1 Ch02-A /16/06 4:18 PM Page 9 C H A P T E R 2 Medical Malpractice Stress Syndrome S. Sandy Sanbar, M.D., Ph.D., J.D. Marvin H. Firestone, M.D., J.D. GOLDEN RULES 1. Medical malpractice lawsuits are extremely stressful. 2. The allegation of medical malpractice may be extremely traumatic to the accused physician. 3. The primary manifestations of medical malpractice stress syndrome are psychological symptoms (e.g., acute or chronic anxiety and depression), and the secondary manifestations are physical symptoms. 4. The accused physician must acknowledge that he or she may be suffering from a medical malpractice stress syndrome. 5. The distressed physician should seek support, understanding, and comfort from immediate family members, close friends, defense counsel, and professional colleagues. 6. The physician needs help to acknowledge and address the fears of medical malpractice stress. 7. The accused physician must continually be reminded that being sued for medical negligence is a predictable hazard of medical practice in our times. 8. Education of the sued physician about medical malpractice stress is the key to dealing with the fear of litigation. The purpose of this chapter is to provide an overview of the medical malpractice stress syndrome (MMSS), its symptoms, diagnosis, and management in hopes of providing physicians who are suffering from, or who are caring for other litigation-stressed physicians, with the necessary tools to effectively manage this disorder. 9
2 Ch02-A /16/06 4:18 PM Page Physicians and Malpractice CASE PRESENTATION Dr. Ray Sunshine is a 43-year-old second-generation family physician. While in medical school, Dr. Ray met and fell in love with his classmate, Angela. They got married the same month they graduated from medical school. He and his wife have three children, two daughters and a son. After Dr. Ray and his wife graduated from medical school at the University of Florida, Dr. Ray completed a residency training program in Family Medicine; Angela also trained at the University of Florida as an Emergency Physician. He has been practicing medicine for 12 years, working with his wife, Angela, and his father, Christopher, at the Family Medical Clinic, in Sun City, Florida. On January 13, 2001, at approximately 1:00 P.M., Dr. Ray returned from lunch to resume his work at the Clinic. His nurse approached Dr. Ray and informed him that the Sheriff (a patient treated by his father) was here to see him. The Sheriff was ushered into Dr. Ray s office. The two of them exchanged greetings. Apologetically, but in a businesslike manner, the Sheriff served Dr. Ray with a summons and complaint, alleging medical malpractice. The Sheriff told Dr. Ray that he was being sued by one of his patients. The Sheriff said goodbye and walked out of the office. Dr. Ray was stunned, shocked, and dismayed. He could not believe that he was being sued by one of his patients. He had never been sued before. He could not think of having done wrong to his patients. He thought to himself: All my patients love me. Who would do such a horrible thing? He had flashbacks of many patients that he had treated in the last few years. He gently placed the petition on his desk without opening it, and he stepped away from his desk, all the time staring at the petition. His forehead became sweaty, as did the palms of his hands. His hands were shaking and his body felt like it was trembling all over. His chest felt tight and he could not breathe deeply enough. He had goose bumps all over. He became weak and nauseated. His lunch-filled stomach felt heavy, and he was afraid he might vomit any time. He felt momentarily unstable on his feet and dizzy. Dr. Ray could not believe what was happening to him. Nurse Susan knocked at his door and entered the office to inform Dr. Ray that his first afternoon patient has been waiting to see him. The doctor, now visibly pale and diaphoretic, did not look back to acknowledge the nurse s presence. Instead, he walked two steps and sat in a nearby chair, with his head bent forward. He felt ashamed and did not want to tell his nurse what had happened. He took his handkerchief out of his back pocket and wiped his forehead. The nurse, realizing that there was something wrong, asked the doctor if he felt all right. The doctor did not answer at first, but then he told the nurse to cancel all his patients for the rest of the day because he was not feeling well. The nurse then informed Angela, Dr. Ray s wife, that Dr. Ray was not feeling well. Angela excused herself and ran to her husband s office. He was still sitting in the chair, staring at his desk. Honey, she said, What is the matter? What is bothering you? Are you hurting anywhere?
