This is part two of the interview with Dr. Stacia Dearmin. She builds on the idea of the physician’s second victim status in bad outcome and potentially in litigation. The plaintiff’s attorney can weaponize our empathy against us after a bad outcome and she teaches us how to defend against that. She builds on ideas on how to recover that were discussed in the first episode.
She is a speaker, coach, consultant and blogger on the topic. She went to medical school at Case Western Reserve and has a masters in religion and ethics from Vanderbilt. She did her residency in pediatrics at Akron Children’s Hospital and worked as a general pediatrician for a few years. She has worked as a pediatric emergency medicine physician since 2004. After working at Case Western Rainbow Babies, she is back at Akron Children’s Hospital. She is the founder of thrivephysician.com, where she focuses exclusively on the well-being of physicians facing adverse outcomes and malpractice litigation. Her experience in practice raised her awareness of the deep pain and isolation that physicians experience after an adverse outcome or in the midst of a lawsuit. She alleviates that isolation and provides insight and support around some of the toughest experiences many physicians will face in their careers. She draws on her personal story to illuminate the experience for physicians and to educate about the needs of physician defendants.
She has created a course to help us at deposition. “Deposition Magic” is a new course designed to give physician-defendants exactly what they need to know to soar at their own deposition. In a series of brief, friendly videos, you’ll explore the nature and purpose of deposition, the goals and tactics of the opposing attorney, and most importantly, the high-integrity mindset and strategies that will serve you as a physician-defendant. Together, we’ll exchange confusion and anxiety for clarity and calm, and help you to level the playing field at deposition. Available to you online on-demand, “Deposition Magic” confers up to 3 hrs Category I CME.
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Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.In the second part of Dr station demons interview, she builds on the idea of the physicians second victim status in a bad outcome, and potentially in litigation. We talked about how the plaintiff’s attorney can weaponize our feelings after a bad outcome against us, and how to defend against that. In the first interview, she had some suggestions for how to start to recover and she builds upon that in the second part. If you didn’t catch part one, be sure to listen to that first.Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing kreb cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.And now, here’s Dr. Bradley Block.Dr. Station deerman. Thanks so much for being on the show again today.Oh, My pleasure. We had fun last time. So it’s good to be back.So last time we ended with the second victim, right? What would you classify that as, let’s say, you have a bad outcome, or rather one of your patients has a bad outcome that, again, makes you the second victim, because you’re going to be taking that personally and grappling with that, and we’re going to get to those thoughts in a second. But what’s the first thing someone should do even before they’ve been served or even thought of litigation? What steps can that physician take to maybe protect themselves?So Well, I think the first thing you have to do, always, always, always, obviously, is do your best to continue to provide the patient with what they need. Right. So first, we’re going to lean into our highest ethical standards or highest values that work To ensure that the patient receives what they need, if the outcome is surprising enough or bad enough that the physician feels burdened by it, they may even want to involve colleagues and helping them to sort out how they’re going to continue to provide that care. They may need relief, they need a colleague step in. They’re really quite stunned by something happening. So there’s, there’s that piece you’re going to lean in to good pair. And you may need some guidance from a risk manager or people with legal knowledge or your division director someone have more years of experience, but you also want to be as truthful and transparent regarding what’s happened with the patient or their family as you can Important for ethical reasons. But also, it’s important to know that the sense that we are being forthright with patients and families, in and of itself, in many instances, Bill, prevent a potential lawsuit from taking root. families feel that we’re not being truthful with them, quite simply, that our anger and anger i think is at the basis of many lawsuits is faces from elastic. So it can be very difficult to feel like you have the words to tell people what you need to tell them or you’re feeling so spun yourself. You don’t know where to begin, if sometimes it can be helpful to involve colleagues and in sorting through that, but I think that’s the starting place there. If you think there’s any possibility at all. that a particular situation may result in litigation. Even if you think it’s a small possibility, then I think it’s prudent. And in many instances, your malpractice insurance policy requires that you make your malpractice carrier aware of what’s occurred. And it’s actually to