Five physicians get real about getting sued for malpractice. They reveal the emotions they felt, the support they received and the impact on their self-esteem. Learn from their lessons should you ever face a jury.

If you've never been sued for malpractice you didn't commit, here's hoping you never face that ordeal. But this is Southern California, so that MD after your name means "here's hoping" has little power against aggressive plaintiff attorneys and frustrated patients fed up with the cost and access problems that plague the healthcare system. The litigation climate here has cooled lately, experts say, and medical liability insurance rates are generally holding steady, but the threat of a lawsuit, especially in the high-risk specialties like obstetrics, is still very real.

So if you get that phone call or that certified letter from a lawyer, here's what you can expect, according to five lawsuit veterans. First, know that you will survive. Even if you don't win the case--and there's a big difference between committing malpractice and being convicted of committing malpractice, especially when a compromised baby or deceased patient is involved--your practice and your mental health will not be damaged permanently. But being sued will be an emotional experience. There will probably be tears.

E. Laurence Spencer-Smith, MD, a Los Angeles-based obstetrician/gynecologist, recalls his reaction upon hearing the "not guilty" verdict when his malpractice experience ended: "A deep breath and a sigh. Ultimate relief. You don't realize how emotionally invested you are until you get that verdict back. It brought tears to my eyes."

Dr. Spencer-Smith had a very different reaction when he got the notice of intent from the plaintiff's attorney. "As an ob/gyn, you're always cognizant of litigation and accusations of medical malpractice. They are always a possibility," he notes. "But I was disappointed, frustrated and, the more I thought about it, angry as I reviewed the case being made against me." It was a case based not on negligence, but on a less-than-perfect result.

He called his insurance carrier, The SCPIE Companies. "They were fantastic and totally supportive," he says. Like many doctors who go through a malpractice suit, Dr. Spencer-Smith raves about the assistance he received from his carrier. "When it comes to legal situations, they'll go to bat for you 100 percent of the time. And whether you choose to go to court or to settle--and even if there happens to be a plaintiff's verdict--they are 100 percent behind you," he says.

In most cases, being sued won't take you down. It didn't faze Dr. Spencer-Smith, who is an attending staff physician at White Memorial Medical Center, an assistant clinical professor at Loma Linda University in the ob/gyn department, and managing partner at White Memorial Gynecologic and Obstetric Medical Group. "I can honestly say the experience never led me to doubt myself or my professional ability," he says, noting that, in 25 years in practice, it was the first malpractice allegation that actually landed in court. He says now, "I feel like it actually made me be a better doctor."

Richard Bond, DO, a family practice physician based in Orange, found the silver lining in his malpractice experience, too. "I looked at it as an opportunity to learn. The plaintiff's attorney, as obnoxious as he was, taught me some things with the questions he asked that changed how I approach my patients today," he says.

Dr. Bond's case involved a young patient who died. He says he expected litigation because of that fact. "At the trial, there were things the plaintiff attorney said that made me think, 'Good point. I should take that to heart and learn from it.' It wasn't all negative--although at times it was hard to see that."

Those lessons were difficult to learn mostly because the lawyer offering them was extremely unpleasant, Dr. Bond says. "The attorney was very aggressive and assaulted me verbally," he says. "I was overwhelmed by it, but I realized he was doing it to try to throw me off balance and get me to admit things he wanted me to admit."

The questioning was especially tough, Dr. Bond adds, because the outcome was unavoidable and nobody's fault. "I could see their point," he says. "It was one of those things medicine is unable to pin down, but when you have someone haranguing you, it puts some doubts in your mind."

Having his insurance company behind him helped, Dr. Bond recalls. SCPIE was his first call, he says, and the team members there let him know right away their job wasn't to judge him, but to provide support. "They said, 'This is what we're here for. This is what we do.' That eased my mind. It gave me a sense of comfort that I had a reliable insurance company that would do what it could to deal with the situation," he says. In fact, his advice, should you face an unfounded lawsuit, is this: "Contact your insurance company first thing and start dealing with it."

Eight months after he made the call to SCPIE, Dr. Bond experienced his TV courtroom drama moment. "The judge said, 'Have you reached a verdict?' The jury foreman said, 'We find the defendant not guilty,'" he says. "I realized, 'They believed me. They believed the information we presented.' It was overwhelming. I shook. I kind of broke down, I guess."

Later, when he thanked the jurors personally for their careful attention to details in what he recognized was a difficult decision for them, he cried. "I thanked them for their fairness," he says. "It felt good to thank them personally."

For the record, Los Angeles-based SCPIE announced in October that it had entered into a definitive agreement to be acquired by The Doctors Company, a leading physician-owned medical malpractice carrier based in Napa. About the combined company, Richard E. Anderson, MD, FACP, chair and CEO at The Doctors Company, says: "Together, we can be even more effective as we continue to aggressively defend claims. Members will benefit from the enhanced value of a financially strong combined organization that is relentlessly committed to protecting, defending and rewarding member physicians."

Paul Reiman, MD, a Murrieta orthopedist, relied on NORCAL Mutual Insurance Co. when he went through his malpractice trial experience and he valued the simple emotional support the team he worked with offered. Because the case involved a patient who died, "it was not an unexpected lawsuit. We had a fair amount of information on the case ready," he says. "The people from NORCAL really served as confidants and advisors and as sounding boards for my anger, confusion and sadness. They provided a lot of information on the legal aspects and on the psychological aspects of how to go through it and what to expect."