3 Ch02-A /16/06 4:18 PM Page 11 Medical Malpractice Stress Syndrome 11 Dr. Ray could not talk. He felt lonely even in his wife s presence. Guilt feelings were running through his mind. Angela asked him what the Sheriff was doing here. Dr. Ray stared at the petition on his desk and nodded ever so slightly. Angela walked toward the desk, picked up the envelope, opened it, and slowly read allegations of negligence and gross negligent acts by her husband. She was shocked herself, but she quickly realized that her husband was suffering from an acute stress disorder. Angela called her father-in-law, Dr. Christopher, who was in his office, and informed him about Dr. Ray. He rushed to Dr. Ray s office and expressed concern and when he was informed of the lawsuit, he told his son that when he was sued by one of his patients for medical malpractice, he likewise suffered symptoms of distress throughout the five years of litigation, until the lawsuit ended in his favor. Dr. Ray s malpractice litigation lasted three years, during which time both his wife and father were extremely sympathetic and supportive. Nevertheless, Dr. Ray suffered distress symptoms throughout the course of the litigation. The trial ended with a defense verdict. Dr. Ray was relieved, but continued to suffer from symptoms similar to those who have post-traumatic stress disorder. 1 STRESS OF MEDICAL MALPRACTICE LITIGATION Medical malpractice lawsuits are extremely stressful. They are predictable hazards of medical practice. Some medical professionals view malpractice lawsuits as an inherent part of providing medical care. Indeed, no individual physician is immune from medical malpractice, and the majority of physicians are affected, directly or indirectly, by patients alleging negligent professional care as the cause for their injuries. It is known that litigation distress may affect any individual who is involved in litigation. There are predictable effects of medical malpractice lawsuits on the defendant physicians characterized by the medical malpractice stress syndrome, a unique variation of the well-accepted litigation stress syndrome. Even though medical malpractice lawsuits are common, most physicians are ill-prepared to deal with the devastating psychological effects of medical malpractice litigation on the physicians, their families, and their medical practices. The stress of medical malpractice litigation may directly contribute to physical illness of the physician, as well as dissatisfaction with medical practice leading to burnout and early retirement. Tragically, if the reaction of the physician is extreme, depression may lead to suicide. MANIFESTATIONS OF MMSS An allegation of medical malpractice (or charges of unprofessional or unethical conduct by a physician s peers) may be extremely traumatic to the accused physician, regardless of whether or not the allegation has merit. The emotional turmoil that results can be debilitating.
4 Ch02-A /16/06 4:18 PM Page Physicians and Malpractice The primary manifestations of medical malpractice stress syndrome are psychological symptoms (e.g., acute or chronic anxiety and depression), and the secondary manifestations are physical symptoms. The physical symptoms may be manifestations of a new disorder or may represent an aggravation of a preexisting disorder. ANXIETY SYMPTOMS The accused physician may develop excessive worry, which would occupy over 50% of waking hours. The physician may have difficulty controlling the worry. When such worry symptoms last over six months, it is characterized as persistent or chronic. The physician may complain of restlessness, tiredness, difficulty concentrating, irritability, tense muscles, and/or insomnia. Such anxiety symptoms interfere with the physician s daily life both at work and at home. Some physicians develop feelings of anger, bitterness, shock, dismay, guilt, shame, irritability, frustration, distrust, loneliness, and diminished self-esteem; and the physician may manifest hyperactivity. The accused physician may react by emotionally distancing himself/herself from family members, friends, and professional colleagues. Interest in work, food, recreation, and sex may be diminished. The accused physician may become insecure, may develop concerns about ability and competency to make decisions, may compulsively order unnecessary tests on patients, and may have thoughts of changing careers. The physician may resort to alcohol, or self-medication, in an attempt to self-medicate many of the uncomfortable symptoms. The accused physician who is already suffering from a preexisting medical illness, such as coronary artery disease, diabetes, hypertension, or gastrointestinal disease, may exacerbate or aggravate those disorders, thereby causing more physical symptoms and signs related to those disorders. CONSULTATION WITH TREATING PHYSICIAN The accused physician must acknowledge that he or she may be suffering from a medical malpractice stress syndrome. It is sometimes difficult for the physician to formally seek medical or psychiatric attention from a colleague. Especially when the symptoms of anxiety and depression are severe, or where there are thoughts of suicide, the distressed physician should seek prompt psychiatric assistance. Management and control of the symptoms of MMSS under the supervision of a treating physician should never be underestimated. The amelioration of the stress symptoms will lead to a feeling of wellbeing, confidence, and behavioral control, thereby reversing the agonizing mental turmoil. Reduction of stress symptoms will also allow the physician to think and act with greater objectivity, to remain focused, and to maintain a more healthy perspective on the litigation process.