your advantage to do so. Because they will start to collect information, collect records, and basically start to lay the foundation to support you in the best possible way if the claim arises. But you want to do that. Another tip I would throw out there that actually very useful to me, my own patient had a bad outcome is that you can even at that moment, within a day or two that something has occurred. Take the time to write down Everything you remember about the interaction and the situation, particularly with an eye towards capturing things that would never be captured in a medical record, like tone in the room or aspects of your conversation with the patient that weren’t captured in the record, write those down in the form of a letter addressed to my attorney may not even know who your attorney would be. You were sued, but address it to my attorney and then that letter becomes privileged, confidential attorney client communication, you can give it to your malpractice carrier. Give it to your hospitals Risk Manager, they’ll guard it for safekeeping for you. And at the time of the claim may arise that letter will go in To the hands of the attorney, sign to your face and provide them with details. You may not remember a year or two or more after the fact,in all of the risk management reduction lectures that I’ve been to I’ve actually never heard that before. That is a that is a first that sounds like excellent advice and easy to do. And also therapeutic I’m sure in some ways.Yeah, yeah, I think that’s true. I think that’s true. I think it is therapeutic. What you don’t want to do is create a shadow record that is not intended to be privileged communication with your attorney. In other words, you don’t keep a journal, a personal journal or personal diary or a personal set of notes that supplement the record if it’s not something that can legitimately be considered attorney client communication and it is Not privileged, and it will become discoverable. If a legal process begins meaning it will become a document that you will be forced to hand over to the legal process.So how do we differentiate one from the other? Oh, by by making it addressed dear attorney, wherever you might descend, and then that’s what make it privileged. Interesting. Okay.Exactly to my attorney.Right. So let’s say you have this bad outcome.And then it does go on to litigation. So you have a colleague who, you watch them get served, right? You watch all of the color leave their face, as it happens, and you happen to be right next to them. What do you see what is someone with your experience and your knowledge of this? What do you say to that physician? What do you say to that colleague?What I would personally say as I I’m so sorry this is happening to you. I have been through it. And I am right here with you. And I am so sorry this is happening to you very much like I would say, I am so sorry to someone who’s lost a loved one because it’s so surprising to people and heartbreaking. The papers that your SIR when your serve suit, really, I think deliberately incorporate a harshest language while alleging wrongful death and willful neglect and just the very harshest language. So they’re very hard to read. And I think particularly if someone has never previously been sued, when we see those papers, really like the end of a chapter of their career in which they could hold out hope that they would never be sued. Does that make sense? You’re suddenly in a new chapterand a very hard time and and we talked about that before the show, and I think it’s important for us to realize. So first, if you haven’t listened to the previous episode, please listen to the listen to the first episode where Dr. Dearman talks to us about the statistics of your likelihood of being sued. And as it turns out, most of us will not spend the lion’s share of us will not spend a career not getting sued at least once. And so, to hold out hope that you are going to be in this small minority of physicians where that never happens seems unrealistic. So I think it’s probably healthier to think it will eventually happen to me, so that when it does, you’re mentally prepared so that you don’t turn from the physician who’s never been sued to the physician who has been sued. You were a physician for both For you are still a physician, and it shouldn’t change your identity. And if you think that going into it, you will, you will come out the other side, the same person, you went in maybe a little bit wiser for it.Right? I might even take a little bit larger view and look just at the adverse outcomes. And again, kind of going back to the second victim theme and say that the literature around who is at risk for becoming a second victim is says that there are two factors all second one having common the first factor being that they are doing, that they possess a deep commitment to humanity, and that there’s some type of professional doing work in the service of humanity will be commitment to humanity. And then the second piece being that they’re doing work of high complexity, often involving rapid fire decision making. And frequently in the face of significant unknowns. So that sounds very much like our work of medicine, right? deeply committed to serving humanity with compassion, and also significant unknowns and make complex decisions. Where those two factors intersect is the place where we are at risk of