Podcast Episode 28 | Medical Malpractice: How to Thrive After Litigation

Stacia Dearmin:             00:00                I began to question my competence as a physician. I grieved her death.

Intro:                            00:08                From Spaugh Dameron Tenny, it's the Prosperous Doc Podcast. Real stories, real inspiration, real growth. A show for doctors who are ready to improve their overall wellness in every aspect of life. Now here's your host Shane Tenny.

Shane Tenny:                00:26                Welcome back to the Prosperous Doc Podcast. Over the last couple of weeks we have been dealing with a couple difficult topics for healthcare providers ranging from the complexity over contract negotiation and employment contracts. A couple of weeks ago we've talked about the confusion around credentialing, being credentialed, preserving your credentials and the sacredness of those, and today we're going to be dealing head on with the stress and complexity around malpractice litigation. We all know it is one of the most dreaded and feared aspects of being a healthcare provider.

Shane Tenny:                01:07                If you've gone through the process, you know first hand the exhausting toll and the confusion that ensues or perhaps you have a colleague or friend that's gone through this process and you understand just the enormous toll that it takes on the provider. Well, I'm here today and excited to be able to engage in a really open and authentic conversation with Dr. Stacia Dearmin. Dr. Dearmin has become one of the countries foremost speakers on the topic of malpractice litigation coming from her own story.

Shane Tenny:                01:43                As you might suspect, she's been in medicine for over 25 years, primarily as a pediatric emergency medicine physician. As I mentioned, she's a highly sought after public speaker for her presentation and works one on one in helping physicians go through the litigation process, prepare for depositions, prepare for courtroom appearance, and just navigate the emotional rollercoaster and ups and downs of the malpractice litigation process. And so, I'm very grateful to have her with us today.

Stacia Dearmin:             02:18                Thank you, Shane. I'm glad to be here.

Shane Tenny:                02:21                I'll just start. I think the background is probably as helpful a place to start as any, and so maybe we could just jump right in the deep end of your story and ask if you could tell us a little bit about what has given you the platform to talk about this topic and make it such a passion of yours.

Stacia Dearmin:             02:40                Well, it's probably easy to guess that I found my way into this work by virtue of personal experience. I practice pediatrics, found my way into pediatrics really because I love children and babies and young adults from the bottom of my heart, have spent most of my clinical career in the pediatric emergency environment, and some years ago, about eight years ago in 2012, I had an experience that really blew me off course, surprised me and blew me off course.

Stacia Dearmin:             03:19                There was a young lady who I saw in the emergency department where I was working at the time who came in on a Friday around midday. I cared for her over the course of five or six hours, did some workup, felt like I understood to the best of my ability what was going on, and made a decision together with her and her parents that it seemed safe for her to go home and follow up with her doctor on Monday, talk to the person on call for her doctor's office and the whole thing.

Stacia Dearmin:             03:52                Sent her home and returned to work on Saturday at 5:00 PM to work the evening shift in the ER and no sooner had I returned to work on Saturday, then a specialist from another part of the hospital, an ENT, approached me to let me know that one of the patients I had seen on Friday was now in the intensive care unit, which surprised me, and when I inquired as to who, it was this young lady.

Stacia Dearmin:             04:23                He proceeded to tell me that she had arrested, stopped breathing, out in the community that afternoon. Her mother had called 911, the paramedics were unable to secure her airway. She was taken to a local freestanding ER closest to her home where a perfectly skilled team also were unable to secure her airway and she was flown by helicopter to the ICU at our hospital where this ENT secured an airway. So, as I'm sure your physician nurse can quickly apprehend, it was immediately apparent to me that her prognosis was not good, and she either was not going to survive, or was not going to recover if she did, and I must say, I was devastated.

Stacia Dearmin:             05:23                I immediately had this funny out of body sensation that I have known myself to get when I've gotten the news that someone I love has died. I began to question what, if any responsibility I had for her death. I began to question my competence as a physician. I felt ashamed, I felt guilty, I grieved her death, I grieved my own sense of myself as a competent physician, and really struggled with these difficult feelings for much longer than I think I might have anticipated. I really didn't know how to understand the experience I was going through.

Stacia Dearmin:             06:16                I had been well-embedded in the department where I was working at the time for over 10 years and had wonderful colleagues, wonderful relationships with a very stable group of nurses, really was very little turnover in that department at that time. So, there were absolutely people who reached out to support me in wonderful ways, but it really was an isolating experience.