5 Ch02-A /16/06 4:18 PM Page 13 Medical Malpractice Stress Syndrome 13 DISCUSSIONS WITH FAMILY, CLOSE FRIENDS, AND COLLEAGUES A friend in need is without question a friend indeed. The distressed physician should seek support, understanding, and comfort from immediate family members, close friends, and professional colleagues. In particular, open and candid discussions with one s spouse, and maybe even the children, may reassure all the family members. This can lead to greater support and understanding of any unusual behavior. Discussions with physician colleagues, particularly those who have been through malpractice litigation, can be helpful. Reaching out to family, friends, and professional colleagues for emotional support should not be construed as a sign of weakness. Just the opposite, it is the imprimatur of a wise and strong person, one who is not afraid to confront reality, no matter how harsh it may seem. MEETING WITH DEFENSE COUNSEL This topic is discussed in detail in Chapter 8. The meeting(s) between the accused physician and the defense counsel can be extremely helpful in educating the physician about the legal system and addressing fears and concerns about the litigation. The physician who develops rapport and trust with the attorney, who gains a thorough understanding of the legal process, and who assists the legal counsel to understand the factual issues related to the alleged negligence claim, will benefit immensely by gaining confidence, thereby reducing the stress of litigation. MANAGEMENT OF MMSS In March 2005, at the 45th Annual Conference of the American College of Legal Medicine, in Las Vegas, Dr. Louise B. Andrew, who is an expert in this area, presented the S. Sandy Sanbar Lecture, which dealt with this personal, sensitive, and difficult subject of malpractice litigation stress, and the following discussion is derived in part from that excellent lecture, as well as from the selected references at the end of this chapter. Dr. Andrew noted the following four essentials of management of MMSS: 1. Replace mystery with knowledge. 2. Replace shame with confidence. 3. Provide insight into the players and drama while being enacted. 4. Provide tools and strategies for combating the emotional and physical stress of litigation. Dr. Andrew pointed out that charging the physician with malpractice is perceived as a wound to the heart. In every known bad medical treatment outcome, the physician blames self long before the patient begins to blame. Hence, the physician already has a wound to self-esteem by the time the legal claim is made. Every step in the legal process, while ostensibly designed to reveal the truth and serve justice is perceived by the physician
6 Ch02-A /16/06 4:18 PM Page Physicians and Malpractice as an attempt to prove intentional wrongdoing by the physician. This is related to the psychological vulnerabilities of the accused physician and the lack of understanding of the legal process. The physician needs help to acknowledge and address the fears of medical malpractice stress, all of which are appropriate to the situation. These include: 1. Loss of control. 2. Loss of livelihood. 3. Loss of reputation. 4. Loss of assets. 5. Loss of significant supporters. 6. Lack of knowledge about the process and potential outcomes. Education is the key to dealing with fear. The physician should be encouraged to: 1. Attend supportive educational meetings. 2. Read available materials on litigation stress support. 3. Seek advice from experienced colleagues, malpractice and estates lawyers, counselors, or consultants. 4. Ask questions, and acknowledge that this is not the physician s sphere of expertise. The physician can do a number of things, including: 1. Begin to transform one s personal definitions. 2. Pay more attention to one s own needs. 3. Assemble a personal survival kit. 4. Pay more attention to the needs of one s principal supporters. 