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Medical Malpractice Stress Syndrome

Carlo Reyes, MD, JD, Mizuho Morrison, DO, and Mike Weinstock, MD

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Litigation-related stress is also known as medical malpractice stress syndrome (MMSS).

Identifying it and making it more acceptable amidst us as colleagues is important to minimize its havoc that it can cause in our personal and professional lives.


  • Providers who are sued commonly develop a PTSD-like syndrome called Medical Malpractice Stress Syndrome (MMSS).

  • Recognizing we are at risk, knowing the signs and symptoms, and taking action early and limit the negative effect of MMSS on our personal and professional lives.


  • Medical Malpractice Stress Syndrome (MMSS) is a form of Post Traumatic Stress Disorder (PTSD) in providers who go through a lawsuit.

  • Most physicians, regardless of specialty, will face a claim made against them.

    • DeVille K, et al. Malpractice risk according to physician specialty. N Engl J Med. 2011 Nov 17;365(20):1939 [Free open access link]

      • Estimates that by age 65, more than 75% of physicians in low-risk specialties such as family medicine and 99% of physicians in high-risk specialties such as surgery will have been sued.

  • Facing a lawsuit attacks physicians at their core

  • We train hard and for a long time to be good at our jobs. The experience of being told you did something wrong or missed something is very traumatic. It is an attack on not only on our professional capabilities, but also our identity that is being scrutinized and criticized.

    • Shock, denial, disbelief

    • Negative self image

    • Depression

    • Physician suicide

  • Carlo believes that all physicians who are sued demonstrate some degree of MMSS



    • Shame

    • Depression

    • Guilt

    • Victimization

    • Anger

    • Outrage

    • Frustration

    • Tension

    • Fatigue

    • GI upset

    • Chest pain

    • Decreased concentration

    • Lack of sleep



    • Viewing patients as the enemy rather than people you want to help.

    • Ordering more tests.

    • Practicing more conservatively in ways that studies have shown do not benefit the patients .

    • Emotional and psychological suffering.

    • There is often a pattern of self-abuse that emerges during MMSS in a variety of ways.

      • Working too much

      • Drinking too much

      • Ignoring important personal relationships


  • ISOLATION contributes to the development of MMSS and makes recovery more difficult.

    • Physicians who are sued do not tend to seek help and we do not have a lot of infrastructure for support within hospitals and professional organizations. MMSS is very much an underdiagnosed condition and we do not have reliable statistics to help us understand the condition.  

    • Often, the physician is not allowed to discuss the specifics of a case while it is ongoing.

      • Can discuss a case with a spouse - those are protected conversations.

      • Consider counseling and psychiatric early in the process - these are also protected, confidential conversations.

      • Can talk about your feelings with anyone. You do not have discuss details of the case, but can express your feeling openly.


  • The average lawsuit lasts 5 years from beginning to end. This is a long-term, high stress situation.

    • You are constantly reminded about the lawsuit in depositions, phone calls, emails.

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A Disposition Conundrum?! Full episode audio for MD edition 207:57 min - 98 MB - M4AHippo Urgent Care RAP - June 2017 Summary 283 KB - PDF