encountering that other person we’re trying to heal or protect, and countering their bad outcome and having an impact on us. So I would say that every day that you go into the situation of caring deeply for someone making difficult decisions, at some level, you’re in the line of fire. Now, is that a bad thing to be in the line of fire? No, it’s amazing work. We’re, I mean, we’re really of service. We’re a very deep service to our fellow human beings. But we have this baseline risk that we’re going to encounter these difficult situation. And similarly, in medicine in the United States, as we invest ourselves in caring for the members of our community, we’re always experiencing a certain baseline risk that a lawsuit will arise. Does that make it pleasant or acceptable to us? Really, it doesn’t. It is not a reflection on any one of us as an individual physician, out of reflection, our competence or compassion or our ability to establish rapport with patients, when one of these adverse outcomes or lawsuit arise, it’s a it’s actually a reflection of the fact out there, a root sets ending at the plate swinging the bat,right? And I’ve heard you say that so if you take it a step further, reframing the situation, and that’s one of the things that helped you to heal. After your lawsuit, right? reframing what we do. So can you go into that for a second? Because I think it really is just a little niche further than what what you were just talking about.So reframing it, in what sense to take me a little further with what you’re thinking soso that we as physicians are willing to put ourselves in such situations that we’re constantly encountering in situations with incomplete information, and having to rapidly draw conclusions that could influence somebody’s health and well being every day, multiple times a day, it takes a certain type of person to put yourself in that situation. So the fact that you treat patients in acute situations, you have to be a certain kind of person in order to be able to handle that. And as such, you are putting yourself at risk for then being you know, being involved in a negative outcome and therefore named in a lawsuit?Yeah, absolutely. I think really all second victims, all professions that run the risk of second victimhood. At some level, they’re doing heroic work. Right. And sort of the classical sense of the hero, the person who is really willing to get out there and take risks that may impinge even on their own well being in the interest of a higher good, right. We are out there taking those risks because we actually care about our fellow human beings. The fact that we actually care so deeply is why we get out there and do what we do. And it is also why it hurts so badly. Things don’t goright. And the plaintiff’s attorney knows that and they use it to their advantage. Right? This is why the personal injury attorney is not invited back for brunch, because the second victim status, and they weaponize it against us. They take the fact that we feel for our patient, we feel badly for the fact that they they’re not doing as well as they could have. Whether or not we could have done anything differently. Even if we practice medicine, like a page out of the textbook and did everything we were supposed to if they had a negative outcome that people don’t sue for people sue for negative outcomes. If you didn’t have a negative outcome. You couldn’t you couldn’t bring a lawsuit. So, but the plaintiff’s attorney knows that we take it home with us knows that we feel guilty and responsible, even if we did everything right. And they’re gonna weaponize that against us. How do we steal ourselves? against that, how do we defend ourselves from falling into their traps?Well, that’s a great question. I think there are probably two primary places that come to my mind that where our own emotions can be weaponized against us. One is that many, many physicians when a bad outcome arises that they didn’t foresee and potentially could not have even prevented, they will feel guilty. They’ll find themselves wondering if they could have prevented it and feel guilty in my particular patient’s case. Even after an autopsy, I don’t really understand why she died. It remains unclear why she arrested why she died. But the fact that I made the choice to discharge her home the day before she arrested left me feeling deep guilt over whether I had played some unexplained role in her death. So we have this feeling of guilt. I think we need to acknowledge to ourselves that it is normal to feel guilty under those circumstances that feeling guilty is not the same as actually being guilty or responsible for an outcome. But a good example a good analogy I would give as someone in the world of Pediatrics, I’m very aware that not uncommon Lee, after a woman has a miscarriage, right after a miscarriage in a desired pregnancy. Many mothers feel guilty and feel like they must have done something that causes miscarriage. Even people who are medical people who know better than an electrical Level feel guilty. So similar thing I think we feel guilty when these bad things happen. Now a plaintiff’s attorney canuse that feeling of guilt as a cooltool to make the argument that we all are guilty and make it difficult for us to defend against that argument, because it aligns with how, how we feel, right. I think we have to really seek a lot of clarity around for one how