Dr. Gita Pensa - The ‘L’ Word: Litigation Stress, Malpractice Stress Syndrome and Survival

in some questions. OK. Oh,OK, yes. She looks, he looks great. And so. Yeah. Yeah. My question. How's that going? It's a very, very, very busy. Is she? Oh. She's really good at it. Yeah. I think my race is going to be tough. Yeah. Yeah. Here. Yeah. Yeah. Yeah. Yeah. It's a very, very busy. Yeah. Yeah. Yeah. I don't know where I just... Yeah. Um. Yeah. Yeah. Yeah. Yeah. I don't know how to do it. I don't know. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. I don't believe there were any fun facts with the person here. Yeah, I didn't really start the live. I didn't really start the live. Thank you. Yeah, I had a question. I just wanted to say a little bit about the experience. I am. Early work. I was thinking of you. You know what happens when you're treated. How are you? I'm good for the owner. Yeah. I know that you're bad for your family. I know this. I think it's like you do have to something. And you know that. Yeah. Yeah. Yeah. Oh. Yeah. No. Yeah. I know. Yeah. Yeah. All right, good morning. We're going to get started. I'm really pleased to announce Dr. Gidepenta today. She's coming to us from Brown. So fairly regional, she's good for her. And then she just told me that her daughter has her orientation at BU this morning. So that's exciting. They came up together. So a couple things. Dr. Pints is going to speak to us on the really the stress of malpractice and litigation. And that's where this falls into the health and wellness lecture series. And I'm excited that she agreed to come speak on this. I think this is one of those things that unfortunately many of us will experience in our careers and being proactive about understanding these stressors. Can I think help us be more mindful through the experience? Should it happen to us? Dr. Pints, I got our undergraduate at BU where her daughter is going to orientation this morning. That she went on to UPIN for her medical degree and then George Washington for her residency in emergency medicine. She's now an assistant professor at Brown and holds many faculty and consultancy roles dealing with the role of stress of litigation. The other thing I want to mention is the way I came across Dr. Pints. And it was actually through Twitter. I know a lot of people are not believers in the medium, but it's a really good way for people, especially in academic medicine, to meet one another virtually or in real life. And I was happy enough to stumble across her podcast on this subject. It was very impressive and thought it was something that I wanted everyone here to hear as well. So I'm very pleased to introduce you, Dr. Pints. Hopefully everyone can hear me in short. So I don't know if I reached the mic quite well. Is that good? We're good. Okay. Thank you so much for having me. I'm really very, very pleased to be here. I know this is a topic that a lot of people don't like talking about. But for this next hour, one good thing is you just get to be in your own head. I don't think that we get to do that an awful lot just to be sort of introspective. You don't have to suck up a lot of data. You just have to listen to a couple of stories. And then we're going to talk a little bit about the problem in general. So I'm going to start you off with a little bit of my story. I'd like to take you back to 2006. And I guess that some of you were probably in grade school. I was a fairly no attending. I'd been out for five years working in a community emergency department. I was a nocturneist. I worked nights. And I was usually the only doctor in the hospital at night. So one night I took care of a 31 year old woman. She was an engineer. And she had a very, very confusing presentation. I really did not know what to make of it. But I took it quite seriously. It's been a lot of time with her and her husband trying to sort out what was going on. I did a very thorough history and physical. I imaged her. I called a consultant. So I woke them up at three in the morning to talk about it. I examined her again and again and found her improved. And then I wound up discharging her home with a plan in place to see that specialist that morning, nine o'clock, three hours from her discharge time. I've said she never made it there. Instead, she went home and went to bed. And an hour later suffered a massive cerebellar stroke. Massive. She's 31 years old. So because she was taken to a tertiary care center after that, I had no idea that anything had happened to her. This is the way you were in team medicine work, seven. But I had no idea anything had happened to her until several months later when I was named in a lawsuit. And it's proverbial, but the expression hit with a ton of bricks sounds about right. I was completely floored. I was devastated. I had read the complaint and I wanted to vomit when I read all the ways that my negligence my malpractice had contributed to this patient's awful outcome. Nothing in my training had prepared me for that moment. I had had a couple of lectures on risk management, right? I'm not to get sued. But not one word, literally not one word about what to do once the envelope was in your hand. Once that finger was pointed at you, what did you do? I had no idea. I had no idea. And I felt utterly alone and ashamed and isolated. I had no idea who to talk to, who to ask. I didn't even know what the first stuff was after you got the papers. What did you call? What did you do? I had no idea. I didn't even know what my carrier was. And so we're going to talk about it now because this is something that happens to the grand majority of us. And it should not be the case that you don't know what to do or what to expect when, not if this happens. So a couple of housekeeping