5. Reframe the case as a Passion Play, and hone one s acting skills for the court drama. According to Dr. Andrew, the physician should recognize that he or she is an actor involved in a malpractice lawsuit drama which is not of the physician s own making nor under his/her control. The arcane script is written by people who have long been dead, by morbid poets, and by modern-day pirates. Indeed, only part of the physician s professional persona is involuntarily involved in the Passion Play. It is important, according to Dr. Andrew, to arm the physician with psychological armor. The physician should be taught that, to the extent that he or she forgets the actual goal of the plaintiff (money), and accepts the stated goal (justice), he or she can and will be disempowered. Therefore, to the extent possible, the physician should ignore what the other side says or does and focus on the fact that the plaintiff is only entitled to money. The physician must remember that knowledge is power and must be acquired. The physician should be encouraged to access resources, including counselors and consultants in litigation stress and witness preparation, talk to close colleagues, and attend support groups. Physicians who have been involved in malpractice litigation should share their experiences and their successes with their colleagues. The accused physician must continually be reminded that being sued for medical negligence is a predictable hazard of medical practice in our times.
7 Ch02-A /16/06 4:18 PM Page 15 Medical Malpractice Stress Syndrome 15 Medical malpractice litigation is one of the most stressful events of the life of any physician. But it is survivable and surmountable. It can be an experience from which the physician can actually become a better doctor. Nietzsche said, What does not destroy me, makes me stronger. The physician can derive therapeutic benefit from the following: 1. Being actively involved with the defense attorney team. 2. Participating in official discovery requests. 3. Assisting in identifying qualified experts. 4. Performing medical literature research to determine nuances of medical care. 5. Attending as many depositions and as much of the trial as feasible. 6. Preparing diligently for appearances by thoroughly knowing the medical records and the medical literature. 7. Becoming educated and comfortable in dealing with the tactics of the plaintiff s attorney and the time and scheduling difficulties required by legal proceedings. 8. Becoming educated about medical malpractice stress and its effects on the physician. 9. Recognizing that there are inherent conflicts of interest between the insurer and the physician. 10. Being prepared to seek counsel by a private attorney if conflicts are perceived with being represented by an insurance company appointed attorney or if claims are not covered or if an excess judgment beyond coverage is possible. FURTHER READING Andrew, Louise, Managing Medical Malpractice Stress, 2003, last accessed February 26, 2006; Charles SC; Wilbert JR; Franke KJ, Sued and nonsued physicians self-reported reactions to malpractice litigation. Am. J. Psychiatry 142(4): (1985). Charles SC, How to handle the stress of litigation. Clin. Plast. Surg. 26(1): 69 77(1999). Charles SC, Coping with a medical malpractice suit. West. J. Med. 174(1): 55 58(2001). Reading EG, Malpractice stress syndrome: a new diagnosis? Md. Med. J. 36(3): (1987). Reading EG, The malpractice stress syndrome. N. J. Med. 83(5): (1986). REFERENCE 1. Diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders,4th Edition, with text revision (APA 2000) (DSM-IV-TR) for Acute Stress Disorder (DSM-IV-TR 308.3) and Post-Traumatic Stress Disorder (DSM-IV-TR ) other than Criterion A (the stressor), describe the signs and symptoms suffered by physicians who suffer MMSS.