the law defines what constitutes medical malpractice. And number two, with difference between our emotions and objective reality and work hard, oftentimes with the help of an outsider, to sort through those feelings. Particularly prior to any situation in which we would need to testify. Like. I think the other emotion that arises that can be, as you said weaponized against us, is the sensation of shame. It’s quite normal for second victims to feel very ashamed of the fact that they weren’t able to protect or prevent, to protect the person or prevent the injury that occurred, and that shame can be used against us. There’s a lot of literature. popular literature from people like me brown and scientific literature from people. Doing scientific research into the experience of the second victim, tells us that the way we heal shame is through connection to others who can hear our story and support a sense So I think that, in and of itself is an important piece of how we heal ourselves and then equip ourselves to deal with the legal process.What was it that helped you heal most, after your lawsuit?Wow, that’s a really good question. I think it was probably a lot of things along the way. I mean, I think the last time you and I spoke, we talked about the support that I received from a couple of colleagues, and from nurses and a social worker, other people who I worked with loved and respected me. But I think there was also a lot of inner work I had to do, examining my values around the value of human life. I mean, I think one of the core values of a, of an ethical physician is that every human life is as valuable as every other And there came a point in the course of my own suffering and healing, where I actually had to remind myself that my life is also valuable and as valuable as the life of the young lady who’s, whose death touched my life, and that it was imperative that I be able to heal and continue to do my work. So I think there’s that piece of it the internal work that we do, there certainly is a huge sense of loss that comes along with feeling like you weren’t able to do for your patient, what you would hope to do a sense of loss that many people experience along the lines that they’re not With physician they thought they were thought they would be if this has happened to them, and then of course that is amplified by litigation, but even just around the patients false many people feel that way. So, coming to terms with that sense of loss, acknowledging that it’s grief and allowing yourself to have that grief just like you would around, you know, the death of a loved one, I think with a piece of it, and then being very careful with what you choose to use to fill the vacuum that a sense of loss creates. So for example, there is a real risk for physicians after a bad patient outcome or in litigation, that they will feel this sort of vacuum of loss and attempt to fill it with things that don’t serve them. Well. classic examples would be alcohol or drugs, or other behaviors that put them at risk like gambling or other addictive things like pornography. But it’s also been shown that we who are very diligent will often fill that sense of vacuum by working more, and that predisposes to depression. So, being very careful to fill the sense of a vacuum with something that actually benefits you. And that might be for me, time in nature was absolutely healing. And I think for many people it is exercise if it’s not used in sort of an addictive way, but if it’s actually used as a means of promoting health and releasing all the healthy neurotransmitters that go along with exercise can be super healthy. digging a little deeper into relationships can be helpful. And many people need just need guidance of someone who’s been through it appear who’s been through it, or have psychologists or other kind of spiritual advisors.That’s where the, the reframing also can be useful because you might be having thoughts like, my patient had this bad outcome. I don’t deserve to put myself in these situations doing these things that I enjoy. But I think the reframing comes in. I put my side for a living I put myself in a position where things like this can happen. Therefore, I deserve to have this time in nature this time exercising this time with my loved ones. I think that’s the that’s and I think I recall that that’s actually how you how you phrased it is is you know, is I I put myself in these situations, and therefore, I deserve to have these things.That’s right. No, I think that’s exactly right, that we owe it to ourselves to attempt to put the one incident into the larger perspective of our lives, and also the larger perspective of the care that we provide, right. Another way that I sought healing was exactly that trying to see my patient in the context of my career. At one point, I sat down and did the math. I’ve been in practice for Let me think like about 14 years or so, when this happened with my patient. And when I sat down and did the math, I realized that I probably seen about 50,000 patients before I met Wow, wow, one in 50,000. It didn’t feel like 151 felt like she was the only one that mattered at that point. But I needed to remind myself that I had given something to 50,000 baby, children and teenagers. And if I could take care of myself and recover, I would yet attentionally if to another 50,000. Right. So I think that can be helpful as