The unspoken reason many doctors and nurses drop out

OOn a recent shift, I arrived to find our emergency department full and our waiting room overflowing with ailing patients. Half of our emergency room beds were occupied by “residents” — patients sick enough to require hospitalization, but with no inpatient beds available for them at our hospital, or any other in the state. These residential patients included a critically ill infant with respiratory distress due to RSV, a moribund elderly woman on a ventilator and a teenager who had been held under security supervision in the emergency room for three consecutive days, awaiting transfer to a bed. psychiatric. Within an hour of my arrival, I cared for four new seriously ill patients who joined the ranks of our residents in the emergency room, having no intensive care unit capable of receiving them. The minute-to-minute bedside care they would demand of us indefinitely meant even less attention for other sick patients.

A veteran nurse whispered to me in a moment of upset, “I can’t do this anymore. It’s not worth my license. And I thought darkly, and not for the first time: this is a dangerous situation. For our patients, and for us.

As a physician who walks with other physicians through the stress of malpractice litigation, I am acutely aware of a truth that has gone unspoken in public discussions about why healthcare workers quit.

What has been published so far is very true: we are exhausted and overwhelmed. Violence against health care workers is a regular phenomenon. We are exhausted by the daily roadblocks set up by intransigent health insurers, error-promoting electronic health records, and C-suite executives who understand little of the perspective on the ground. We have worked through COVID-19 and staffing shortages, in collapsing systems around us. And when there is an outcome that causes pain and grief to patients and their families, not only are we crushed by those failures, but we also become the faces of them.

Learn more: Caring for caregivers after the pandemic

Malpractice litigation is a tricky subject to discuss openly. Even among doctors, although litigation is extremely common, it carries an air of shame and secrecy. Personal experiences in litigation are rarely discussed. Many doctors don’t understand how litigation actually works. But malpractice litigation happens to many good doctors. For example, a survey showed that more than 80% of currently practicing obstetrician-gynaecologists and general surgeons have been sued at least once.

For many, the initiation of a lawsuit or disciplinary investigation is almost as important as its outcome. The formal charge of malpractice, whether it has occurred or not, marks the beginning of a long cycle of shame and psychological distress for the clinician who has dedicated his life to his profession and genuinely cares about patient outcomes . The opportunity to talk to the patient or his family – to heal, to explain, to listen, to soften – is lost; now the lawyers attack or defend in our place. Added to the distress of a serious adverse outcome for their patient is now the fear of personal assets at risk, the potential loss of licensure or livelihood, and the stigma of the enduring public record of the trial; worry is ever-present, as is the shame of being judged incompetent by patients and peers. This fear is generally ignored by clinicians who are warned by their lawyers and insurers not to talk about it, but is heavily exploited during the legal process by opposing lawyers, who are well aware of the psychological distress that litigation creates in the patient. respondent. They know that a highly stressed doctor is more likely to make a mistake in their testimony, push for a fair settlement to end their ordeal, or appear poorly on the stand as a witness at trial.

Serious medical errors TO DO do arise, of course, and the risk increases as our healthcare system unravels. Discussing the impact of litigation on healthcare workers should in no way diminish the suffering of patients or their families in the event of an error. Historically, however, many malpractice suits have not involved actual error. The majority of lawsuits filed end in non-payment, and when cases go to trial, doctors win in 85% of cases. Yet, it is important to recognize that whether or not an error has occurred, and regardless of the end result of a case, the stress of malpractice litigation is a major driver of burnout. work, addiction, divorce and mental health crises among clinicians.

Physicians as a group have a remarkably higher suicide rate than the general population, and a 2011 study of more than 7,000 U.S. surgeons found that recent malpractice lawsuits were “strongly linked to burnout.” , depression and recent suicidal thoughts. Another JAMA study from 2020 demonstrated that “civil legal problems were a significant risk factor for suicide among healthcare professionals”. For a doctor whose identity revolved around being “the good doctor” but who is now a defendant, an inner crisis is brewing that often goes unaddressed.

Medical providers are often poorly supported by their institutions during litigation; the result is a general feeling of distrust between the administration and the hospital staff. Doctors and nurses are acutely aware of the recent RaDonda Vaught case, in which a nurse was convicted of criminally negligent homicide for a medication error, although faulty hospital drug delivery systems also contributed. Clinicians often expect to be “thrown under the bus” once the wheels of litigation begin to turn.

Regardless of litigation, medical errors themselves are linked to increased suicidal tendencies among physicians. We measure our intrinsic worth not by the thousands of times we’ve been right, but by the few times we’ve been wrong. And today, our dangerous understaffed conditions are driving more adverse events – and in a vicious circle, the impact of those events will scare us away even more.

This has always been part of our job, but the more we are burdened with the impossible and blamed when we can’t achieve it, the more we realize that every malpractice lawsuit needs a face, and that face will soon ours. . What we openly say about the health care exodus is true: we are overwhelmed, we are exhausted, we cannot help everyone who needs our help. People are dying who wouldn’t if we only had the time and the resources to do our job the way we were trained.

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