things to get out of the way. I don't have any related financial disclosures. I'm also not a lawyer. I have been around the block a few times. And so I know of what I speak in general, but don't take your legal advice from me. And you're going to hear some excerpts from a podcast that I do about litigation. And I call it Doctors and Litigation, the L-Work project. And that is not really reflective of my hospital system of brown or of lifespan. So I'm going to start with just a little bit of audio. This is not mine. This is from NPR. All right. So there's a lot to unpack in that. So lately we've been having a lot more attention paid. So wellness and burnout in medicine as a whole. And there's not one special team that is unaffected. Surgery is affected. And it's just affected. And the grand majority of all of us, if you practice long enough, will be sued. And what we do know is that physicians who are being sued are at much higher risk for burnout and for suicide. And this is why we need to talk about it. So the reason I call this project the L-Work is because we don't like talking about it. There are all sorts of things that we like to prepare for. As surgeons, anesthesiologists, as an emergency physician, we like to be prepared for bad things. We simulate them. We rehearse them. We mentally go through what are the steps required to get through this. But we never, ever do that for this. And it's a cultural issue in medicine. But what it leads to is us being entirely unprepared. And this is how one doctor put it. And all of the voices that you're going to be hearing are physicians who are still practicing. But who wanted to share their stories for this podcast just in an effort to help people who are coming up behind them. So at the end of my kids, you guys like kids, right? And so some of the places where I've spoken about this, I've gotten a little pushback from people who say that it's hard to talk about. People shouldn't really be, I shouldn't be scaring younger physicians, trainees. And so I like to tell this story about my youngest, this is Sonia, who not long ago came to me and said, Mom, what's a period? I said, oh, okay, I guess it's time to talk about that. So we drew some pictures. I went, you're some ovaries, stuff like that. Everything was good. Until we got to the part about bleeding and she said, whoa, whoa, whoa, wait, wait, wait, wait, wait, what? That's going to happen to me. And I said, yes, pretty good chance it's going to happen to you. I'm probably not not too long from now. And she said, stop talking. You're ruining my life. You ran away. And you know, I tried to, you know, later on, I figured, well, we'll come back to that. But it's probably better that she's a little bit informed like, oh, maybe that's what she was talking about. Then to be completely blindsided and think like, is this, I don't know, the only person that's happens to, when in fact, you're not. It happens to you almost all of us. And so a lot of times, trainees feel like that. When I speak to my residents about this, the most common answer, I get like, well, what would you do if you were a suit? The first is usually, I don't know. And the second is usually I would quit. And that says a lot. If in high-risk specialties over 80% of us will be sued, if you have a long career, that says something. So even though it's uncomfortable, we need to talk about it. So why should we be prepared? Well, if for nothing else, you should know that stress defendants, people who are burned out and very stressed by litigation tend to make more errors, which makes this sort of vicious cycle, prepared defendants make better defendants. If you're better prepared to go through the rigors of a lawsuit, you will be a better defendant and more likely to win altogether. This will happen to the majority of us. If you keep practicing, really the only things that matter in terms of being sued, I know we talk all, we're going to talk about all the things we talk about in terms of keeping you out of lawsuits, but really it's now in patients you see in how long you practice. And then the fact that we are unable to talk about it openly perpetuates the stigma and isolation that goes with it. But in fact, if we are all getting sued, how can we all be bad doctors? And finally, it's just the right thing to do. As I said, we prepare for things that are rare and difficult medically. This is something that we should be prepared for because it will be a very large professional hurdle for most of us to get over and we need to be able to teach our learners about how to get through it. So a little bit of good news. It's very rare for cases. Well, I say very rare. It's less than 10%, but if you know, if a lot of people are getting sued, that's actually not that insignificant a number. I've been to trial and talk about that. There's this notion of punitive damages where they're going after your personal finances. Those are very rare. And overall, the rate of paid claims is down by over 55% since the 90s, but the mean payment has gone up. A little bad news is that in higher specialties of which surgery is definitely one. Merring to medicine store in the middle that's my and anesthesia is somewhere right below that. We'll be naming that some point during your career if you have a long career. And every year about 7.5% of all physicians are named anew. And nowadays, you know, I hear more and more about plaintiffs attorneys using these tactics of threatening personal financial risk and that is incredibly stressful. But it is still rare for that to happen. And then there are certain states. I highly that Rhode Island because that's where I am, but Massachusetts is up there also with those of the states. Now, I will say if anyone feels like doing research in this