well. I view it really, and I like to encourage other physicians to view these experiences, not as a flaw as the result of a plot and meme, but rather as sort of an occupational injury, right? Like if someone’s working on scaffolding and some pieces of scaffolding this way and they fall several stories and somehow survive. Well, we certainly would want for them to get the best care possible in order for them to continue to live a full life. I think when these events are And frequently like we’ve fallen from the scaffolding, but the fact that we work on scaffolding is an important part of why we have potential.It’s interesting that you draw that parallel because I’ve definitely heard other physicians refer to the workman’s comp system and how it would actually make sense for our medical malpractice system to work more like the workman’s comp system where you know, if a patient has has an adverse outcome, then they get compensated by the system, but at the same time, you know, that when something does happen, there, there is an opportunity for quality improvement, but still not this, you know, almost cannibalistic system where, where physicians are through what were put through.Right, right. And you,you said that it was your colleagues, your friends, your family that that really were part of the crux that helps you get through this, but For other physicians who are who are grappling with this, what are some other resources that you would recommend for them? Either books or blogs or websites? other podcasts?Yeah. Well, I have a website, I blog regularly and I would invite everybody who’s interested to visit the blog at www. Fry physician calm. The focus of my blog is very much on issues surrounding litigation, and issues surrounding physician and other healers well being after adverse outcome. So that’s one resource that’s out there. And actually, I’m in the midst of developing my first online course on the subject of deposition and hope to develop an array of courses that people can pack them to, if and when they need them. So that is out there. Quite recently, another physician colleague practicing general Emergency Medicine named Dr. Geeta pensa started to create a podcast called The L Word l for litigation. And that you can find, I think, pretty much wherever podcasts are found she has maybe four or five episodes out now exploring litigation and how it impacts on us as physicians, what we experience is like, and trying to think what else there are a few books available, not as many as maybe we might like, but there’s one called when good doctors get sued. I can’t give the name of the author at the moment, but that is well worthwhile. And there’s lots of very interesting literature on the experience of the second victim written by a gentleman named Sidney Decker de Payton er, who is actually a pilot, who now specializes in safety science. And explores the experience of the second victim has written quite a lot about second victims in health care. So there’s some resources that come to the top of mind.Well, I can definitely vouch for thrive physician as an excellent resource as well as Dr. penances podcasts. But both of those have been, you know, extra have been extremely helpful for me and very, very engaging as well. So I’m glad to hear that.I’m glad to hear that anyany parting words for our audience?I guess the last thing I would like to say in line with what you were alluding to, in regard to reframing experiences is that while this was one of the hardest experiences of my life, it has in common with all very other hard life experiences the potential to grow us and make us better people. And there again, the literature on second victims alludes to this theme After these hard experiences, some people drop out. Some just barely survive, and others thrive. And the one to thrive seems to be the one to find a way to take the very hard experience and extract something beautiful from people can read more about this on my website if it interests them. But I would simply like to say, anyone who’s going through this at all, it is very hard. But it need not be the end of your life may not be the end of your career, certainly not the end of your joy. It like many other hard life experiences, has the potential to become something you look back on as a place where you grew tremendously, and where you learned a lot about yourself as a person and about Life as a human being on this beautiful earth, so I want to encourage you to just hang in there and hold out hope in the very, very long run, you will be a better person or having been through what you’re going through.Well, Dr. Station Gentlemen, I really appreciate you taking the time to talk to us on two episodes. And really, all of the work that you’re doing is going to help everyone that you touch to be a better physician and more prepared for these outcomes and your your gift from this is that it will make it much easier for us to get through these experiences. So thank you for your time and thank you for all the work that you’re doing.Thank you so much. Thank you for giving me the chance to share it.That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm, or wherever you get your podcasts. If you have a question For previous guests or have an idea for a future episode, send a comment on the web page. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.Transcribed by https://otter.ai