Physician wellness

Coping with the stress of medical practice

Medico-legal problems and their emotional impact

Originally published August 2012
W12-005-E

While many physicians cope well with medico-legal issues such as a lawsuit or medical regulatory authority (College) complaint, the experience can cause anxiety. Recognizing this, medical officers at the CMPA can help members keep the situation in perspective and identify resources to alleviate the emotional stress associated with medico-legal difficulties.

Understanding the legal or College complaint process

Members are encouraged to discuss the legal or College complaint process with a medical officer. Understanding these processes may counter some of the misconceptions and reduce the level of stress associated with them.

Members should keep in mind the following key points of the legal process:

  • 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 that a physician attains perfection. A physician's treatment is said to have conformed to the standard of care if the physician has demonstrated the degree of skill expected of a prudent practitioner of similar training and experience when faced with a similar situation.
  • Physicians are expected to comply with the legal requirements regarding consent. To this end, a physician must obtain the informed consent of the patient by discussing the nature and consequences of the procedure including common risks or potentially serious consequences. A physician should also discuss any reasonable alternative treatments that are recognized. The adequacy of a consent explanation is judged according to what a reasonable patient would expect to be informed about in such circumstances before providing consent.

Learn more about legal proceedings and the College complaint process:

Poor outcomes and adverse events

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. Physicians need to keep the legal or College matter in 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.

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 an adverse 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 adverse events 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. In fact, 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 the positive reputation established over the years. The reality is 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 would often prove 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 discuss their situation with a CMPA medical officer and 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 about how they are feeling, and take care of their health by getting enough sleep, eating well, and exercising. Good physical and mental health can help physicians withstand stress.

Physicians may 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 medical officer.
  • Members who are assisted by a lawyer should not hesitate to discuss with them the emotional effect of the proceedings.
  • 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 want to consult the Canadian Physician Health Network.
  • 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.