topic, it's definitely needed. Like most, you know, a lot of hard data comes from 2011 was the most recent big paper about this in New England Journal, but we could use you. So it's easy to do it, right? Why is this so hard? It's really hard, but it's hard to talk about for so many reasons. And part of it is that we teach you all this stuff, right? You will not get sued. This is risk management, right? You will not get sued if you practice good medicine. If you show your patients that you care, if you stick to your protocols, and if you deviate from them, you document, and you document well in general, and you don't get angry at your patients, and you should never look like you're in a hurry, and you sit down to talk to them, and you hold their hands, and you look in their eyes, and you listen to them, and you instruct them clearly, and you make sure they understand. Kind of the bad, I don't know if you can see the bottom of the screen, but the basic message seems to be like, just don't have any bad outcomes, and everything will be fine. So you're not any bad outcomes, you won't get sued, and then, yeah, but the inference there really is that if you get sued, you must have done something badly here. You did not manage a risk, right? Something, something you did led to this bad outcome, and sometimes that might be true. And I'm not saying that's not either, that is something that definitely happens, and we should talk more about that within the House of Medicine, but the general gestalt is, you didn't do something here, and that's how you got in this mess. So one thing that we, you know, be sort of go hand in hand, the adverse event in general, is something that we also don't talk a lot about, right? So I imagine, you know, starting your career and feeling like, oh, if I do everything right, then everything will always be fine, and people who practice long enough know that that's not true, okay? So we're sort of mentally unprepared, psychologically, we don't really have this discussion very often about how do we deal with the adverse event in general, right? And there actually is this whole sort of psychological, and this is, you know, basic human response, and we are not immune, not even surgeons, not even anesthesiologists, and then I'm just a really immune to normal basic human responses to very large psychological stressors. So there's this whole, you know, cascative events, you know, the horrible thing happens that you weren't expecting, and then there's these things that you have to work through where eventually, psychologically, you will become okay with it. However, at every step, there are ways where you could develop sort of a maladactive response to this, whether it's with just excessive reactivity, meaning that you're just really sort of hypersensitive about things you can develop in acute stress disorder where you are just all the things you recognize in your patients who have, who have acute stress disorders. Those could really happen to you. Maladaptive behaviors where we're talking now, substance abuse, anger issues at home, you know, you're fighting with your spouse, you're kicking the dog, you're reacting in all sorts of really unhealthy ways. And finally, if it's not worked through, then definitely PTSD is something that we see in physicians that have not really adequately dealt with the adverse event in general, and especially as it comes into then perhaps litigation and what becomes a much more chronic stressor because litigation has a tendency in the last few years. So getting back to why this is so hard, well, most of us are perfectionists, right? And that's good. That's good. We want to do our very best for our patients. We want to be as skilled and educated and as thoughtful as possible, right? But it's an awful heavy load to carry around. And society also, as we know, also expects perfection, right? Nothing less than a perfect, complete, normal outcome. We do take responsibility for our patient outcomes. Sometimes we take outsized responsibility for those outcomes. And sometimes we feel like we did everything right and something bad happened anyway or we're getting sued for nothing and the anger that can come along with that, the bitterness and the resentment that can come along with that is really not to be discounted. Once you enter the litigation process, you'll find that you have virtually no control over what happens. And that's a super hard place for physicians to be because we like to be the person in charge. And then once you find that other people are calling shots and you are a bit player, it's hard to swallow. There is a great deal of isolation. People that I talked to about this, that's the thing they keep coming back to is that this is this really difficult time in their lives and they're kind of told from the outset, like you really can't talk to anybody about this. We're going to talk about that in a second. That's not really entirely true. But they're also afraid of their colleagues finding out they're afraid to tell their family. They're afraid that people in the community will know that they're being sued and think less of them. And it makes it really very very difficult to deal with. In no other space, do we traumatize someone and then say, okay, now keep that to yourself. It is not healthy. It is not good. And then finally, some, a lot of people do worry about financial ruin, as I said before, it's exceedingly rare. But when there's any chance, it's hard not to worry about. So this is the way one another physician very respected academic in Philadelphia practiced for 40 years, seven lawsuits, went to trial twice. And stayed in it, but had a lot to say. So here we are. We're named in a lawsuit. And there is this constellation of symptoms different for