Expired CME Article

Psychologic Effects of Poor Outcome and Professional Liability Actions on Physicians

Authors: Cecile B. McAninch, PhD, Suneet P. Chauhan, MD, Everett F. Magann, MD, Vidya B. Chauhan, MD, Jacob A. Brown, MD, John C. Morrison, MD

Abstract

Objectives: Little is known about the psychologic effects on obstetricians and gynecologists of adverse maternal or fetal outcome and malpractice claims.


Methods: An anonymous survey regarding the psychologic effects of professional liability claims, as measured by 19 items which were used to create four composites rated on a 5-point scale, was mailed to the members of the Central Association of Obstetricians and Gynecologists.


Results: Among respondents, 78% had at least one malpractice claim, and 9% experienced a patient death, 12% a fetal demise, and 21% neonatal neurologic damage. In general, professional liability claims had significant effects on psychologic trauma (P < 0.001), shame/doubt (P < 0.005), and active coping (P < 0.05), but not on job stress, whereas patient death, but not fetal death or neonatal neurologic injury, had significant effects on all 4 composite variables.


Conclusion: Physicians experience psychologic trauma influenced by patient death and professional liability actions.


Key Points


* Obstetricians and gynecologists are likely to be sued, as 78% have at least one professional liability claim during their practice.


* Among those experiencing a professional liability claim, there were significant effects indicating psychologic trauma, shame/doubt, inactive coping, but oddly enough, not job stress.


* Physician experience of maternal death had a significant effect on all composite variables.


* Physicians experience psychologic trauma influenced by patient death in professional liability actions.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Charles SC. The stress of litigation: do we still have something to fear? Prim Care Update Ob/Gyns 2003;10:60–65.
2. Bettes BA, Strunk AL, Coleman VH, et al. Professional liability and other career pressures: impact on obstetrician-gynecologists’ career satisfaction. Obstet Gynecol 2004;103(5 Pt 1):967–973.
3. Benbassat J, Pilpel D, Schor R. Physicians’ attitudes toward litigation and defensive practice: development of a scale. Behav Med 2001;27:52–60.
4. Illinois State Medical Inter-Insurance Exchange. Cumulative Summary of Closed Claim Data (1976–2001). Chicago, IL, Illinois State Medical Inter-Insurance Exchange.
5. American Medical Association. E-mail News Briefs. Texas’ Efforts for Liability Reform Garner AMA Support. Chicago, IL, American Medical Association. Available at: www.ama-assn.org/ama/priv/article/1827-6102.html. Accessed November 9, 2007.
6. Martin CA, Wilson JF, Fiebelman ND III, et al. Physicians’ psychologic reactions to malpractice litigation. South Med J 1991;84:1300–1304.
7. Dejin-Karlsson E, Hanson BS, Ostergren PO, et al. Association of a lack of psychosocial resources and the risk of giving birth to small for gestational age infants: a stress hypothesis. BJOG 2000;107:89–100.
8. Kellner KR, Best EK, Chesborough S, et al. Perinatal mortality counseling program for families who experience a stillbirth. Death Educ 1981;5:29–35.
9. Chauhan SP, Chauhan VB, Cowan BD, et al. Professional liability claims and central association of obstetricians and gynecologists members: myth versus reality. Am J Obstet Gynecol 2005;192:1820–1826; discussion 1826–1828.
10. Druzin ML, Gabbe SG, Reed KL. Antepartum fetal evaluation, in Gabbe SG, Niebyl JR, Simpson JL (eds): Obstetrics: Normal and Problem Pregnancies. New York, Churchill Livingstone, 2002.
11. Charles SC. The psychological trauma of a medical malpractice suit: a practical guide. Bull Am Coll Surg 1991;76:22–26.
12. Strunk AL, Esser L. Overview of the 2003 ACOG survey of professional liability. ACOG Clin Rev 2004;9:1–16.