Stacia Dearmin:             06:43                So, about a year thereafter, not surprisingly, a lawsuit was filed against me. I was not the only defendant. It turned out there were other physicians who had seen her before me. I was not the only defendant, but I certainly was the lead defendant, and I would say the challenges of a lawsuit in some ways exacerbated the emotional journey that I was already on. The lawsuit went on for about two and a half years, which is probably slightly longer than average and by no means especially long for a malpractice lawsuit.

Stacia Dearmin:             07:21                And so, about three and a half years after her death, I went to trial, was in the courtroom for three weeks, and the verdict was unanimous, and was in my favor that I had practiced to the standard of care, but I really have to say that winning a lawsuit like that does, at least in my experience, very little to erase the stress and the strain that led up to that place and it was a long road thereafter before I really felt like I had healed.

Stacia Dearmin:             08:00                I mention that because I think it might be tempting for people to think that if their colleague who's struggling with something like this is given a verdict in favor of the defense, well, suddenly the story's over, but I really don't think it is over at that point for people. I think that is a stepping stone along the way, and I think people who have a verdict in their favor can be hurting just as people who do not have a verdict in their favor may be hurting.

Shane Tenny:                08:31                I know you've talked and written about the two sides of malpractice litigation and I think what you're alluding to, there's more than just the litigation side, and being exonerated in that respect is certainly good for the defense, but it's not the only side ... Talk a little bit about that.

Stacia Dearmin:             08:52                You raise a really interesting point. I think about it as two separate stories. One story being the story of our experience, the adverse outcome, and the other story being the experience and malpractice litigation and those two, when they co-occur, they intensify each other. People could certainly have one experience without the other. Sometimes people are litigated against and they really don't have any question in their minds about whether they had a role in the patient's bad outcome. Other times people had the bad outcome and never experience litigation and still struggle along and hard, and in some ways there were some aspects of my litigation that helped me to process my bad outcome.

Stacia Dearmin:             09:30                So, there are two interlocking, but different stories. Probably about 11 or 12 months after my patient died and before my litigation was filed, I was very much still struggling with the emotions I was having. I was struggling with really classic ... I see now, classic emotions for a person going through this experience, and most saliently, those tend to be shame and guilt, and if you want, we can talk about what's the difference between those two, but shame and guilt, grief or sort of bereavement over her death and over my own experience, fear, anger, some sleepless nights, some sort of hyper-adrenalized states at times in the course of my work, struggling with all of that, partially criticizing myself for the fact that I couldn't seem to shake it off because that's really the culture of medicine is that somehow we should be able to have these experiences and just move on.

Stacia Dearmin:             10:39                And so, I felt critical of myself that I wasn't shaking it off, and that caused me to question even further, do I belong in this profession. I see now that all that emotion is actually very closely tied to how seriously we take our work. So, the people who feel it the hardest in some ways are exactly the people who belong in medicine, but maybe 10 or 11 months after my bad outcome, I stumbled on an article from way back in 2000 by a physician named Dr. Albert Wu who was writing in response to a report from the Institute of Medicine called To Err is Human.

Stacia Dearmin:             11:19                It was a major medical report on the impact of medical errors and it was oriented towards improving patient safety and Albert Wu who was an internist at Johns Hopkins wrote an essay published in the British Medical Journal on the theme of what we call the second victim. Now, not everybody likes that term. We can talk or not talk about the controversy around that term, but basically he identified the second victim as a physician or other healer who has injured themselves when something bad happens or nearly happens to a patient and that physician has made or fears that they've made a mistake.

Stacia Dearmin:             12:04                Finding that essay was so powerful for me because he described the emotional experience I was having, and the poignant moment for me was that he made the point that in his experience, some of the most reflective physicians feel this experience the hardest. And I thought, "Oh, that's me. I'm not weak. I'm not badly suited to medicine. I'm reflective, and we don't want the reflective people to all abandon medicine." So, that was powerful for me to realize that that emotional experience that that story comprises is actually a reflection of certain weaknesses that are embedded in our strengths. Our vulnerable points are embedded in our strengths and it's the strengths that bring us into medicine, and it's the strengths that make us vulnerable to the hardships that this work implies. It's embedded in the work.

Shane Tenny:                13:06                The fact that you feel it deeply is in fact proof I think to the point you're making that the calling is legitimate. The fact I care makes it very hard to carry this weight.