everybody that are actually normal and expected. This is a normal, expected reaction to an ad-mormal stressor, especially compounded by the fact that we're telling you don't really talk about it. So guilt, self-acquisition, if it was something you feel that you were responsible for, you were afraid of repercussion or judgment, you are in shock, you feel traumatized, you are ashamed. Impostor syndrome is something that we're talking a lot about these days. This whole feeling, like really there's nothing that will trigger imposter syndrome, like being named in a lawsuit, where you feel like I can't do this job. I just shouldn't be here, I cannot do this. And the obsessive recounting of the events or how things went wrong or just could something have gone differently, it can become very intrusive. And that's something that we see a lot. And so what winds up happening are this myriad of symptoms that you probably recognize in patients who are very stressed. Physical symptoms become really predominant. Actually, we'll talk about that just a little more in a second, but an older surgeon, actually I was talking to one into A5 the day after he was named. It's really very common to have minds typically GI, but physical symptoms become more and more important and intrusive. Depression, anxiety, difficulty, or task with work, strain on relationships. I don't know if this is something that really occurs to people, but when you are put into this position of longitudinal stress for years and years and years, it tends to come out at home. It's hard not to let it come out at home. And if you think that it's easy for a spouse or a partner to deal with that day in and day out for years and years, it's asking a lot of someone. And so, oh, sorry. So this is where you feel like things are kind of coming out and really taking a toll. When you start to find that it's affecting your everyday life in terms of how you feel physically as well. So if you're anxiety, depression, reactions, GI symptoms, remind, sort of eating, and this is what one physician has to say about it. So next to my story. So I, it was typical textbook, although it's not in any textbooks, litigation stress, what I found myself going through, sleeplessness, weight loss, tears on the way into work alone in my car. Every patient was a minefield. I was just terrified of missing something or hurting someone. And at home, I was impatient with my children. I was ballistic with my spouse. You know, every lawyer's correspondence would bring this just flood of negativity that would last for days. And that was the thing that's never seemed to end. The weeks turned into months, the months turned into years. There were these series of events that would just knock me flat. Settlement offers were rejected. Mediation attempts failed. And I had anxiety and depressive symptoms. I've never had them before in my life, but they continue to mount, especially as it became apparent that we were heading to trial. I had little control or even understanding about what was happening. I was a chess game. I mean, I was a piece in a chess game that had $28 million stakes. That was what they were asking for. And I was with Soul Defendant. And I had seen the play out before. I had seen in our state, you know, front page news about giant verdicts in our state naming positions, you know, calling them out by name, listening all the ways in which they were incompetent. I really didn't think I could take that. We'll get back to that. So a couple of practical points just because I want to leave you with some tangibles, okay? So you've been served. Now what? As I said, I had no idea what to do, right? So a few pointers. The details of your case. There is a difference between talking about what's happening to you and talking about the details of your case. Yes. The needy-gritty details of your case you should save for your attorney. So the first thing that happens is you're going to call your carrier, right? You're going to find out who your malpractice carrier is and learn about that. That's a good thing to know before your student. You're going to call your carrier. And if you don't already have a lawyer that you want, they will help you find a lawyer. And everything thereafter goes through your lawyer, right? They're going to be your stranger. When you're a stranger in a strange land, they are going to be the person that guides you through. The details of your case, they're going to give you your attorney. There are some exceptions. Pure review. I want everyone to be careful now because pure review is actually under attack. Hospital reporting systems. That's actually a thing that's happening in Rhode Island right now. In a case that's going on, we had to turn over our event reporting from the hospital. So things that you really think should be protected may not be so be careful. A lot of times we talk hypothetically. You know, I won't say anything about that except that that's what people sometimes have to do to kind of get through things. Let's talk about, because the urge is you want to talk about the medicine. You want to know, like, did I do something wrong? Can someone who understands this, tell me, like, would you have done something different? This is one of the hypothetical cases. You just need to be able to say a deposition. I have not discussed the details of this case with anybody but my attorney. That's the, there's no law against you're talking about it, but it's because they will depose people that know about what happened. Okay? So you just have to be as true to that oath because it will be under oath. The true to that oath is you can be. And even spouses in some states are protected. Other states are not. So you have to know the details of what's happening in your state. But