November 2006

Reduce stress to prevent lawsuits

by Timothy Feuling, CBS President

It's hardly breaking news that when you're tired and under stress, you tend to make more mistakes and react with irritability. At home, you snap at your spouse and misplace your car keys. On the golf course, you miss easy shots and curse as the ball drops into the sand trap.

Things get far more serious when you go into the office. You grab the wrong patient record file, hit the wrong keys on the computer, forget people's names, give the wrong instructions to your CA. You're abrupt with patients and fail to focus on their needs and on the good communication skills essential for positive doctor‑patient relationships.

That's why stress and fatigue can be major factors in malpractice lawsuits.

In a Medical Economics article, Edward E. Bartlett, a risk‑management consultant in Rockville, Md., who conducts stress‑reduction seminars for medical‑malpractice carriers, says, "Stress affects patient care in subtle and insidious ways. You can't always separate and quantify the stress to show a cause‑and‑effect relationship to a patient's injury. But we know it plays a big role... Stressed‑out doctors are emotionally exhausted and may just be going through the motions, not completely attuned to their patients' physical or emotional needs" ("Why burned‑out doctors get sued more often" by Dennis Murray, Medical Economics, May 26, 1998).

The article also quotes Theodore L. Passineau, senior health care adviser for PICOM Insurance Co., who states, "There's a link between stress and liability. Calmer, rested doctors are more careful, and therefore get sued less."

Even lawyers are taught about the stress‑to‑lawsuit correlation. Dr. Amiram Elwork, director of the Law‑Psychology Graduate Program at Widener University, and author of "Stress Management for Lawyers" notes that, "Chronic stress damages lawyers and their families, diminishes their ability to serve clients, raises health insurance costs and subjects their law firms to greater risk of malpractice lawsuits."

Even when your office is running smoothly and enjoying success, stress can leak into the practice from situations at home. Among the most common stress‑causing problems:

***  arguments with family members

***  personal financial difficulties

***  physical ailments

***  a death in the family or of a close friend

***  boredom with off‑hours activities

***  a lack of time for hobbies or personal relationships,

***  physical and mental changes associated with aging

***  significant events (moving, filing tax returns, children moving out on their own, etc.)

Even joyous events such as a birth or marriage, preparing for an upcoming vacation, or buying a new home or car can cause stress! Most factors, taken alone, might not be significant, but the combined effect of several can throw you off your balance enough to make you careless, short‑tempered, or forgetful ‑‑ and ripe for a mistake that ends in a malpractice claim or a board complaint.

The first thing you need to do is to become aware of your own stress levels. Go so far as to appoint one staff member (or family member) to be your "stress monitor." Instruct him or her to let you know (without fear of retribution!) when your mood or your activities indicate you may be feeling above‑average stress.

If you feel your practice is suffering from stress‑induced problems, consider taking a stress‑management course or read a book on the topic and practice some of the proven stress‑reduction techniques (deep breathing, meditation, etc.).

Try dealing with the problems before seeing patients. Just as couples counselors always advise people not to go to bed angry with each other, doctors should never go into their office until they can do so with a positive and focused outlook.

When that isn't possible, use visualization techniques to leave your problems outside the office. Before entering your front door, visualize yourself stuffing all your personal problems ‑‑ the fight with your kids, the car in the shop again, the overdrawn credit card ‑‑‑ into a large plastic garbage bag, and depositing it on the doorstep. It'll be there for you to deal with later, but while you're seeing patients, you can focus on them.

No matter what you do, however, there will be days when you just can't avoid stress during practice hours. In that case, being aware of your stress will help you avoid its negative affect on your performance. Compensate by using checklists and cue cards to make sure you don't miss important tasks such as updating patient notes or having new patients read and sign a "Terms of Acceptance" form.

Post a large sign in your private office that reads: "Put the Patient First." This will help keep you focused on the real reason that you're going in to work each day, and help, at least temporarily, to block out the distractions of personal problems.

By eliminating or managing stress in your practice, you'll not only be able to better serve your patients, you'll be reducing your risk of malpractice lawsuits.

(Timothy J. Feuling, as president of chiropractic Benefit Services, assists doctors in maximizing their practices through the proper choice of insurance and related services. Mr. Feuling is also available for speaking engagements at state conventions and other chiropractic events. Doctors may contact him with questions, comments, and requests for insurance quotes at 2950 N. Dobson Rd. Ste. 1, Chandler, AZ 85224, by phone at 800‑883‑0412 or by e‑mail: feuling@cbsmalpractice.com).