Stacia Dearmin:             13:18                That's right.

Shane Tenny:                13:19                But, it also validates why I'm in a profession where I care for people. Now, the article you're referencing from Dr. Wu, it sounds like it almost helped to give a vocabulary to you.

Stacia Dearmin:             13:32                That's right [crosstalk 00:13:33]-

Shane Tenny:                13:33                And, an understanding for something that you were feeling, but couldn't quite name, and I think most folks know that when you can name something it begins to help you work through it. You brought up two important names, I actually do want you to go down the road a little bit here, shame and guilt. A lot of people feel those things, might not be able to name them, might not be able to parse the differences. How do you see the difference between shame and guilt?

Stacia Dearmin:             13:57                So, the difference is really simple, although emotionally they're complex experiences and I want to make it clear that this is not my definition, these differences. This is coming very much from the work of people who are experts in psychology, Brené Brown would be one, a man named Sidney Dekker who's actually a pilot and a safety scientist in Australia and an expert in the second victim experience also makes this distinction.

Stacia Dearmin:             14:29                So, they both tell us that guilt is a feeling that I have made a mistake or I've done something wrong and the way we address guilt is through some kind of action. Sometimes that action might look like making amends, sometimes it might look like seeking forgiveness, sometimes it might look like taking action to prevent something similar happening in the future or improving the world in some way. So, that's the nature of guilt.

Stacia Dearmin:             15:09                Shame on the other hand, as opposed to the sense that I have made a mistake or I have done something wrong, shame, which is a universal human emotion, other than among true psychopaths, we all have shame. Shame is the sense that I am the mistake, that I am what is wrong here, and as you can probably imagine, a pervasive sense of shame unchecked can lead people down very dark paths. It can lead them to a very destructive place and I think in some instances can even be linked to suicide, untreated addiction, can be truly devastating.

Stacia Dearmin:             16:02                Now, shame is not repaired through the same kinds of actions that guilt is, although addressing guilt can help alleviate shame, the people who research shame tell us that shame is alleviated through connection to another human being and as Brené Brown puts it, it's a matter of connecting to someone who has earned the right to hear your story and letting them hear your story, and I think her emphasis on the fact that this person has earned that privilege is important. It needs to be someone trustworthy, you need to have given though to how they might support you, and if they're unable to successfully support you, then you find someone new, but shame results in isolation, it makes us want to turn and hide and pushing ourselves or motivating ourselves to de-isolate and to connect is the way we relieve it.

Stacia Dearmin:             17:12                So, I think that's why it is powerful to have a vocabulary for these experiences because if I'm able to name your experience, just like Dr. Wu was able to name my experience, well certainly right there you realize, oh, I'm not so alone in this. This is actually commonplace.

Shane Tenny:                17:32                And, it's interesting because to this point of just naming things, I think it's very possible to simply feel like, "Oh, I just want to be alone." And, I don't call that shame, I call that I'm tired, I'm exhausted, it's been a big week, I want to be alone, I'm going through a lot right now, and it manifests through something that I think often we wouldn't even be willing to label as, oh, I want to isolate. We just label it as, I want to be by myself or that sort of thing, but I think as evidenced even by the fact that this topic is so rarely talked about in a candid way and as graciously as you're being with it, is it right to say that in some ways isolation is one of the core aspects of the struggle in often going through a malpractice litigation, it's just that tendency to isolate driven by some sense of shame, embarrassment, that sort of thing?

Stacia Dearmin:             18:25                Yeah, I think there are two pieces there. One is that for very legitimate, legal reasons, the first thing a defense lawyer or a risk manager will say is, "Don't talk to anyone about this." And, we physicians who are perfectionists will sometimes take that advice at face value and truly talk to no one. Well, it turns out there are people you can talk to and you have to be just extremely selective. I think, take that advice to talk to no one as license to really isolate ourselves around this very difficult thing.

Stacia Dearmin:             19:10                So, if I talk with physicians about this, they'll say, "Oh, well, but my lawyer said I can't talk to anyone." But, I think the shame really drives us to want to isolate and that advice condones that behavior and we end up buried under a rock somewhere. It's terrible.

Shane Tenny:                19:27                Well, I want to talk, right after this break, about your comment about the healing process because we don't only want to focus on how to survive these most stressful of circumstances, but I know part of your passion is helping physicians thrive through them. And so, we'll get into that right after this break.