you should tell family and friends that you've been named and how you're coping. And you should seek out colleagues and other physicians who have been through the process because they get it. Right? You tell another doctor, I'm being sued. They get it. You don't have to go through a whole bunch of why this is important and why this feels terrible. They understand. So many hospitals now have peer support systems. I don't know if you have one here, but definitely avail yourself of those. And finally, there are books and professional society resources that will help guide you through this process. I highly recommend that you get one and you read it. I highly recommend that you do that before you were ever named. And these are some that I like. Sarah Charles, the psychiatrist, and she was really the first person to do research and to write about this after a federal malpractice case that happened to her in the late 70s, I believe. I liked the second book. Someone gave that to me during my process and just the title made me feel better. You know, when good doctors get sued, oh, good doctors get sued. That's good to know. Someone wrote a book about it. So I guess it's true. That actually lives in my nightstand for a long time. The last one is just a sort of nothing bolts. Like this is what happens. This is the step. This is how you prepare, which I also found very helpful. There are several of them. And other other physicians may have other recommendations. This would be great. If you can do it hard, hard, but people who were able to do it, you know, that's I highly recommend. I do want to mention that, you know, I said before that all those symptoms are normal, human reactions to an abnormal outside stressor. We are used to add normal outside stressors, right? That's what we do. We take that stuff. We internalize it and makes us stronger. It makes us better. Right? This does not. Okay. So if that stress is not handled well, because it's something that's completely foreign to us. As you heard that older physicians say, like this is, you know, we, we really run on our egos. I mean, we do, right? And so when someone is attacking them, it's very hard to keep your equilibrium and the confidence required to keep doing our jobs the way we do it. So litigation stress is on a continuum with what we're now calling malpractice stress syndrome, which is really just like any disease. There's a spectrum of it, right? And so if you wind up on this end with really affecting your ability to live your life and to do your job, if you are abusing substances, if you are thinking of suicide, this is where you are. And this is where you really, really need to start seeking outside help. Could you hear what he said? He said he's sort of saying I had a death wish. I had unhealthy relationships at work. He is chair of his department. He still is. And so what I, what I hope to get through this when you hear all these voices is that this is not a bad doctor problem. Okay. We just, we need to get out of that mindset. This is not a bad doctor problem. This is an accomplished physician, any specialty problem. So all of us are at risk for malpractice stress syndrome because we're all at risk for being sued. But the people who are typically at the highest risk are in cases, you know, some obviously some lawsuits are new instances and some lawsuits are soul-shattering. And cases where there's a very poor outcome or death are certainly more stressful. Cases in which the physician feels that it was their mistake and there was a bad outcome typically or higher risk. People will have underlying depression and anxiety or burnout aren't high risk. The data says females tens, words depression, males tens, words substance abuse. I don't think that's a hard and fast line. High stakes cases where they're seeking punitive damages, where the press is involved, where you feel like you're under the magnifying glass. Those can be extraordinarily stressful. One of, there's a website called MDMentor.com that's Louise Andrew who's an MD JD who's written extensively in this talk in this arena has developed a survey where you can go or your spouse can take it or whatever and to see if it seems like you're at high risk for malpractice stress disorder. I'm just going to see how we're doing on time here. I think we're okay. So this is her. So there's a lot of barriers to seeking help. A lot of them are self-imposed. This feeling like we should not be seeking psychological help because we are supposed to be strong like our attendings. But of course as you know, now here in some of these voices your attendings are probably also dealing with this at some point during their career. There are other barriers that are real and they vary from state to state but state licensing boards can be very difficult if you're reporting anything about seeking treatment for depression or anxiety. If you find yourself abusing substances, it's very difficult to get help without worrying about your license fees. Concerns are real and valid. However, we still need help. And so the best advice that I can give you currently, depending on what your local culture is, is to avail yourself of that peer support network. To find those doctors who have been there and help you navigate what you need in terms of getting help. But obviously when it gets to this stage of really significant psychological distress and suicidality, it is time for professional help. This is how one physician put it. So we need more help and we need to help. Each other. So litigation turns into a very chronic disorder. You almost can think about it like an illness where it's a chronic stressor and that is acute of exacerbations at deposition time or when settlement fails or when you're heading to trial. So every time