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Case Study 1: Leadership Qualities

January 25, 2018

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Case Study 3: A day in court: who is the judge?

April 22, 2018

“Your worst enemy cannot hurt you as much as your own unguarded thoughts.” The Buddha.

 

On Dr. Rick Andrew’s birthday, the compunctious physician celebrated his acceptance into a small club: the 10% of radiologists who hadn’t been sued by the age of 65. He felt tremendous pride in this accomplishment construing that it reflected his deep commitment to his profession. 

 

It was devastating to him when a few months later he opened a registered letter outlining a malpractice case against him. He'd been accused of negligence in a case involving the outcome of a hospitalized patient. His heedlessness, per the summons, had caused irremediable damage to the patient's health.

 

His lawyer felt the lawsuit had been frivolous, and that his inclusion in it was an attempt to tap into another revenue source for the plaintiff. In his opinion, Dr. Andrews had upheld standard of care in his conduct and should not be concerned about this trivial case. For this reason, the lawyer was going to fight the case tooth and nail.

 

Despite this reassurance, Dr. Andrews was wholly unnerved, unable to get the accusation out of his mind. Overcome by shame and anxiety around the upcoming proceedings, he couldn't focus on his work. Images of losing his medical license and judgments from his peers preoccupied him. He worried he would lose his retirement account and even his home. He saw himself helpless and destitute, without friends or family. 

 

He experienced revulsion for the plaintiff's lawyer, who had a reputation for unnerving clients by “getting under their skin.” He worried that he would “lose it” on the stand, either by recoiling and admitting guilt or by lashing out and letting his rage get the best of him. 

What mental bombshells he didn’t send the plaintiffs, he saved for himself. How could he have been so careless? He questioned if he was cut out for medicine and second-guessed his value not only as a physician but as a husband and father. 

 

To deal with his stress, he drank more than usual to “get the case out of his head” and had considered an early retirement. He implored his lawyer to settle the case, even though he wasn’t at fault. Out of shame, he didn’t share the news with his wife and grown children who had grown concerned by his preoccupation. 

 

Concerned that his client's nervousness would hinder his capacity to advocate for himself, his lawyer recommended we explore inquiry before his deposition.

 

As a first step we made a list of his stressful thoughts: 


The lawyer will badger me into saying the wrong thing. 

My peers will judge me. 
My wife will lose respect for me.
I will lose my medical license. 
Being sued means that I am not a competent physician. 

 

Once isolated, we practiced inquiry, deeply questioning these beliefs using the four questions. Was it, in fact, true that this would happen? How did he react when he believed these thoughts? How did he treat himself, the plaintiff's lawyer, his wife, when he held onto these narratives? And then to glimpse life beyond these treacherous thoughts: Who would he be without them? 

 

Then, in the turnarounds, we explored the possibility of other realities. There he noticed his proclivity for judging himself. He saw that his interpretation of how others would react was merely a projection of his shame. His peers had mostly all been previously sued and were happy to help him through the process. His wife felt closer as they navigated this together. Being sued didn’t mean he wasn’t a competent physician: it meant was a physician. As he found examples of these possibilities, they became his new reality. He not only intellectually believed he was OK, but embodied it. 

 

Traveling through the underworld of his stressful beliefs caused the doctors' mind to become integrated. He was able to access parts of his brain that weren’t caught up in fight or flight. He was able to reclaim a much saner perspective on the case, not trapped by his shame and anxiety. He was able to see himself, and the lawsuit, more objectively and with more compassion. 

 

He was no longer unnerved by the lawyer, who he realized was merely doing “his job”: it wasn’t personal. His sleep improved as he stopped future tripping.

 

As his fears abated, he opened up to his colleagues and family, who, attracted by his vulnerability, opened up about their own struggles, further connecting him with his peers and loved ones. He felt closer to them than he had prior to the case. 

 

After a few sessions, Dr. Andrews gave his deposition with a new sense of courage and calm. His new demeanor paid off: after the deposition, the plaintiffs withdrew him from the case. They later heard that the plaintiffs felt he was too likable and confident to put on trial. 

 

When we are stressed, we interpret events around us in a constricted fashion. We develop a severe cognitive bias towards poor outcomes. In this state, the future is a dangerous place. 

 

As it turns out, this a rarely the case. In a study of chronic worriers, 95% of the time outcomes are significantly more favorable than expected. In the remaining 5%, the worrier is much better able to cope with the trauma than expected. 

 

Byron Katie puts it simply: “reality is always kinder than the stories we make up about it.” 

 

Inquiry allows us to see the truth behind the stories while we can still make a difference. We don't have to wait for eons to develop wisdom, it is accessible here and now through the process of inquiry. 

 

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