Will Koster:                   19:55                I'm Will Koster, bringing you this episode's financial wellness tip. For many physicians and dentists, the desire to purchase a home comes soon after finishing school. With loan programs offering 100% financing to PGY1s, the barrier to buying a house is so low it almost becomes difficult for many to justify renting. While buying a home can be more than just a financial decision, it gives a sense of ownership and freedom that renting doesn't.

Will Koster:                   20:24                I want to make a few points that might make you think twice before rushing into the decision and let me make a disclaimer that the merits of buying a home as an investment or a wise financial decision are very complicated. Here are three often under-discussed factors of buying a house. Number one, hidden costs. The maintenance on a house can be sneaky expensive. Replacing a washer dryer or repairing the AC unit can easily set you back a couple of grand without increasing the value of your home much at all and that barely scratches the surface of some of the pricey repairs that can be in store for home owners.

Will Koster:                   21:01                Number two, paying 6% of the sales price for a realtor to help you sell your house can often be a wise investment in order to save time, hassle, and to get you a higher price for your home. However, this cost, as well as the closing cost paid on your mortgage certainly need to be factored in when judging the merits of the investment. Number three, lack of diversification. Oftentimes when a young person buys a house, it immediately becomes the overwhelming majority of their assets. The other assets being cash in your checking and savings account and maybe a few holdings in a Roth IRA or retirement plan through work.

Will Koster:                   21:39                The cashflow that is then dedicated to the mortgage can hinder your ability to save to other buckets. You also don't want to be house poor. Don't get me wrong, I own a home and I love it. However, I hope this financial wellness tip helps bring a healthy respect to making the decision of buying a home. Until next episode, I'm Will Koster.

Shane Tenny:                22:05                All right, so we're here with Dr. Stacia Dearmin. We're talking about malpractice litigation and adverse patient outcomes and the enormous stress and toll that it takes on the providers and the caretakers. Stacia, you were describing before the break just the emotional toll, the shame, the guilt. We talked about isolation and I think you referenced something very powerful, which is just because there's a favorable outcome in the courtroom, it doesn't suddenly mean that the cloud has lifted and life is back to normal and I think my question is, is healing possible or is it a permanent wound?

Stacia Dearmin:             22:45                That is a great question and well-stated. Yes, healing is possible and yes, it's a permanent wound. So, maybe we could say that it's going to leave a mark and there's the potential for the mark that it leaves over time to become a more positive than negative mark, but you will not go back to where you were before and nor should you aspire to. Some of the most awesome people any of us know are people who had struggled through some of life's challenges and come out better people on the other side.

Stacia Dearmin:             23:42                So, I think that is what we can aspire to that we're going to heal and in the course of healing we're actually going to grow to become something bigger than what we were before. I once read a quote, I can't remember exactly where I read it, so my apologies to whoever I'm quoting, but I read this quote about the fact that for us to grow, the shell of the seed that combines us must rupture and then the growth occurs. And, I look back on my experience with this patient and with litigation and I feel like I was inside a very though shell and someone hit the shell with a hammer and I have grown enormously as a result, but it was not fun being hit with a hammer.

Stacia Dearmin:             24:35                And, I should put out there, this is not just me talking. There's absolutely literature research in what happens to second victims and that research demonstrates and my experience with other second victims affirms that they tend to go down one of three paths. Some of them drop out by which we can mean a variety of things, some of which turn out to be productive. They may change their clinical setting. They may move into administrative medicine, they may limit the scope of their practice, they may retire early or unfortunately for some, it may result in untreated depression, untreated addiction or suicide, which is the ultimate way of dropping out of a painful situation.

Stacia Dearmin:             25:22                The second group of people do what the researchers call survive, by which we mean that they remain in place and limp along, and they're surviving, but their joy is diminished. They're not necessarily doing well. And then, there's a third group of people who do what the researchers call thriving, and I've named the work I do Thrive for that reason and what tends to happen with those folks is that they do find some way to take what is really ugly and make something beautiful out of it. That can come in a lot of forms. For a nurse who experienced medication error that harmed a patient, related to medications with similar names for example, that nurse may become heavily involved in the movement to improve medication labeling procedures.

Stacia Dearmin:             26:23                That would be a great example. You may have a surgeon who becomes determined to improve the way a given procedure is done or to improve resident education around certain outcomes. You may have a physician who partners with families with patients of a certain condition to improve the team based care they receive. There are all kinds of ways people thrive and in that thriving process a lot of the healing comes. Now, there's not judgment by saying that these are the three paths people follow and I think in fact, they sometimes, I think in my experience, I also did bounce around among those paths a little bit until I could settle into a groove that worked for me. I limped along for a while. I thought about dropping out. There were a lot of ways my mind went along the way.

