What is stress and when do its harmful side effects begin? Stress is a state of emotional or mental strain or tension resulting from demanding/adverse circumstances. Stress begins in childhood, when we are exposed to new environments, meeting new people, the loss of a pet, a divorce in the family and learning to meet the often, high expectations of parents to excel in just about anything; these are just a few of the stressors a child might experience.
But what about you and me, both as professionals. as well as fellow human beings? I become easily stressed with political infighting, conspiracy theories, the large number of Americans who refuse to become vaccinated, the number of patients that one is expected to treat in a Covid ICU, observing co-workers falling ill from Covid and becoming statistics because they were first line providers. As an older PA, I become stressed with EMRs because I have practiced for more than thirty years without this distraction. We can become stressed with concerns for family, finances and the future in terms of retirement and independence. We can suffer the stress of fearing a malpractice action. Even PA astronauts like our first “PA in Space” probably endured some stress as to whether her rocket would survive re-entry or whether they might collide with an asteroid or space junk.
How does chronic stress and anxiety affect our health? Some of us may suffer from anxiety or depression. When anxiety becomes unchecked, it can evolve into panic attacks and prevent us from excelling in patient care. A person cannot always mask this anxiety which is why we can observe certain cues through conversation, facial expression, eye contact, and bodily movements. One of the advantages of close relationships are that “our trusted other” can observe our mood changes. This ability to discern helps to create an excellent diagnostician. Don’t get me wrong: it’s normal to have occasional anxiety. My wife has it whenever I am the driver of the family car.
Stress can be classified as a disorder when it becomes disproportionate. Forty million Americans suffer from anxiety, but only 37% are treated for it with drugs or counselling. This medical condition requires three chapters in a book to articulate all its implications. We are generally more familiar with the effects of stress: headache, GI symptoms, binge eating and subsequent obesity, diabetes and chronic kidney disease, hypertension, and behavioral changes.
How does chronic stress affect our ability to practice medicine? It serves as an almost constant distraction, it makes us sluggish, it slows down our mental processes, it causes us to leave a room quickly, thus interfering with our patient interactions and is easily recognized by those who suffer from the same disease. Perhaps the key is to turn our skilled diagnostic eyes upon ourselves. We have, all of us, committed our lives to be caregivers. First and foremost, we must care for ourselves.
There are 17,000 medical malpractice suits filed every year. The odds of winning are 10% with weak evidence, 20% with medium evidence and somewhere between 30 % and 50% with strong evidence. Nonetheless, people (Americans in particular) are litigious. Some claims have a valid reason such as physical bodily harm, severe incapacitating injury or loss of life due to incompetence. Many others are weak because they are rooted in a poor relationship between the patient and the provider. These relationships are often affected by our attitudes stemming from our own personal problems. We are told to leave those personal issues at the entrance of the surgical suite but that is not always possible. It can become worrisome if the patient feels that they have lost our attention, or perhaps that we are not hearing them, that we fail to evidence concern. So many lawsuits are frivolous, but all are required to be answered upon receipt of a subpoena. In order for a lawsuit to be considered strong, it must have the four D’s: Duty, Deviation from duty, Damages and Direct cause. Response from the provider requires legal counsel and can be very expensive because the legal process is slow. Litigation can easily take two or three years for resolution and all of the legal back and forth plus securing expert witnesses is very costly. Thus, we MUST purchase and maintain malpractice insurance coverage.
If your employer offers malpractice insurance coverage, make certain that you are a “named insured”, but frankly its much safer and secure to own your OWN policy. This way, YOU are always the policy’s top legal concern – not your supervising physician, the clinic or hospital or other providers who might be named in the same lawsuit. Plus which, with your own policy you will not be “sharing the financial limits of liability” which could dwindle, if there are other (more senior members) charged in a lawsuit.
When purchasing a professional liability policy (AKA malpractice insurance), there is a lot to consider: occurrence vs claims-made, tail coverage, policy hammer clauses, not to mention understanding the history, track record and financial strength of the underwriting insurance company (to pay claims) and the insurance provider who will tailor your coverage. Given the importance of this protection and the unique complexities of this kind of insurance, I have depended on the same company for almost thirty years and recommend them without reservation: CM&F Group. With over 100 years of insurance expertise and endorsed by our national organization AAPA, they have faithfully served as my trusted advisor and insurance provider as they do for thousands of other healthcare professionals across the country!
By: Bob Blumm, PA-C Emeritus, DFAAPA
PA Advisor to CM&F
Image Courtesy of: Unsplash