from colleagues, avoiding the kind of case that led to the suit, reduced hours, early retirement |
| Relational | Irritability at home, absence at the dinner table, a partner who is shut out because the physician cannot talk about it |
Course
The symptoms track the accusation, not the merits. Physicians who are dismissed from suits report the same sleep loss, intrusive thoughts and loss of confidence as physicians who lose.
9% fewer patients. 5% higher cost per patient. Persisting.
Emergency physicians after a malpractice allegation, compared with their own pre-claim baseline, with no detectable return to baseline and the same effect when the claim was dropped. National Bureau of Economic Research working paper 28330 (Carroll, Cutler, Jena).
The average claim takes 20 months to resolve once filed, about three and a half years from the incident, and the average physician spends close to eleven percent of a career with at least one claim open. Seabury et al., Health Affairs, 2013.
It does not stop on its own. It needs active intervention. The Legal Trauma Institute treats it as legal trauma: a specialty, with its own diagnosis and its own method. If you have just been sued, start here.