The Journey: A Spiritual View of Malpractice
By Curtis E. Harris, M.S., M.D., J.D.
Today's Christian Doctor, Summer 1997, Volume XXVIII, Number 2.
Editor's note: This article is the third of a series dealing with the issue of medical malpractice.
"Discussions with physicians about the emotional impact of their mistakes has been equivalent to a descent into the underworld of medicine. It is a journey into a place of shame, fear and isolation."1
Much has been written about the subject of malpractice, but very little attention has been paid to the emotional and spiritual impact of a suit on the life of the physician who is sued. If there is a "conspiracy of silence" in medicine, it is surely the silence of shame, fear, and isolation felt by the physician blamed by others for the severe injury or death of a patient. Never intending to do harm, always intending to do good, a physician who is sued is suddenly faced with a level of viscousness he or she never imagined possible, from a patient he or she sincerely cared for and about. There is no opportunity to apologize or commiserate, no chance to seek spiritual healing though forgiveness, no possibility of welcome as a mourner.
"The medical profession simply seems to have no place for its mistakes. There is no permission given to talk about errors, no way of venting emotional responses. Indeed, one would almost think that mistakes are in the same category as sins: it is permissible to talk about them only when they happen to other people."2
The emotional reaction of physicians who have been involved in the treatment of a patient who was injured is remarkably the same, whether the care given was good or not, and whether a malpractice suit was filed or not.
"The emotional impact is often profound, typically a mixture of fear, guilt, anger, embarrassment, and humiliation."3
However, in the litigious society in which we practice, there is no opportunity to share our feelings, and certainly no opportunity to admit our guilt (if guilt there is). For to openly say "I was wrong and I am sorry" is to court the whirlwind of public blame and financial ruin. Further, "[P]hysicians are typically isolated by their emotional responses; seldom is there a process to evaluate the circumstances of a mistake and to provide support and emotional healing for the fallible physician."4
"The only real answer for guilt is spiritual confession, restitution, and absolution."5 But there is no place for this healing in modern medicine. The silence concerning malpractice is deafening. The true cost of malpractice has yet to be calculated.
Much of the current dialogue concerning malpractice only serves to increase guilt and a sense of incompetence. "If only I had spent more time documenting what I did, I wouldn't be in this mess!" But time is our most precious commodity; I would rather watch my son and daughter grow up than sit alone at my desk. "If only I had spent the time to develop better rapport, or maybe I'm just not good at that. Maybe I should have prayed with my patient. Maybe I should have done a hundred things I failed to do. Then I wouldn't have been sued." Maybe so, but rapport is a complicated and delicate emotion, far more complex than some writers in this area imagine, and often not in the physician's control. 6
Error in medicine is usually treated as evidence of a character flaw, when in fact most error in all human experience is well beyond the individual's control.7 The practice of medicine is no exception to that rule, but we treat it as if it is (or should be). We all want perfect doctors and perfect airline pilots. In such an atmosphere of denial, a lie is told that somehow even physicians believe at some level: "Good doctors don't make mistakes." Therefore, if I make a mistake, I am not a good doctor. But how would any of us know if we are a good doctor or not? We practice in a vacuum of silence, with no opportunity to test reality. Again, how would we know if we were competent? By our financial success? Maybe, maybe not. By our ability to satisfy patients? Maybe, maybe not. By our patient outcomes? Maybe, maybe not. Compliments come easy; useful criticism comes hard.
Breaking the Barriers
It is the goal of the Christian Medical & Dental Society to change this bleak horizon of malpractice into a new dawn for Christian physicians who need and seek help. A new ministry has recently been started, which is called The Medical Malpractice Ministry, or "3M." The purpose of the ministry is to provide written materials, audio and video tapes, and personal counseling for physicians who have been sued for malpractice. I believe that the most exciting part of the ministry will be the personal counseling component.
Nine physicians have committed themselves to this counseling ministry. Each was selected based on several criteria, including Christian maturity, service, and character. However, these characteristics were not enough. In addition, each physician has been sued at least once, and each looks upon the experience as a time of great piritual growth, even though painful at the ti.me and painful to recall. None of these nine con iders his experienc easy or the lessons learned simple. All of them have learned more about the legal process of malpractice than they ever hoped to know, and all have experienced the painful drama of trial. Some were accused falsely; others realized that they may have committed an error. All learned about their personal weakness in the face of a loss of control of their lives brought about by the suit. Each learned of the power of God to take something intended for evil and to make it into good. None feel bitterness; all are grateful for their faith in Christ. It is this group of physicians who have made themselves available to anyone who calls.
A Few Shared Comments
Recently, the members of the Malpractice Ministry shared their experiences with each other. Sometimes through tears, sometimes through prayer, sometimes through the written word, each member had the opportunity to do something he had never done before: to discuss his malpractice experience with other physicians in a caring and secure situation. The following are excerpts from what was shared:
"During my deposition I was angry and upset and was aggressive and combative most of the time. By the trial, I had begun to pray that the lord's will be done, win or loose. That was a big change for me, since surgeons are taught to go into the OR to win and win big. I began to focus on His love for me and His sovereignty. When I reached the stand, I was not angry, the answers flowed easily, and I was genuinely concerned for the plaintiffs."
"During both trials I was reminded of the strength which comes through prayer (Phil 4: 6-7). The most significant memory I have is of my Christian friends sitting in the back of the courtroom praying for me. They were praying that God would be glorified, and that truth would prevail (James 5:16). The most marked aspect of both trials is not that we won, but that I felt the Lord's strength and power imparted to me. Would I go through it again? It's far from my first choice, but it will be easier now that I see it as a chance to sense God at work in me (James 1: 2-5)."