NORCAL assigned a team of attorneys that Dr. Reiman describes as "very, very good and very, very helpful at helping me sort things out." He lauds them especially for trusting his professional judgment on defending the medical aspects of his case. Those medical aspects were especially difficult for him during the trial because the case involved "an unfortunate death after a surgery," he explains. "There was a non-preventable complication. It really was a loss for everybody."

Indeed, sadness was Dr. Reiman's first response to receiving a certified letter announcing the lawsuit and reminding him of the tragic case. "I went back into my office, shut the door and sat down," he says. "Then I called my wife." He couldn't have known when he made that call that it would be four full years before he'd feel a similar sadness, coupled, this time, with relief, when the jury found him not guilty. "It was a tragedy, and the plaintiff deserved her day in court," he says. "I don't feel I won. There was no jumping for joy. It was simply a process that needed to happen."

The extra-long duration, he says, resulted from Riverside County's clogged court system. Dr. Reiman's trial was postponed not once, but twice. When it finally commenced, the trial itself lasted just over a week. Yet the end of the trial hasn't ended the effects of the case entirely. "The memories do come back sometimes," he says. "But I haven't changed how I practice because I did what was right."

That was something Dr. Reiman needed to remind himself of more than once during the trial. "You start to doubt yourself," he says. "The plaintiff's attorneys are supposed to try to show that you did not meet the standard of care, and they have people on the stand stating that. If an expert witness says that in every case you should do some specific thing, you find yourself thinking about that. You question yourself."

Learning lessons is valuable, but it's important to stop and remember: I'm still a pretty good doctor. "You have to look within yourself and say, 'What I'm doing is good medicine. I work hard to take care of people,'" Dr. Reiman concludes.

Ronald Moser, MD, a San Juan Capistrano-based cosmetic surgeon, didn't really grapple with such issues during his malpractice lawsuit experience. "It was a BS case brought by a patient who caused her own problems, so everything moved ahead very expeditiously," he says.

Dr. Moser's biggest obstacle: a showy, well-liked plaintiff attorney. "He's an eloquent guy, and a lot of people are afraid to go up against him. He must have taken acting classes." That's not a compliment, by any means, but the tactics such attorneys employ often work with jurors who know little more about medicine than what they see on "Grey's Anatomy" or "House." "We had to be very precise about everything that transpired with that patient," he says. "So we set up an easel and took the jury through every step and showed how she ended up with the problem she had."

Dr. Moser's confidence in that demonstration made him balk at settling the case, even though he was dealing with a plaintiff attorney's dream--a lovely 20-year-old with a visible scar from the physician's alleged malpractice. His insurer, Medical Protective, stood behind him. "I didn't want to settle the case because I did absolutely nothing wrong. The problem was caused 100 percent by the patient," Dr. Moser says. "MedPro asked me if I wanted to settle, and I said no."

The insurer's response to that refusal pleased Dr. Moser. "A lot of insurance companies just want to get rid of a case for a small amount of money, especially if defending a winning case will cost more than settling," he says. "I was impressed that MedPro let me call some of the shots on determining whether the case had merits."

Dr. Moser offers a bit of advice to physicians who dread the badgering they'll have to endure on the witness stand. "You got yelled at and screamed at by the attending physician during your residency, and you got through it fine," he says. "And that was three or four or five years." He also recommends showing up every day of the trial--not just the day you testify--to make it clear that you have an interest in defending yourself.

John Sanchez, MD, a Los Angeles ob/gyn, drew strength from his close relationship with NORCAL. That relationship has passed the ultimate test: He was sued and lost. "There was an unavoidable bad outcome, but in no way do I feel I did anything wrong," he says. "Considering the way I treat patients, I know I'm a good doctor, maybe even a great doctor."

The problem he faced is familiar to physicians. Dr. Sanchez says: "The jury felt the patient's family should be compensated, that things couldn't have turned out so badly with no liability. ... But it never got to the point where I felt I was a bad doctor. A big part of that was the support I got from NORCAL."

Dr. Sanchez's still-healthy self-esteem may have seemed in doubt at the moment the verdict came down. "It was a 'We the jury ...' moment. You could hear a pin drop," he recalls. "I was stunned when they said, 'Negligent.' My wife was with me in court. She says she gasped. I just could not believe that after hearing the evidence and the experts that they would come to that decision. It was really a huge disappointment."

Hearing the word from individual jurors after the verdict was read only made things worse, and then they all left as soon as they could, without stopping to explain their reasoning. "It was Friday," Dr. Sanchez says. "They could not start their weekends soon enough. I really was hurt that they wouldn't even take two or three minutes to discuss it with me. You just can't believe people would do that when they know the importance of their decision to your self-esteem and to your career."

This specific disappointment will resonate with many doctors: "I was chair of my department at the hospital and was involved in the peer review process. I always felt I held myself to a higher standard as a result, and that I hadn't been sued successfully because I'm a great doctor. It was a real blow to my ego to have this happen. Now I can't tell myself I've never been sued successfully."

But that's where the emotional damage stops. "It's a given that if you practice obstetrics in Southern California, you're going to get sued. When it happens, it's going to be adversarial, and as physicians, we're not used to that," Dr. Sanchez explains. It's important to remember the big picture and not internalize the charges against you. Plaintiffs are trying to get something: money from your insurance company for alleged negligent acts. "You have to be strong enough to realize that, even though they're going to belittle you in a public forum. You did the right thing. You have to have inner strength."