COPING WITH A MEDICAL MALPRACTICE SUIT Sara C Charles, Department of Psychiatry, University of Illinois School of Medicine, West J Med 2001;174:55-58 INTRODUCTION In this article, I discuss how and why
USVH Disease of the Week #1: Posttraumatic Stress Disorder (PTSD) Effects of Traumatic Experiences A National Center for PTSD Fact Sheet By: Eve B. Carlson, Ph.D. and Josef Ruzek, Ph.D. When people find
Healing the Invisible Wound Recovery and Rehabilitation from a Post Traumatic Stress Injury By Dr. Amy Menna Post Traumatic Stress Disorder can affect anyone. It is a term used to describe a reaction to
Post-Traumatic Stress Disorder - PTSD Introduction Post-Traumatic Stress Disorder, or PTSD, is a common disorder in which a person experiences disabling anxiety after a traumatic event. People with PTSD
Outline Impact of complaints on doctor health and wellbeing Georgie Haysom, Head of Advocacy at Dr Penny Browne, Senior Medical Officer at 25 October 2015 1. The medico-legal context 2. What does the research
[TRACK 5: SURVIVOR STORIES: EMOTIONAL ASPECTS OF CANCER] Alexa, Marguerita, Lyrio, and Elena are all survivors who have been meeting together in a support group for over a year. Some of them began to meet
Traumatic Stress and Substance Use Problems The relation between substance use and trauma Research demonstrates a strong link between exposure to traumatic events and substance use problems. Many people
Reference document Alcohol addiction Table of content Introduction 2 Definition 2 Signs and symptoms 3 Intervening with an employee 4 Available treatments and resources 5 Conclusion 5 Reference document
Self-Esteem and Mental Health Contents Section 1 Building Your Self-Esteem Section 2 Using Good Communication Skills Section 3 Mental and Emotional Health Section 4 Understanding Mental Disorders Section
Caring for depression Aetna Health Connections SM Disease Management Program Get information. Get help. Get better. 21.05.300.1 B (6/08) Get back to being you How this guide can help you Having an ongoing
WHAT IS BULLYING? For Parents and Families: What to do if a Child is Being Bullied Bullying among children is aggressive behavior that is intentional and that involves an imbalance of power or strength.
HEALTH 4 DEPRESSION, OTHER EMOTIONS, AND HEALTH GOALS FOR LEADERS To talk about the connection between certain emotions (anger, anxiety, fear, and sadness and health) To talk about ways to manage feelings
GUIDANCE FOR CAREGIVERS: CHILDREN OR TEENS WHO HAD A LOVED ONE DIE IN THE EARTHQUAKE Introduction to trauma The earthquake was a terrifying disaster for adults, children, families, and communities. The
Cooper Counseling, LLC 251 Woodford St Portland, ME 04103 (207) 773-2828(p) (207) 761-8150(f) Psychological Assessment Intake Form This form has been designed to ask questions about your history and current
About Postpartum Depression and other Perinatal Mood Disorders The entire period of pregnancy up to one year after delivery is described as the perinatal period. Many physical and emotional changes occur
Top 7 Social Security Disability Blunders: How Honest Hardworking Texans Destroy Their Entitlement to Social Security Disability Benefits The social security disability assessment system was designed to
Great Bay Mental Health Associates, Inc. Notice to Clients and Consent to Mental Health Treatment Agreement Courtney A. Atherton, MA, LCMHC, MLADC Patient Name (please print): Welcome to the therapy services
Postpartum Depression and Post-Traumatic Stress Disorder Emotional Recovery: Postpartum Depression and Post-Traumatic Stress Disorder By: Lisa Houchins Published: July 23, 2013 Emotions vary widely after
Injured on the Job Your Rights under FELA Quick Facts: What To Do If Injured 1. Consult your own doctor for treatment. Give your doctor a complete history of how your injury happened. Make sure that the
Your guide to anxiety treatment after a motor vehicle accident November 2003 ISBN 1 876958 16 2 Published by the Motor Accidents Authority of NSW Level 22, 580 George Street, Sydney 2000 Phone: 1300 137
Disability Management: Best Practices and Holistic Approach Presented by Nicole Raymond October 30, 2013 AN ALARMING SITUATION 2 An alarming situation Mental health is the number one cause of disability
Lesson Plan: Dealing with Stress Objective: Identify effects of stress on everyday issues and strategies to reduce or control stress. Time: 45-60 minutes Structure: On-line homework before class (Stress
Open Your Eyes Wrongful Death and Survival Actions In Maryland & the District of Columbia A Wrongful Death Action What is a wrongful death lawsuit? In the context of a medical malpractice lawsuit, wrongful
