■ Physician wellness:

Coping with the stress of medical practice

Medico-legal problems and their emotional impact

The CMPA is here to provide guidance and support

Two tired-looking doctors sitting in an operating room

5 minutes

Published: August 2012 /
Revised: April 2022

The information in this article was correct at the time of publishing
W12-005-E

The experience of being involved in medico-legal issues, such as a lawsuit or medical regulatory authority (College) complaint, understandably can cause emotional distress for many physicians. Recognizing this, physician advisors at the CMPA can offer members sound advice and meaningful support and can identify resources to alleviate the emotional stress associated with medico-legal difficulties.

Understanding the legal or College complaint process

Members are encouraged to familiarize themselves with CMPA resources that address the College complaint process, and to consider discussing the legal or College complaint process with a CMPA physician advisor. Understanding these processes may counter some misconceptions and reduce the level of stress associated with them.

Learn more about legal proceedings and the College complaint process:

Members should keep in mind that the plaintiff in a legal action must demonstrate that the physician's treatment of the patient fell below the standard of care and that this failure resulted in harm to the patient. The law does not require perfection from a physician; a physician's treatment will have met the standard of care if the physician demonstrated the degree of skill expected of a prudent practitioner of similar training and experience when faced with a similar situation.

Poor outcomes and harmful incidents

Medicine is a caring profession. Physicians often develop a close rapport with patients, particularly when they have cared for them for many years. When patients suffer a poor outcome and later initiate a complaint or lawsuit, physicians may feel betrayal, guilt, or remorse. In retrospect, a physician may wish to have done things differently.

One poor outcome may exert a far greater effect on the psyche than hundreds of positive ones. A strong understanding of the legal process can help put the complaint or lawsuit in context and maintain perspective.

Objectivity

When faced with a complaint or lawsuit, physicians can lose objectivity. Hindsight provides a vastly different perspective on a situation. For example, a diagnosis may be missed or delayed because a serious illness may present atypically or with non-specific symptoms. Diagnoses are based on an analysis of probabilities, and a particular diagnosis may elude even the most astute physician. In hindsight, after a lawsuit is commenced years later, the physician may look back and unfairly judge their own actions based on what became known subsequently.

It is an established legal principle that courts must not rely on hindsight to assess a physician’s negligence. Instead, a court must assess the physician’s actions in light of the circumstances that existed at the time of the alleged negligence.

Critical language

The language used in statements of claim is usually cold, harsh, and critical. The competence of the named physician may be called into question, and even a physician's character may be criticized. It is important to remember that a statement of claim is not an impartial or objective account of events.

Understanding the circumstances

Physicians have many competing priorities and demands on their time. They have to manage their practice, keep up to date with medical knowledge, and may have administrative, teaching, research, or other responsibilities in addition to seeing patients. They may work in sub-optimal conditions and face resource shortages. When a patient suffers a negative outcome, it is important to understand the circumstances leading to the outcome, participate in properly structured quality improvement reviews when they occur, and seek ways that will assist in moving forward.

The CMPA advises physicians about the significance of disclosing harmful incidents to patients. Disclosure discussions can be stressful, but when managed properly, will address the patient's information needs and provide physicians an opportunity to disclose the known facts.

Media reports

Some medico-legal cases might be considered newsworthy. Because news reports are often based on the statement of claim, they rarely portray the events from the perspective of the physician. To maintain patient confidentiality, doctors should not speak to the media about specific patients.

On learning of news reports, the doctor named may wonder if the reports will destroy or irreparably damage their reputation. However, the effect of media reports on reputation is usually far less dire than anticipated.

Support

Some physicians keep their medico-legal problems secret; however, the support of friends, family, and colleagues often proves to be beneficial.

Physicians should feel free to seek support as needed, keeping in mind not to discuss details or make assumptions of fault or blame when speaking with others. CMPA members can feel safe to fully discuss their situation with a CMPA physician advisor and, if applicable, the lawyer assigned to their case.

Physicians who are trying to cope with stress from a medico-legal problem should consider following the advice they would recommend to others. They should consult their family doctor or a trusted healthcare provider about how they are feeling. It is also important to remember that taking care of their physical and mental health can help physicians withstand stress.

The CMPA offers resources for physician wellness. Physicians may also consider using the services of the physician health program in their province.

Points to keep in mind...

  • Members should not hesitate to discuss their feelings or the progress of the case or complaint at any time with a CMPA physician advisor.
  • Members who are assisted by a lawyer should not hesitate to discuss with them the emotional effect of the proceedings and the legal aspects of their case.
  • Support of colleagues, friends, and family will prove beneficial — but members should be careful not to divulge the clinical details of the case.
  • Members may also consider seeking medical assistance, including consulting their own physician.

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.