you feel like you've reached this sort of this point of equanimity, there's something else to kind of push you over. And so if it's not managed, again, this turns into a process that lasts for a long time. And so what I ask of you is to find somebody. None of us should be going through this process alone. I recognize that there are barriers to talking about it, to getting help about it. But it's really important. And this is that same physician. That emotion that you hear in her voice is a decade after it happened. So I'm going to bring it back to that athlete analogy again. There needs to be one, at least one, but one, please one person, who understands what is happening to you and the significance of it that you can talk to about this. Someone who preferably has been there who gets why it's painful, who doesn't need a lot of explanation, but that you can lean on when it's time because this is extraordinarily difficult. And it will probably happen. And so getting back to that athlete analogy, you'll see why this is relevant in a minute. This is the 1992 Barcelona. So some of your old enough to remember this. The athlete's team is Derek Bredmond. That's his father who also was his trainer. I love that. I don't know if you can hear the cheering. So at some point in your career, you may feel like Derek Bredmond. And at some point in your career, you may have the opportunity to be Derek Bredmond's dad. So what happened to me? Well, I did indeed go on trial in 2011. It lasted for four weeks. They were horrible. There's really no sugar coating it. They were among four of the worst weeks of my life. But I did win. And I went back to work. I was still miserable, still hated it. But I also did not know what else to do with my life. I, being a physician, was really everything I had ever wanted to be. And just a huge part of my identity. And so I went back to work. Just kind of going through the motions until I got the notice of the plaintiffs intent to appeal. And that was not even anything that had actually occurred to me as a possibility, but indeed it was. And so the nightmare as it was started all over again, as it proceeded through every level of the state courts. And in 2015, my verdict was overturned. And I found myself heading back to trial. Any Hunger Games fans here? It was very very catnous, everdeen having to go back for the quarter quail. I just, you know, it was incredibly unfair. And I did not actually think that I would survive. And I begged, literally begged, my insurance company to settle, because I just did not think I could go back to trial. And as I mentioned before, you had very little control in these processes and they would not settle. They actually felt that I had done everything medically possible for this patient. And were fairly insistent that I go back to trial. I was not well. And I just did not think I could do it. Until one day, after a particularly stressful phone call with my attorney, talking about getting ready for trial, I hung up the phone and, you know, these great heaving thaws that I had become very acquainted with. Finally had what I described as my scarlet ohera moment. If anyone's really old enough to know gone with the wind when I had a scarlet ohera moment where I decided a decade in, okay, I will fight this. But with God as my witness, I will never be like this. Again, I had spent 10 years, 10 years of my life just underwater struggling with this, continuing to work, being unhappy and depressed. And I finally realized somebody somewhere has to know how to do with this better than I am. And that's a huge admission for any of us. I mean, I'm into an Ivy League medical school. I was AOA. I was, you know, I'm really good at what I do. It is a really hard thing. I'm sure for any of you in here, to realize like, I suck at this. And I need help. I need help. I am doing a really bad job. Someone somewhere must know more than I do about this. And so for the first time in my life, I got self-help books. I ordered books about litigation, the books that you saw, I ordered books about coping with longitudinal stress. I read them. I took notes in the margins. I tried the Hoke exercises that are actually not that Hoke and they work if you actually open your mind to the possibility of them working. And I tried to make myself better. And I'm not saying that it was an easy process. But I am saying that as soon as I opened myself to the possibility that I could try other things and maybe feel better that I started to feel better. So one of the first steps was to feel, to say to myself that if I cannot learn to love medicine again, I am leaving medicine. I have to learn how to like this again. And so, you know, I started very small. And it wasn't in the trauma day. It wasn't in, you know, the real, you know, giant resuscitations. It was just with meaningful human interactions with patients, right? Just every time I'd walk into a room, I would think, where is the good in this? What can I do? I have a set of skills and this person has a need. What can I do in this capacity to help them? I read an essay about the spiritual satisfaction and taking care of, you know, societies forgotten the homeless, the chronic alcoholics. I cut it out. I carried it around with me in my pocket for a long time. And then gradually, you know, the love kind of started creeping back in and then I started making other changes. I actually started looking at the lawsuit through a very different lens. It's something that kind of gave me license to make choices that increase my happiness, my family's happiness. I would say, I'm getting sued and it sucks. So I deserve X. A lot of times the X was, you know, chocolate. But sometimes it was, I am changing my job. I am joining an academic faculty. I am learning to