DEALING WITH POLICE MISCONDUCT OR EXCESSIVE FORCE IN WISCONSIN Written by: Jonathan S. Safran This guide attempts to answer some of the most common questions and provides a basic understanding of the steps
How to Professionally and Personally Survive a Malpractice Suit John Baillie, MB, ChB, FRCP, FACG ACG Annual Meeting 2013 How to Professionally and Personally Survive a Malpractice Suit John Baillie, MB,
Litigation Stress Author: Louise B Andrew, MD, JD, Physician Litigation Mentor and Stress Counselor, Physician Well-Being, Independent Consultant. Louise B Andrew is a member of the following medical societies:
Atlanta Center For Positive Change Karen Kallis, M.Ed., LAPC, NCC 333 Sandy Springs Circle, Atlanta, GA 30328 An important part of the helping relationship is understanding the expectations of the relationship.
Medical Malpractice Litigation What to Expect as a Defendant Being named as a defendant in a malpractice suit may be your first exposure to civil litigation. You will probably wish it would just go away.
Life with MS: Mastering Relationships with Family and Friends Getting the Support You Need The bonds we have with friends and family are linked to our happiness and well-being. They bring us joy during
Supporting Children s Mental Health Needs in the Aftermath of a Disaster: Pediatric Pearls Satellite Conference and Live Webcast Thursday, August 25, 2011 5:30 7:00 p.m. Central Time Faculty David J. Schonfeld,
Psychological Impact of Disasters Clinical and General Approaches Dr.V.D.Swaminathan Professor of Psychology & Director in charge University Students Advisory Bureau, University of Madras Disaster means
Medical Malpractice VOIR DIRE QUESTIONS INTRODUCTION: Tell the jurors that this is a very big and a very important case. Do a SHORT summary of the case and the damages we are seeking. This summary should
TM Understanding Depression The Road to Feeling Better Helping Yourself Your Treatment Options A Note for Family Members Understanding Depression Depression is a biological illness. It affects more than
Patient Education Coping with Multiple Sclerosis Strategies for you and your family Most people are not prepared to deal with the changes in routine and lifestyle that MS may require. Coping with MS can
Suzanne R. Merlis, Psy. D. Georgia-LLC Licensed Psychologist If going to asylum officer at affirmative stage: ASYLUM OFFICER, ARLINGTON ASYLUM OFFICE In the Matter of Mr. X Respondent If referred to judge:
The Family Library DEPRESSION What is depression? Depression is a medical illness that causes a persistent feeling of sadness and loss of interest. Depression can cause physical symptoms, too. Also called
Anxiety, Fear, and Depression Having cancer affects your emotional health A cancer diagnosis can have a huge impact on most patients, families, and caregivers. Feelings of depression, anxiety, and fear
PSYCHOLOGY SERVICES CONTRACT Welcome to my practice. This document contains important information about my professional services and business policies. Please read it carefully and jot down any questions
Taking Care: Child and Youth Mental Health ANXIETY WHAT IS IT? Open Learning Agency 2004 WHAT IS IT? Anxiety is a normal human feeling characterized by worry, nervousness and fear. Not only does anxiety
FURR & HENSHAW http://www.scmedicalmalpractice.com 1900 Oak Street Post Office Box 2909 Myrtle Beach, South Carolina 29578 (843) 626-7621 (800) 849-2525 email@example.com and 1534 Blanding Street Columbia,
Counseling Services Faculty/Staff Referral Guide for Students in Crisis The purpose of this guide is to provide faculty and professional staff with information about counseling services, referral information,
Breathlessness and anxiety Being anxious can make breathlessness feel worse Not being able to catch your breath can be very frightening Learning to relax and slow down can help to build your confidence
Deborah Issokson, Psy.D. Licensed Psychologist HEALTHCARE PRIVACY AND SECURITY POLICIES PSYCHOTHERAPIST-PATIENT SERVICES AGREEMENT Welcome to my practice. This document (the Agreement) contains important
Understanding PTSD treatment Do I need professional help? Whether or not you need help can only be determined by you and a mental health professional. However, you can take the self-assessment in the PTSD
Dale C. Godby, Ph.D., ABPP, CGP 6330 LBJ Suite 150 Dallas, Texas 75240 972-233-0648 Problems in love and work, as well as troubling symptoms like depression and anxiety, often lead people to seek therapy.