"I want to be sure that any physician who has never been sued before understands what it is like to have the suit drag on and on. It is a chronic problem that won't go away, and it lasts for years. Just about the time I started to live my life again, my attorney would call with a new development or something I needed to do. But I also think that this aspect of being sued is really what brings about the greatest opportunity for spiritual growth."
"I was sad because of the loss of health of my patient, and started to focus on all of the problems she would have because of the complications she had suffered. I began to feel deep guilt and shame, so much so that I lost any joy in living. I began to live in fear of what might come next, and I let that fear degrade my family relationships. For a while, I called my feeling 'compassion,' but my wife helped me see that was just a cover-word for guilt. Even though I sincerely feel that nothing I did caused my patient any harm, it is hard for me to accept that someone isn't responsible. In my darkest moments I still blame myself for things I did not do.The most important thing this experience has taught me is to trust God. He is the Rock that I can cling to. He has forgiven me when I have trouble forgiving myself."
"I was reminded of a quote I read somewhere:'God is too kind to be cruel and too wise to make a mistake.' I knew that what I was going through was hard, but I also knew that God's Holy Spirit in me was up to the task."
"Being sued is a lot like the thing cancer patients fear the most: pain and isolation. I would awaken at night in a panic. Sometimes I would walk or run around the neighborhood. Sometimes I would read Scripture. But always I would pray.''
"During the trial I realized how intelligent and knowledgeable the plaintiff's attorney was, and how much I needed God's help to survive the experience. I realized how little control I had over the whole process, how much of what went on was out of my control .. . and how much more I needed God."
"Early on, I prayed that God would just take it all away. When He did not do that, I began to realize that what I should want is what He wanted. I remember Christ's prayer in the garden 'Father, if you are willing, take this cup from me; yet not my will, but yours be done' (Luke 22:42). He taught me to trust Him, like Peter who took his eyes off Christ in the stormy waves and began to sink. Like Peter, even when I failed,Jesus reached out His hand to save me.''
"I still struggle with the issue of forgiveness of both the plaintiffs and their attorney. I know that it is the Lord's will for me to forgive them, and I know that He will complete this task in me, but for me it is neither quick nor easy."
"Once I made a mistake and gave aspirin to my patient who was allergic to aspirin. I knew better, but I made the mistake nonetheless. He almost died, but he didn't.The good thing for me was that I was able to tell the family about my mistake, and I eventually got their forgiveness even though they were extremely angry at first. I paid for the extra hospital expenses caused by my mistake because I felt responsible.Something my patient's wife said to me will always stay with me: 'Doctor,' she said,'we know that we can sue you, but we are Christians, and we don't believe that's the way people should deal with each other. Suing because of a mistake is not right. We realize that this was a normal human error and has no reflection on your ability as a surgeon.' I learned several things. First that I was only human and that I would make mistakes again. I also learned how important it is to be honest about our weaknesses and mistakes. And I realize that God worked through my patient to give me a very special gift that most physicians never get:forgiveness and the chance to say I was sorry."
"Although I have been a Christian for years, this was the first time that I found a situation so totally out of my control. I know how naive that sounds, but now I know it was God's way of teaching me that He is ultimately in control of all things."
"My wife was involved with the entire process, from the beginning to the end. I think that this is absolutely essential. But in spite of the involvement of friends and family, I did get the feeling that I was very much alone. I must point out the importance of spending time with the Lord so that He can calm your heart and mind. Since there were times I couldn't sleep, I would get up early and spend a long time with the Lord in prayer and committing Scripture to memory. It was the verses that I memorized during these sleepless nights that went through my mind and kept me calm in court."
"I realize now that much of the negative publicity about my case was quickly forgotten by the people in the small community I live in. What most of my patients and colleagues really wanted to see was how I got through it all. I realize now that my Christian faith was never more on display than when I was sued. I also realize now that when you are vulnerable, people treat you as more of a real person. I felt a closer bond with others during my trial than I ever had before. I am able to help others who have pain and suffering now in ways I would not have known had I not been sued."
Malpractice exacts a heavy toll on the emotional and spiritual life of physicians. Feelings of isolation caused by shame, anger, and guilt are common.
The emotional pain of a malpractice suit is often grinding and demoralizing, and can leave deep scars. The greatest challenge to the physician is to work through these normal but intense feelings in the absence of community support and without the opportunity to seek forgiveness.
Christian physicians need to be sensitive to the suffering of their colleagues, and to reach out with the love of Christ. Since forgiveness comes from God through Christ, a malpractice suit provides an opportunity to present Christ to colleagues who have been sued, or to help a fellow Christian physician grow in faith through the experience.
For Christian physicians who have been sued, there is the opportunity to strengthen personal trust in God and to model faith to others.
In the end, it is not the malpractice suit that matters, but rather what we do with the pain we experience, what we learn from the "fire" God uses to refine our faith.
Two truths seem to be central themes of those who contributed to this article from their experience with malpractice. First, the experience helped them know that the love of God through Christ does sustain us in the hardest of times. Second, the love and support of others who trusted and prayed for them during the trials they faced became, for them, the face of God. What an opportunity we have!
Members of the Medical Malpractice Ministry who contributed to this article by sharing their feelings and experience: Jon Askew, Craig Cole, Heinz Elsner, Carl Haisch, Curtis Harris, Steven Pelton, Tom Perry, Richard Peterson, and Bob Scheidt.
Curtis E. Harris, M.S., M.D., J.D., has been in the private practice of endocrinology for nearly twenty years in Oklahoma City, Okla. He is an adjunct professor of law. He has testified as a medical expert on numerous occasions over the past ten years. He is a member of the CMDS Board of Trustees. (1997).