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Psychotherapist and litigation stress coach Gail Fiore discusses her KevinMD article, “Recognizing and addressing medical malpractice stress syndrome (MMSS).” In this episode, Gail explores the prevalence of MMSS among physicians, the common misconceptions surrounding it, and the significant impact it has on both individual doctors and their legal cases. She highlights the need for specialized litigation stress coaching as a practical solution to help physicians manage anxiety, depression, and other PTSD-like symptoms associated with medical malpractice claims. Gail also offers actionable strategies for improving physician-attorney communication and maintaining the quality of patient care despite the stresses of litigation.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Gail Fiore. She’s a psychotherapist and litigation stress coach. Today’s KevinMD article is “Recognizing and addressing medical malpractice stress syndrome.” Gail, welcome to the show.
Gail Fiore: Thank you. Thank you so much for having me today. I’m very excited to talk about how to beat medical malpractice litigation stress.
Kevin Pho: All right. So how did you get into this area, and tell us what exactly is a litigation stress coach?
Gail Fiore: I got into this, Kevin, because in 2008, I was the subject of a medical malpractice lawsuit. I had been in practice for over 25 years, and then I received a complaint. I was shocked. When I received this complaint, I had the wind knocked out of me. I felt like I was in the twilight zone.
And what I’d like to say to your listeners is this: It doesn’t matter how successful you are as a professional, it doesn’t matter how good you feel about yourself as a person—when you receive a professional medical liability complaint in the mail, it knocks the wind out of you and makes your heart stop.
Since I was in the field of mental health, I had a private practice, I put myself in psychotherapy to cope with the stress of being in litigation. And being in the field, I knew who was the top talent in my city, so that’s where I went. But in spite of my respect for their talent, and my respect for them and their devotion to try to help me, the best these psychologists could do was to give me consolation. They would say to me, “Don’t let the bastards get you down.” But that kind of consolation doesn’t work. It actually makes things much worse, because I would end up leaving the conversation thinking: If all they could do for me is give me consolation, then there must be something really bad going on.
So after about a year into the case, I made a decision that I could no longer call my sister or my friends and tell them that I was depressed and suicidal. I realized I had to help myself. So I googled “psychological symptoms of being in a lawsuit,” and all this research came up by Dr. Sara Charles. You may be aware that she did all this research about a physician’s psychological experience of being in a litigation, and her research was beautiful. I devoured all of it. Then I researched further the experiences of other physicians who had been in litigation and felt they were traumatized by the experience as well. Some provided excellent guidance on how to deal with the legal dynamics, but no one ever really said, “Here’s a way to resolve the litigation stress.”
So I developed one. I did it—so I was my first patient. I made my first treatment plan. I started getting a lot of positive feedback from my sister, from my friends, from my attorney, and that’s when I realized I had something that could help other people. I called up Sara, explained it to her, and she said, “Take it to professional medical liability companies and get it out there.” So I did. I call this my proprietary protocol, and it has helped many physicians over the past eight years. That’s how I ended up in this.
And the reason I’m talking to you today is that I understand the pain of being in a lawsuit. It is awful, and I’m talking to you to reach out to physicians who are struggling with being in litigation, they’re struggling with litigation stress—those who are currently in a lawsuit, those who were in a lawsuit but the lawsuit still haunts them, because litigation stress does not necessarily go away just because the lawsuit ends, and those who are not in a lawsuit but fear one could possibly come their way. What I want to say to them is: Have hope. There is a solution. There is a way that you can control your litigation stress instead of it controlling you. That’s how I got into this.
Kevin Pho: All right. You talk, of course, more about that in your KevinMD article, “Recognizing and addressing medical malpractice stress syndrome.” Talk about that article, and before you do, tell us what exactly medical malpractice stress syndrome is, and how is that stress different from other types of stress?
Gail Fiore: That “medical malpractice litigation stress syndrome”—what it’s really about is distinguishing legitimate concerns from fears. When you’re in litigation, you can’t sift out what is a fear from a valid apprehension, because it all gets mixed up for you. In addition, every personal issue you have—when you’re in litigation—gets lit up. It gets lit up into crisis.
If it’s a fear, remember fears haven’t happened yet. Since they haven’t happened yet, there really isn’t sufficient data to substantiate them. You can contort information or contort experience to make you think it’s real, but in fact, the case isn’t over. You haven’t lost the case. You haven’t been found negligent. You haven’t lost your last dime. Physicians can get caught up in that, as opposed to valid, legitimate concerns that have actual, concrete data to substantiate them.
I could go into all the symptoms of litigation stress, but that’s really what it’s about—getting caught up in the fear. In my work with physicians over the past eight years, I would do the initial consultation and find out what was really going on with them. Four major fears would come to the fore.
The first fear that I heard most often was the fear that they made a mistake. Even if they would deny that at the beginning of the interview, once we really got into the meat of the interview, that fear would crop up: “I do worry and wonder if I missed something, if I should have gotten a consult,” etc. They can get caught up in that and then start living in response to that fear, sabotaging themselves, undermining their confidence and competence in how they practice.
The other fears that commonly come up are the fear they’d lose the resources to be able to provide for themselves and their family; another fear is rejection from peers and from family; and then the haunting fear of “Who’s going to sue me next?” and “What’s the next bad thing that’s going to happen to me?”
The name of the game is to get someone to help you identify your fears, sift them out from valid concerns that need to be logically addressed, and not to get caught up living out a script in response to a nonreality.