CASE INFORMATION SHEET FLORIDA LEGAL PERIODICALS, INC. P.O. Box 3370, Tallahassee, FL 32315-3730 (904) 224-6649/(800) 446-2998 * FAX (850) 222-6266 COUNTY AND COURT: Orange County Circuit Court NAME OF
National Institute on Aging AgePage Depression Everyone feels blue now and then. It s part of life. But, if you no longer enjoy activities that you usually like, you may have a more serious problem. Feeling
FACT SHEET TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS According to SAMHSA 1, trauma-informed care includes having a basic understanding of how trauma affects the life of individuals seeking
New Beginnings: Managing the Emotional Impact of Diabetes Module 1 ALEXIS (AW): Welcome to New Beginnings: Managing the Emotional Impact of Diabetes. MICHELLE (MOG): And I m Dr. Michelle Owens-Gary. AW:
Leland E. McHatton, MFT Marriage Family Therapist 1430 East Avenue, Suite 4C 530.566.1212 Chico, California 95926 CLIENT QUESTIONNAIRE Client s Name: Spouse s or Parent s Name: Date of Birth: Date of Birth:
Depression in Older Persons How common is depression in later life? Depression affects more than 6.5 million of the 35 million Americans aged 65 or older. Most people in this stage of life with depression
Anxiety and are common in people with asthma. The good news is that there are effective treatments both for asthma and for anxiety and. With careful management, the symptoms of anxiety and can be treated
MySkillsProfile Report Stress Assessment questionnaire Dave Smith myskillsprofile.com around the globe Report The SAQ questionnaires are copyright MySkillsProfile.com. MySkillsProfile.com developed and
You are not alone. It was not your fault. You have courage. You have choices. You have power. We re here to help. A Guide for Childhood Sexual Abuse Survivors Breaking the silence. Raising Awareness. Fighting
Martha T Hinson, M.Ed. Licensed Professional Counselor National Board Certified Counselor General uneasiness to panic attacks and phobias Excessive fears and worries, feelings of restlessness Continual
1 Kids Have Stress Too! Especially at Back to School Time As a Parent, You Can Help! Stress can infect and affect the physical, emotional, intellectual and academic well being of children. It can interfere
Traumatic Stress with Alcohol and/or Drug Addiction information for individuals and families Eastern Trauma Advisory Panel What is Post Traumatic Stress Disorder (PTSD)? How people react to a traumatic
Minimize Your Risk: Mental Stress And The WSIB By Joseph Cohen-Lyons and Samantha C. Seabrook Mental health in the workplace has been the focus of both employer and legislative interest in recent years.
Self Assessment: Substance Abuse Please respond TRUE (T) or FALSE (F) to the following items as they apply to you. Part 1 I use or have used alcohol or drugs for recreational purposes. I use alcohol despite
`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= Overview: Common Mental What are they? Disorders Why are they important? How do they affect
Theory and Practice Edward M. Kantor, M.D. Department of Psychiatric Medicine University of Virginia Teacher s Fear Never Wanes After Assault New York(AP) Students had threatened Susan Hudson before, but
Prescription drugs are the 3 rd most commonly abused drugs amongst teens in Nebraska, and the same statistic holds true on a national level. The rise in prescription drug abuse is becoming increasingly
Traumatic brain injury EMOTIONAL AND BEHAVIOURAL CONSEQUENCES OF HEAD INJURY Traumatic brain injury (TBI) is a common neurological condition that can have significant emotional and cognitive consequences.
