I have a colleague who just had a bad outcome with a patient and it just makes me so nervous. I work in a high litigation state with no protections. I have multiple borderline patients. How do you guys deal with it? Suicide rates going up. I'm barely out of training. No one really talks about this. Everyone seems terrified. Everyone tells you to document well, but what happens if you get sued? Do you go broke? Is your career over? No one wants to talk about this. How do you guys deal with it?
How do you manage anxiety about malpractice?
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First, keep in mind that going above policy limits is really rare. When it happens (which is not often at all) it is not the absolutely devastating amount you might imagine. See: Malpractice Insurance - Above Policy Limit Judgments - Podcast #155 | White Coat Investor
Next, know that malpractice risk comes with the territory. Use that to practice high-quality medicine. For example, work for places that allow adequate time to see patients and that allow you enough control over your own practice. If somewhere wants to cram high volume patients through your practice with little control over who you see, turn that job down. When you have more control over who you see and you take the time to establish connections and provide good care, the odds of a lawsuit decrease. I also make sure to document carefully for those rare (probably <5% of interactions) cases where I do see serious risk and where I would want my reasonable medical judgment carefully spelled out if there is a bad outcome. That provides a bit more protection and, if a suit happens, increases the odds of a favorable settlement or verdict.
Many of us will be sued at some point, and it often creates stress for several years as the lawsuit winds its way through the system. Ultimately, though, it isn't some indictment of you as a human being or even as a professional. Do your best not to take it personally if it does happen, and as above remember it's not the end of the world. The worst thing that could realistically happen is that you do something so egregious your license gets pulled. It's not worth ruining your career and life with worry over.
Finally, make sure you don't start seeing your patients as the enemy. After people get sued they can start viewing every patient interaction as a potential lawsuit, and every patient as a potential enemy. That saps the joy and purpose from professional practice and is a quick route to burnout (and likely leaving medicine early if able). Keep connected to the purpose and benefit of what we do every day, and remember that the vast majority of patient interactions are beneficial and far more people are grateful for your impact on their life than are bitter and wanting to sue.
Next, know that malpractice risk comes with the territory. Use that to practice high-quality medicine. For example, work for places that allow adequate time to see patients and that allow you enough control over your own practice. If somewhere wants to cram high volume patients through your practice with little control over who you see, turn that job down. When you have more control over who you see and you take the time to establish connections and provide good care, the odds of a lawsuit decrease. I also make sure to document carefully for those rare (probably <5% of interactions) cases where I do see serious risk and where I would want my reasonable medical judgment carefully spelled out if there is a bad outcome. That provides a bit more protection and, if a suit happens, increases the odds of a favorable settlement or verdict.
Many of us will be sued at some point, and it often creates stress for several years as the lawsuit winds its way through the system. Ultimately, though, it isn't some indictment of you as a human being or even as a professional. Do your best not to take it personally if it does happen, and as above remember it's not the end of the world. The worst thing that could realistically happen is that you do something so egregious your license gets pulled. It's not worth ruining your career and life with worry over.
Finally, make sure you don't start seeing your patients as the enemy. After people get sued they can start viewing every patient interaction as a potential lawsuit, and every patient as a potential enemy. That saps the joy and purpose from professional practice and is a quick route to burnout (and likely leaving medicine early if able). Keep connected to the purpose and benefit of what we do every day, and remember that the vast majority of patient interactions are beneficial and far more people are grateful for your impact on their life than are bitter and wanting to sue.
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lol so engage in avoidance and limit career opportunities?
"All that reframing stuff is great but realistically if you're so scared of getting into a car crash that you can't drive, just don't get a job you have to drive to"
I'm into concrete solutions. If this worry is something that keeps the OP up at night and actually harms the care they deliver, I definitely don't consider federal employment career limiting. It sounds liberating, actually. "Practice good medicine and chart well" is just too vague for me.
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I mean if you like working for the VA awesome....but going to work for the VA because you're worried about malpractice while working in one of the lowest malpractice risk specialities is such a fear based behavior that it would seriously make me worried about someone's own insight and ability to deliver psychotherapy effectively. It also a very clear setup for significant internal conflict going forward without a good exploration of why this fear is so prominent and impairing.
My point is not to make OP feel bad about these fears but that automatically jumping to "if you can't get out of a physician adverse state, change jobs" without working on exploration and challenging the fears doesn't seem like the best solution. For instance, it can be as simple as OP doesn't really understand how a malpractice suit works...alluding to "going broke" if you get sued suggests that OP didn't realize that the vast majority of cases are either tossed out or settled out of court.
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Try to rest easier knowing Psych is one of, if not THE lowest malpractice field(s) in medicine.
Also maybe try to imagine being a lawyer and having one of your BPD patients as a client. That doesn’t exactly strike me as the ideal clientele for an ambulance chaser, but what do I know?
Also maybe try to imagine being a lawyer and having one of your BPD patients as a client. That doesn’t exactly strike me as the ideal clientele for an ambulance chaser, but what do I know?
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You can check that out to see if there is anything else you can do. Once you have done everything you can do, then you have done everything you can do!
Yeah, this is more it. It's not keeping me up at night, but it's something frankly no one talked about in training and I honestly don't know how this works.
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Malpractice Insurance - Above Policy Limit Judgments - Podcast #155 | White Coat Investor
Answering listener questions today including above policy judgments, starting a side gig, investing vs paying off debt during this bear market, and lots more.
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