Kevin Pho: As we know, sometimes these malpractice cases can last years, right? This isn’t something that’s resolved in a matter of weeks. Talk about some of the stories you’ve heard from your physician clients about the toll it extracts from them professionally as well as at home.
Gail Fiore: They’re very worried about their children. The litigation turns their family life upside down. There’s a lot of concern about marriages. Some marriages have a partner who is very supportive. Sometimes the partner is upset and calls me. It can really undermine and deteriorate the marriage. Sometimes the partner needs to participate in litigation stress coaching as much as the physician because attorneys will tell them, “Don’t talk about the case.” So we don’t hear the nitty-gritty of the case, or what they actually do in their practice. But you can hear that they become much more cautious about what they do.
I’d say it’s tremendously isolating for physicians who are undergoing a medical malpractice lawsuit, the fact that it’s completely upending their personal and professional lives, yet they’re not really allowed to talk about it with anyone.
That is, I would say, the most common complaint they have: often another physician is involved, so they can’t go and talk to that physician about what happened. So they have to carry around unresolved issues and questions inside them. They can’t debrief with the other physician, and it gets all tangled up—what they’re accused of, what they’re not accused of, what they feel they should be responsible for. They can’t debrief with the other party, who is probably going through the same thing.
Kevin Pho: Now, other than coaches like yourself who specialize in this, do physicians have any other resources they could turn to?
Gail Fiore: That brings up two points I want to say. First of all, Kevin, I’m a psychotherapist, been one for 40 years, love being one, constantly training to be even better. With that, I’m going to tell you that psychotherapy is contraindicated for dealing with litigation stress, because the therapist, in an attempt to be empathetic, will say to the physician, “Tell me more,” or “What a terrible burden you’re carrying.” That puts the physician in a position to talk more and more about the fear, so they re-present the fear to themselves, they reinfect themselves with trauma, they build up in their mind that the fear is legitimate and real, and they build up their anxiety instead of dismantling it.
What in fact has to occur is for the psychotherapist to be able to recognize what is a fear and what is a legitimate concern, examine the fear with the physician, enable them to see that it doesn’t hold water, and then delete that fear so they don’t live out a life in response to it. That’s the primary reason why psychotherapy is contraindicated.
The other reason is that psychotherapy is typically client-centered. When you’re in litigation stress, as I said, every main issue you have gets lit up. So you’ll come into a session and whatever is most problematic at the moment is what you’ll dive into—like, “Oh, my partner is upset, I’m having a problem with my adolescent child, the person who is supposed to do intakes isn’t doing them right.” You get lost in that and go down rabbit holes. You won’t deal with the root of litigation stress, which is to address the fears and get them out of your mind. One of the most common complaints I hear from physicians is that they can’t get the case out of their head. The way to stop that is to identify the fears.
Kevin Pho: So what are some tips you can share with physicians who are listening to you now and may be dealing with litigation stress? Short of finding a coach like yourself who specializes in this, what are some things they can do?
Gail Fiore: I guess if I was to suggest something, I would say this: Write down everything you perceive your concerns to be. List them. Then go down through them—if you can’t go down through them with someone close to you, do it alone—and ask, “Is there evidence to substantiate each concern?” Scrutinize that evidence: is there actual evidence for the concern you listed?
If there isn’t sufficient evidence, delete it. Don’t waste any more time thinking about it or considering it. Get it out of your mind. Then address the concerns that do have validity and need problem-solving.
I would also really encourage physicians to get some kind of professional assistance. I say that because videos, YouTubes, websites, books on litigation stress—they’re all great, but they are not enough to free a person from the intensity of experiencing litigation stress. What’s needed here is the human touch, and that’s why I say it’s beneficial for them to find someone who understands the dynamics of litigation stress, can help them sift out fears from realistic concerns, delete the fears, and move on with their lives. Otherwise, it can hold you captive, and you don’t want to be captive.
Kevin Pho: Tell me a success story of a physician—or it could be an amalgamation of cases—who has come to you for litigation stress and you really moved the needle and helped them out. Give us a success story.
Gail Fiore: Sure. I had one gynecologist call me—she was young, in her late 30s—sobbing on the phone about what happened to her patient, insisting she would not allow herself to feel better until she knew her patient was OK. So she was going to torture herself until she knew that patient was OK. I interviewed her, heard her other concerns, then referred her to a coach in my practice. I did a follow-up in three days, and it was, “Hi, Gail, how are you?” She was fine.
I get a lot of that. It’s really interesting how effective this protocol is. Some physicians can free themselves of litigation stress in one session; some need more; some love the relationship with the coach so much they don’t want to stop. But I get many stories that their lives changed, and not only is the protocol helpful for dealing with litigation stress, but it’s relevant for all areas of their lives. They learn how to control their anxiety in other areas, too. We encourage them: teach what we teach you—teach your patients, your children, your friends, your family members.
Kevin Pho: We’re talking to Gail Fiore. She’s a psychotherapist and litigation stress coach. Today’s KevinMD article is “Recognizing and addressing medical malpractice stress syndrome.” Gail, let’s end with some take-home messages that you would like to leave with the KevinMD audience.
Gail Fiore: I would say: This is not a situation where it’s “physician, heal thyself.” Don’t be proud. I know you want to feel you should handle this yourself, I know you want to be in control, but I want to say, seek someone who understands the dynamic of litigation stress. Allow yourself to be in a personal relationship, get the help you need—there is a solution. You do not need to suffer needlessly or alone. Get help. There is a solution.
Kevin Pho: Gail, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.
Gail Fiore: Thank you very much, Kevin. It’s been a delight.
