It is the worst crisis some emergency physicians ever face, so stressful that it can creep into every thought, taint every encounter. In fact, there is an actual clinical name for it now: malpractice stress syndrome.
With one of every four physicians likely to be sued for malpractice at one time or another and with more than half of all practicing physicians already having had the experience, it isn't surprising that many in the medical profession feel under a cloud of risk. (Medical Risk Management Advisor 2005;13:1.) What is somewhat astonishing is that, apart from the lawyers and the insurers, the physicians targeted in such lawsuits often have little professional assistance in navigating an effect of litigation that can be continually disruptive to practice: the psychological impact.
But thanks to someone dubbed the “Godmother of Wellness in Emergency Medicine,” emergency physicians have a colleague in their own specialty who can help with the pressures of a legal challenge and aid them in dealing with the emotional fallout. And this colleague, who has racked up dozens of medical honors and awards, considers such consulting work among the most significant of her many achievements.
Louise Andrew, MD, who was most recently bestowed the James D. Mills Outstanding Contribution to Emergency Medicine award by the American College of Emergency Physicians, began her trek toward becoming an emergency physician and an attorney as a “little Southern gal” who knew early on — by the age of four, in fact — that she wanted to be a doctor.
Determined to follow in the professional footsteps of her uncle and several grandfathers before her, Dr. Andrew had some big shoes to fill. Her great-great-grandfather was Dr. Matthew Moore Butler, a Tennessee surgeon who assisted in amputating the arm of General Stonewall Jackson. Her grandfather, Dr. Harry Brockman, co-founded a clinic that eventually gave rise to a regional hospital in her home state of North Carolina.
But it wasn't simply her family lineage that drew her to medicine. By the time she was ready to use a pencil, it already was clear to her that she was “much better at giving orders than responding to them,” she said jokingly.
Dr. Andrew attended nearby Duke University, and applied to medical school there, clinching an early admission spot. By the time she got her medical degree, she had decided she wanted to be an emergency physician, even before it was a specialty. And even though her professors at Duke sneered at the choice, telling her, “It is a waste of time, all just triage,” Dr. Andrew went off to Johns Hopkins to join its emergency medicine residency.
It was a hand-in-glove fit. “It is exciting,” she said of her specialty choice. “It has a little bit of everything, and it all takes place in a limited time frame.”
She did a second residency, too, in internal medicine, a first at the institution. But Dr. Andrew broke ground in another, arguably more important, way. She was the first resident ever to be pregnant and give birth on the Osler Medical Service.
“I drank 16 cups of coffee a day, and maybe had an apple to eat,” she recalled. “Thank goodness everything went okay.” Dr. Andrew and her husband, Ted Harrison, MD, have a son who is a computer scientist and a daughter training to be an occupational therapist.
Looking back, she considers herself the lucky recipient of support from great mentors and a rather fortunate victim of a lawsuit. The former sustained her stamina; the latter proved career-turning. It was a brush with the legal system that prompted Dr. Andrew to become a lawyer herself. She was sued for signing her name to a form filled out by a resident physician.
Even as a peripheral part of the suit, the experience proved traumatic. A plaintiff's lawyer named her as part of the complaint after she gamely stood her ground in a deposition defending a colleague. The seemingly retaliatory attack gave her an up-close and personal look at the toll a legal battle can take.
After launching her emergency medicine practice on the faculty of Johns Hopkins, she earned a law degree from the University of Maryland, and she now offers consulting to colleagues facing what she once did for simply signing her name. “Doctors can feel like pawns in this process,” she said, noting that it can drag on for years. Generally, a suit progresses in fits and starts, and it can wreak havoc on a practice, the family, and the physician's self-esteem.
Armed with reassuring statistics that indicate physicians prevail the overwhelming majority of the time and the knowledge and experience to “walk them through the process,” Dr. Andrew said she offers an approach that is necessary but uncommon. Even when a physician feels there is a good chance of winning, “it still feels like a body blow,” she said.
Several years ago, Dr. Andrew established a web site dedicated to mentoring in emergency medicine (www.mdmentor.com), and she also is involved in suicide prevention for doctors, including a test on her site for physicians to gauge their litigation stress and a link to www.physiciansuicide.com. She continues to be an active senior member of the Medical-Legal Committee and Professional Liability Task Force of the American College of Emergency Physicians. Three years ago, she and Bernard Ackerman, MD, co-founded the nonprofit Coalition and Center for Ethical Medical Testimony (www.ccemt.org). Last fall, in announcing the James D. Mills award, ACEP President Frederick Blum, MD, stated that her efforts have resulted in “healthier, happier practitioners.”
Dr. Andrew also was the first recipient of the Distinguished Alumni Award given by the Johns Hopkins Emergency Medicine Residency Program. In addition, she is a co-founder and past president of the American Association of Women Emergency Physicians.
In reviewing her career, Dr. Andrew, who now lives in British Columbia, credited the fact that before she even entered elementary school, family members were lauding her choices, and the support continued among friends she formed in emergency medicine. “I would say to anyone that one of the greatest things you can have in your life is five people or so who have endless confidence in your ability.”
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