Shane Tenny:                27:20                The path of healing isn't a linear one, it's a challenge.

Stacia Dearmin:             27:23                That is right.

Shane Tenny:                27:23                Now, I don't know that ... I certainly don't have as eloquent a quote as your comment about the seed rupturing, but I think what I have often said is I like having experience much more than I like getting the experience and I'm wondering, given your story and the five years or so since the litigation aspect was over, how has the experience of both the outcome of your patient and the ensuing litigation, how has that impacted or has it, and in what ways has it impacted the way you interact with patients now and also the way you interact with colleagues now, or the way you encourage or mentor them?

Stacia Dearmin:             28:03                I don't know that it's changed the way I interact with patients to any great degree. I'll be very forthright simply to say that when a physician is really hurting like I was hurting, it can be hard for a while to connect as closely with patients as you did before. So, if a person's feeling like they're reluctant to really connect with patients after an outcome like that, that is completely understandable, and that is a piece of their joy and their work that's worth restoring.

Stacia Dearmin:             28:43                With colleagues, obviously this has become sort of a second vocation for me in life. I should maybe mention that in the course of my trial, about halfway through the trial, which was three weeks long, I stumbled on a TED Talk by a physician named Pamela Wible. I wouldn't have watched this TED Talk had I known what it was about, but at the time, the talk had a humorous title, so I tuned it in and it turned out to be on the subject of physician suicide.

Stacia Dearmin:             29:21                As many people now know, I don't think this was so widely known then, but as many of us now know, roughly the equivalent of about 400 American physicians die by suicide every year and in that talk she compares that to the loss of an entire medical school, which blew my mind just to stop and think about that. And, the very next day in the elevators riding up to the 17th floor of the justice center to the courtroom I said to my lawyers, "I don't know what all the factors are that result in physician suicide, but I know with certainty that what I'm going through has to be one."

Stacia Dearmin:             30:04                I just felt this overwhelming compulsion at that moment that no matter how my case turned out because I really did not know and my lawyers were very open that they did not know what the verdict would be, I had to do something to make something positive out of really what was just the hardest experience I've ever had. So, I dove in pretty quickly. Within a month of the end of my trial, started to dive into reading literature and exploring the larger communal aspects of the experience I'd had and began to prepare to do some public speaking and pretty quickly started to move forward with the work I do today.

Stacia Dearmin:             30:50                I will say that the whole experience has just made it so clear to me how many of us experience litigation, which is most of us, how many more of us experience bad outcomes that don't result in litigation, how profoundly this impacts us as just human beings who are engaged in this work where we're diving into other people's lives at a level very, very few people can imagine and it's just given me such a very, very deep compassion for my colleagues and really for everyone who practices any healing profession, nurses, psychologists, dentists, all of us. We're all in this together.

Shane Tenny:                31:36                I want to give you a chance to talk about the non-clinical work that you're doing in the medical community, walking with colleagues who are going through this, but before we go there, can I pick up on the account that you just gave about riding in the elevator with your attorneys? For listeners who have not gone through a malpractice lawsuit or perhaps are afraid that one is looming or they're aware of an adverse outcome and not sure of what's coming, can you just talk practically about how does one get an attorney? Do you need to hire your own? How do you work effectively with the legal defense team through that process?

Stacia Dearmin:             32:19                First of all, most, I hope virtually all American physicians who are practicing clinical medicine carry some kind of malpractice insurance, malpractice coverage, and what usually happens if a lawsuit is filed is that your malpractice carrier will assign an attorney to you. So first let me say, if you're in a true private practice setting, even in a hospital setting, and you get any inkling that a lawsuit may be in your future, it is absolutely in your best interest immediately to notify your carrier. As horrible as it feels to call them up and say, "I think I might be sued," they get those calls every day of the week. It's all they do.

Stacia Dearmin:             33:17                So, you need to let them know immediately that you're worried that maybe in your future ... And, they will already begin to collect records if needed and start to prepare for your defense should that become necessary. So, once you actually receive notice that a lawsuit has been filed, your carrier may or may not be aware of that. So, if you're in private practice, you've got to notify the carrier the very same day because what they're going to do is get a lawyer on board. The defense lawyers are not their employees. Defense lawyers are practicing law out in the community and are there to be your servant.