teach. I am learning new skills. I am learning to blog and podcast. I am finding ways to reinvent myself. I am working on the marriage. I am spending time with my kids. I am doing things that make me a better person and a better doctor. Kind of by default. It became like a social experiment with an end of life, with like in trial A, intervention, trial B. And it turns out that the results were actually quite positive. So I want to leave on a little bit of a higher note. So I was doing actually pretty darn well. All things considered approaching trial number two. And then about six months ahead of that, I kind of thought, you know, I'm thinking a lot about this trial. I think I need something a little extra to distract myself in the next few months. And I was talking to people. I was talking to my friends. I was pretty open about what was happening. Everybody at work knew it was actually really kind of helpful to have the support of people that I work with every day who would just say to me, like, you know what? Whatever is coming at you, you're better than we like working with you. You know, we've got your back. And I got an email from one of my colleagues who knew what was going on. And it was about a charity ballroom dance competition for doctors called Dancing with the Doctors that happens in Rhode Island every year. And I had heard about this before and thought that it was kind of cool. And Amy, this is where Angel Anderson is the she's the MC every year. And it you fund raised for a particular charity for that year. And then it culminates in a giant gala like a thousand people gala. And I thought before like, oh, that sounds fun. But I don't I really don't have time to do that. And then I noticed the date. And the date of that year's gala was one week before my trial was supposed to start. And I thought, well, maybe this is the thing, right? It's going to keep me distracted. It's going to give me something else positive to do. Terrified of it. It'll give me something else to stress about. So I filled out the email and I had sent and I had this like, oh my god, what did I just do? Moment. And then I was in it to win it. I was in it to win it. I shook down everybody I knew for money. I trained with a professional ballroom dancer for four months, at least twice a week. And he was this Czechoslovakian or Czech Republic three time national ballroom dance champion. When I say this through dance, you could dance. And it was really one of the most singular, coolest things I have ever done. So at the gala, one, you know, again, one week before trial was supposed to start, I am happy to report that I won. Thank you. And having reached $25,000 for the Ryland Freaks Clinic on my own, when I say through myself into this, myself into this. And, you know, in front of a thousand people, including a third of our ED staff that came, nurses, secretaries, techs, docs, they all knew. And they all knew why I was doing it. And it just felt amazing. And it was this reminder that, you know, what will save us in the end are our relationships. And people love you and want you to be okay, right? They do not think less of you because this is happening to you. And so one week later, I walked into that courthouse for the second time. My head held high. I had also trained and prepared for that role as well. I, you know, testified for days like a boss. And I wanted to be the model of grace under pressure that I would like my children to admire. Remember, this now had been 12 years, 12 years of litigation. I had an pregnant with that little kid Sonia asking about her period. I had been pregnant with that kid when I saw this patient. And now, they're teenagers. Watching to see how their mom dealt with it. And I was going to do it right. Those same nurses, techs, docs that had come to the gala, came to the courthouse. Day in, day out, they made a schedule. They came to talk to me during the breaks. They told me, like, this is all BS. Like, don't listen to the thing they say. Like, you know, we're going to go after this. It's going to be okay. And it meant more than you could possibly imagine. Three weeks later, I won a second time. And this time, they declined to appeal. So for the first time in 12 years, as of last year, last April, I was finally free. And I could make a good argument that although I will never say that I'm glad this happened, that I am finally stronger for it. And what I know is that my career is more than any one case and so is yours. So, what can you do? Talk. Talk to your friends, talk to your family, talk to each other. If you're someone who's been through this, let people know that you can serve as a light for them. Lots of places have support networks. Your professional societies probably do. If you recognize that you are in trouble, please seek professional help if you know someone who's in trouble, walk them to help, get them there. Educating yourself on the process is crucial because knowledge is really an antidote to anxiety, the more you understand about it, the better you'll be. And then some of the hockey exercises really do work. Make a list of the things that make you happy about what you do. Refer to it often. Remind yourself that this process is about money. It's not about blame, certainly not about medicine. There's a lot to say on that topic, but it's about money. And the sooner you can really make that realization, the better off you'll be. And finally, this is a skill set like any other. If you talk to my attorney, he would tell you that I was probably one of the worst defendants that he had encountered. Actually, he does say that in one of the podcasts coming up in here and say, you were probably one of the worst. Then he now he ranks me at maybe his top five trial test fires. It's skill