When Trouble Comes Knocking, What's a Physician to Do?

Several clients have endured the trauma of malpractice law suits, Medicare audits, and stinging accusations or criticisms from patients or colleagues that leave them reeling.

These clients have shared feelings of:

• shame

• despair

• depression

• loss of self-worth

• disillusionment

• confusion

• hurt

• defeat

Oddly enough, one of the least common feelings they're able to get in touch with is anger.

Maybe it's because my clients are self-selected, and many tend to be goal-oriented strivers with a perfectionist streak. They were, as was I, accustomed to the elitism and derision from senior doctors that medical training often encourages. They've been brow-beaten into thinking of themselves as "failures" long before they're able to see how “the system” has failed them!

These are not belligerent ranters and ravers who throw scalpels across the room and sarcastic barbs at nurses.

Pop psychology aside, what can you do when you receive notice of an intended law suit, or an audit, or just a bile-filled nasty letter from a disgruntled patient?

• Pause a moment ... and take a deep breath. This act encourages you to become aware of your inner feelings and to begin self-managing your thoughts.

• Recognize that you are entering a difficult period. Most of your feelings will stem from grief and loss. Loss of the good feeling you had about your patient, or about practice, loss of self-esteem, grief about how hurt and betrayed you feel. And, as Elizabeth Kubler-Ross taught us, grief resolves slowly and in fairly predictable stages. Even the most difficult periods come to an end, but that offers no reassurance at the moment of impact! However, being able to tell yourself that this is likely to be a shitty time, but that you will eventually get through it, will provide you with a dose of reality.

• Know that your "gremlins" are going to have a field day. A gremlin is a coaching term for the stern and judgmental Inner Critic that feeds on this kind of drama. Being a striver and somewhat perfectionist goes hand-in-hand with self-criticism -- and self-criticism is manna for the Inner Critic. There's little one can do to forcefully undo this habit. Instead, awareness of what is likely to happen will sharpen your ability to manage your thinking.

• Play the reality game. Byron Katie, of The Work offers a marvelous, four-step "simple yet powerful process of inquiry that teaches you to identify and question the thoughts that cause all the suffering in the world. It’s a way to understand what’s hurting you, and to address the cause of your problems with clarity." I encourage you to familiarize yourself with her techniques, for immediate relief of your suffering. The steps may sound easy-to-dismiss for many skeptical, hard-on-themselves physicians, but I promise you that with practice, you will discover how powerful this tool can be.

• Pay attention to depression. Depressed or sad feelings are normal, in the face of a distressing situation. However, prolonged depression is not normal, and needs help. Check your feelings a little more deeply. Where is your anger? Who are you mad with? If you did something truly foolish, anger directed at yourself is appropriate unless it's excessive. (Feeling stupid is normal too!) Often, depression is anger that has been turned inward, in the face of feeling powerless or helpless. Finding an appropriate outlet for your anger seems impossible or dangerous. If this describes you, it is time to get professional help!

• Leak your anger constructively. Productive ways to release anger include hiring an attorney to go to bat for you, putting yourself through really tough workout, writing a letter expressing all your feelings ... and then burning it 24 hours later. Avoid rash responses, verbal attacks on the spouse or staff, and actions that you will later regret.

• Line up your support team. As ashamed as you may be feeling, you need the folks who have got your back. This is no time to isolate yourself and hunker down. Pick that one person who will not judge you or make light of your feelings. Open up ... trust. Please don't tell yourself that no one wants you to burden them with your hassles. True friends feel honored that you trust them enough to ask for support.

• Be kind to yourself and your supporters. Neither of you is going to get this right, perfectly. You're going to let yourself down even if you are following all that I've suggested. And your supporters will offer too much advice, interfere too much, minimize what you are going through, and more. However, they will love you. And that is worth everything.

Being a physician is a demanding job. It's not for the faint of heart. And yes, you will get past this traumatic event. It will just take time. I'd love to hear what's worked for you when the world has suddenly become a disappointing place.