Stacia Dearmin:             33:59                They may be paid by your malpractice carrier, but they're there to be your servant, so they will assign that lawyer and the lawyer has got to respond to the claim within a given timeframe, which is generally about a month. It varies state to state, whether it could be 28 days or 30 days, but someone's got to respond immediately, or it's as if you had agreed that there is truth in the claim and you will now have a defense then.

Stacia Dearmin:             34:29                So, you will be assigned a lawyer. It's been my experience that for the most part the malpractice carriers have a group of lawyers they know well in the communities where they serve physicians and they generally do a pretty good job of choosing a defense lawyer for you. So, I would go into that with optimism, meet that lawyer, have your first couple of meetings with that person, and as things unfold, if you feel like they are not a good fit or they're not providing you with adequate defense in some way, you can let your claims manager at the malpractice carrier know that.

Stacia Dearmin:             35:12                You can if you wish, ask around for names from physicians in the community as to who is a great malpractice defense lawyer in, I don't know, Braddock, Missouri and take those names to your carrier and say, "I want to meet some of these people." Sometimes that will resolve it and if push comes to shove, then you hire a lawyer to write a letter to your defense carrier raising your concern that the defense you're being provided is inadequate and they will deal with that pretty posthaste I think, but for the most part, in nine cases out of 10 or more, the lawyer that your malpractice carrier assigns is really going to be more than adequately equipped to address what you have lying ahead of you.

Stacia Dearmin:             35:59                How to work with that person? Well, I think there's a few things I would like to put out there. First of all, they need a few things from you. The most important thing they need from you, no matter how scared and ashamed and awful you feel, they need for you to come to them with absolute and complete integrity and tell them the truth about everything you know about what happened. Everything you say to them is in complete confidence and really what their job is, is to look at the picture of your situation and try to find the best possible path through it.

Stacia Dearmin:             36:43                In many cases, the best possible path is settlement. The majority of cases do not go to trial. That's 10% or less that go to a courtroom. The majority are settled, or dropped, or resolved in some other way before ever going to trial. So, your lawyer needs to know the whole truth, so that they can really be there for you and prepare you well for your deposition, which can be a real turning point in the case, and so they can lead you through it in a path of ultimate integrity.

Stacia Dearmin:             37:16                If they figure out that you've not been truthful with them, it will make them as angry, if not more so, as it makes us when we figure out that a patient's been deceiving us. So, just know that, just put it all out there. They've heard all the ugly stuff. All they do every day is deal with adverse outcomes, so put it all out there and then I would say you've got to pull on your humility. I think for a lot of us, we're accustomed, in the course of our professional lives when the chips are down to taking charge and trying to take control of the situation.

Stacia Dearmin:             37:57                And so, here we are in this emergency in our professional lives and we're not in a position to take charge. We don't have the knowledge base required to take charge. It feels very disorienting and disempowering, so you've got to take a big breath and remind yourself that although you may not know how these cases go and what are all the possible paths it could go down in your particular state, that defense lawyer does know those things and they are your leader. It's so hard, it was hard for me and I think it's hard for many physicians to say the proverbial caca has hit the fan and I have got to sit back and follow. It's very hard, but I think that is really important.

Stacia Dearmin:             38:47                Now, one thing you can do for yourself if you're in that in between stage where you think a suit might be filed, it has not been filed, but you think there's a possibility either because of a bad outcome that's happened or even if you feel you practiced well, let's say a known surgical complication and your spidey sense, or something a family members says, or any factor leads you to wonder whether a lawsuit will be filed, I would encourage you at that moment or within days to sit down, write a letter addressed to my attorney, confidential, and you're going to write down everything you know, what happened, details of conversations, the sense you got about things, your intuition about the interaction with the family, all the things you wouldn't necessarily capture in the medical record or things you just missed recording in the medical record, write them down.

Stacia Dearmin:             39:53                And, you can give that letter to your malpractice claims manager when you let them know you have this concern or you can give it to your hospital risk manager, one of those people will keep that letter secure and in complete confidence, which is where it needs to stay, but it's got to be addressed to my attorney, and then if and when a case is filed, what will likely happen is that that attorney will get ... The attorney you're assigned will get that letter and may have even read it before you meet with them for the first time in the course of doing their very initial, rough assessment of the case and you will have captured a lot of details for them because given the statute of limitations, which in pediatrics in many states extends to the age of 21, many years can lapse before a case is filed and the details will not be fresh in your memory. It'll give you added confidence that what you're sharing with your lawyer is an accurate and truthful representation of what happened.