set. You can learn it. It's just it's foreign to us, but you're smart people. You can learn how to it's a game. It's a game that you need to learn how to play. You can all do it. It's not rocket science. It's not surgery or anesthesia. It's just learning what your job is and then learning how to do it well. And the sooner you acquire those skills, the better off you'll be. And then finally, when you've been through it, that people know you've been through it and that you can serve as their advocate. We need advocates on a national scale. We need advocates on a state scale in terms of changing the way this game is played because it's really not fair. But in the meantime, we just need to be there to help each other to get through it. And finally, if you are someone who's been through it or in a position of authority in your institution, there are ways to be better colleagues. We feel isolated because sometimes you hear whispers that something's happening that you don't want to talk to them about it. And they seem like they don't want to talk to you about it. But reach out to them. Reach out again because they'll probably rebuff you the first time. Say something. Anything. Doesn't have to be about the case. It could just be like, you know what? I heard something's coming at you. I just want you to know that I think you're better than that. I like working with you. I think you're a good doctor. I love doing cases with you. Even if you're a resident student, I love working with you, Dr. X. I always learn something. Something positive. Because of I said, this is when we all start to feel doubts. Advocacy, politics, research, we need all of these things. And for the leaders, what we really need from you is active support. It's actually the chair of my department at the time who organized the schedule to get people to the courthouse. People need active support and not avoidance. Please remember that you're not alone. I am always happy to answer questions. And that's my email. And yes, you can find me on Twitter. You can send me a direct message. But it's time that we start talking a little more. And I'm always happy to do it. So thank you for your time and your attention. And now, face your day. Thank you so much for that talk. That was absolutely fantastic. Your perspective and how you bring things together, it was really refreshing to hear. I come at this from a perspective of being a huge believer in peer support. And for years, I've said that when you approach someone offering peer support, please have this in mind. It'd be a respectful of it. And I've often said that when you're opposed because you talk to someone after a bad event, try and not have those discussions about the details. But if all you remember in truth is how someone felt, I can't imagine that being on a stand saying, I don't remember any of the clinical details, but they were devastated at the outcome. I can't imagine that being harmful to the defendant. I was wondering if you could comment on that. No, absolutely not harmful at all. Especially if that's if that's what they remember and that's what they're going to testify. And we all want to believe that that's how things go. The only time that I worry about sharing those details is in environments where there are multiple descendants and they are pitted against one another, which is an ugly thing to think about, but it definitely happens. And it's not really so I you know, I've talked to an attending who had separate representation from their resident and their lawyer through the resident under the bus. There's a lot of, you know, there it is it is an ugly, ugly world. And I think we all need to be mentally prepared for the fact that it's super ugly. And even you know, if that attending felt terrible, but again, you don't have any control about how this game is played. Right? And so I think, you know, it is best to speak hypothetically, to let people know I'm changing some details, but you know, this is what I want to know from you. The fewer people who can say that they know exactly what went down, especially in those circumstances, the better. Now for me, like I was I was the only defendant, but a lot of times what they'll do is name, you know, name as many people as possible at first. And then, you know, it's sort of like, you know, just throw everything at the wall and see what's six. And if they can find a crack to see if we can hit this doctor against this doctor. And again, their lawyer is not their doctors. It gets crazy. And you just like the way they twist things. But yes, it always looks better for the defendant for a jury in particular to know that they, whether or not they accept fault, that they have a human response about caring about what happened to the defendant. Right? We, the things that jerry's hate are doctors who seem arrogant or dismissive or don't care what happened or like this wasn't my fault. I didn't do anything, you know, and have that sort of provato. It is far better to appear human and caring, and hopefully you are, you know, human and caring. And if somebody else is going to testify to the fact that you felt this way, even though it was not your fault, you just had a relationship with this patient and wanted the very best for them. And yes, you were devastated when things went this way. That, yes, that would only be helpful. So sorry, round about answer, but I wanted to get that plug in about a minute. Still, your lawyers will still very much caution you about sharing all the details. But again, vague is fine. Thank you so much. We are, unfortunately, out of time, but Dr. Pences agreed to stay for lunch today up on beta three. So if you want to talk to her more, she'll be there from 11 to 1230. Come get a snack and ask them whatever your question is.