Shane Tenny:                40:53                Now, as we come near the close of our episode today, Stacia. I do want to have you share with folks how you are transforming your experience into one that can help others and earlier when we were talking about the concept of shame and just the result in isolation and the remedy to shame being sharing the story with someone who has earned the right to hear it I think was your phrase. That begins to touch on the work that you're doing through Thrive Physicians. So, tell us a little bit about that work and even how folks can connect with you if they're listening or have a friend or a colleague or someone from medical school that they know should hear this episode or should connect with Dr. Stacia Dearmin.

Stacia Dearmin:             41:40                So, really it started small and has branched out in a lot of directions. It started first with a talk I gave with my defense lawyer to my own department in my own division and branched out to further public speaking and then blogging and now I am engaged as a coach. I coach physicians one on one who are processing adverse outcomes or traversing malpractice litigation and it's an entirely confidential, professional relationship that affords them a safe place to talk through things.

Stacia Dearmin:             42:16                I think it's important for physicians to know that when your lawyer says, "Don't talk to anyone about this," what they mean is don't discuss the details of the case or the confidential details of your conversations with them, the details of the medical case, and the medical decision making is what I mean to say, but what we can safely talk about is our feelings, our emotions, how it's impacting on our ability to practice and navigating all of that. So, this coaching provides a place to do that and I take it very seriously.

Stacia Dearmin:             42:50                That also created a CME course for physicians. As I mentioned, really deposition is a turning point in many malpractice cases. It tends to be the place where it starts to become clear whether a case it going to be dropped or settled or go to trial and can have far reaching impacts on the case if it does go to trial. So, your defense lawyer certainly will spend significant time preparing you for deposition. Nonetheless, I feel like there are not adequate resources out there to prepare physicians for deposition, so I created an online CME course called Deposition Magic, which people can find a link to at my website and can spend their CME dollars if they have them in part to obtain it because I feel like it's a plus if we can use these dollars in a way that doesn't come straight out of our paycheck.

Stacia Dearmin:             43:45                And then, a third piece of this work is that I aspire and have aspired for a couple of years to create healing retreats and opportunity for physicians to come together and connect with each other around these experiences. Now, it was planned for this year but thanks to COVID, the first retreat is hopefully going to happen in 2021 and the nature of it is that it will be a white water rafting retreat on the Colorado River through Canyonlands because I have a very deep belief in the power of nature to heal us, body and mind, and the power of a small group in a private setting to be healing around these types of matters, know that it's not just me who understands what you're going through, but a whole group of people who share your experience.

Stacia Dearmin:             44:40                So, I'm planning to host this retreat together with a doctor named Kathy Stepien, who is the founder of the Institute for Physician Wellness and look forward to taking a small group on this healing, the Heart of Their Heal Retreat. My work can be found at my website, which is www.thrivephysician, all one word, T-H-R-I-V-E-P-H-Y-S-I-C-I-A-N.com and it's very easy. If you go to that website there is a button you can click for a contact forum. If you need to reach out to me in any way, just shoot me an email, it will come straight to me. I'm the one who checks the inbox and responds, and I am happy to confer with people about whether the services I provide are what they need, or to direct them in other directions if I think they need someone's help other than me.

Shane Tenny:                45:32                Well, Stacia, I am grateful for your time and your candor and your humility in sharing your journey with us and especially for your willingness to help your colleagues around the country prosper through difficult times, so thanks for being here today. Thank you for your time, for listening today and for your support. Don't forget, we've got more episodes queued up. We release them every other Monday. You can also connect with us through our Facebook group and would welcome any reviews through iTunes or Google Play, wherever you download your podcasts. If you have any suggestions or questions about our guests or suggestions for future topics, you can always email me directly. I check my inbox directly as well. It's shane@whitecoatwell.com. Thanks so much for being with us today and we'll see you back here next time.

Outro:                          46:22                This episode of the Prosperous Doc Podcast is over, but you're not alone on your journey. Spaugh Dameron Tenny has been helping physicians and dentists prosper through financial planning for over 60 years. To connect with us, visit sdtplanning.com today and take your financial wellness to new levels. Join us on the next episode of the Prosperous Doc Podcast.