CHAPTER 24 DEPOSITION GUIDANCE FOR NURSES I. INTRODUCTION With the number of personal injury and healthcare-related lawsuits increasing each year, at some time in your professional career as a nurse, you
NEW PATIENT INFORMATION Date Patient Name Sex Age DOB / / Address City State Zip Phone Email Emergency Contact: Relationship to patient: Phone #(s) How did you hear about my practice? RESPONSIBLE PARTY
OUR MISSION. Your Wellbeing. WE HELP YOU TO ACHIEVE WELLBEING 01 OUR FOCUS. Develop employee s total potential. HELP EMPLOYEES GET FIT, GET WELL, GET INSPIRED TO EXPERIENCE ULTIMATE BLISS IN LIFE. 02 WORK-RELATED
My Doctor Says Stress is Bad for My Diabetes... What Can I Do About It? BD Getting Started Stress and Diabetes Doesn t Everyone Have Stress? It s true that stress is part of everyday life for everyone.
Cooper Hurley Injury Lawyers 2014 Granby Street, Suite 200 Norfolk, VA, 23517 (757) 455-0077 (866) 455-6657 (Toll Free) YOUR RIGHTS WHEN YOU ARE INJURED ON THE RAILROAD Cooper Hurley Injury Lawyers 2014
Methodist Assistance Program Anxiety, Panic and Other Disorders Anxiety, panic and other disorders such as agoraphobia, social phobia, compulsive disorder and posttraumatic stress disorder are all very
COMMON TERMS: Denial: The "hallmark" of the disease. All family members and close friends are affected by the actions of the Chemically Dependent Person. The refusal to admit the truth is a part of the
Psychiatric Issues and Defense Base Act Claims Dr. Michael Hilton Criteria for DSM-IVRPosttraumatic Stress Disorder with changes now in effect with DSM5 a. The person has been exposed to a traumatic event
Contemporary Ethical and Legal Challenges in Mental Health University of South Alabama Mobile, Alabama March 11, 2016 Meet the Presenter Theodore P. Remley Jr. JD, PhD, NCC, LPC, LMFT Contemporary Ethical
DISABILITY CLAIMS UNDER INSURANCE POLICIES This article by our legal contributor and Information & Referral Associate is to assist persons living with Parkinson s in making claims for disability benefits
ANNALS OF HEALTH LAW ADVANCE DIRECTIVE VOLUME 19 SPRING 2010 PAGES 306-315 The Effect of Medical Malpractice Jonathan Thomas * I. INTRODUCTION: WHAT IS MEDICAL MALPRACTICE Every year, medical malpractice
The Grieving Process Lydia Snyder Fourth year Medical Student What is Grief? The normal process of reacting to a loss Loss of loved one Sense of one s own nearing death Loss of familiar home environment
There is help. Take action. Sexual Violence Survival Guide Options available to victims of sexual assault crimes. You are not alone. Help is available. Call 1-888-956-7273 (RAPE) or go to www.fcasv.org
Suicide Screening Tool for School Counselors I. Risk Factors Check all that apply History of prior suicide attempts Self-injurious behaviors (past or present) Feelings of hopelessness Impulsivity Anxiety
Testifying in Court about Trauma: How to Prepare It is critical that therapists willingly go to court to try to impart their knowledge to the judge. The judge will only make a good decision if he or she
Common Myths About Personal Injury and Wrongful Death Cases 1 By B. Keith Williams There are several myths about accident cases and the attorneys that handle them. It is important to keep these myths in
monitor track manage A TRUEinsight Guide manage Diabetes and Emotions Understanding and Coping With the Emotional Aspects of Diabetes The importance of understanding your emotions A TRUEinsight Guide about
PSYCHOTHERAPIST-CLIENT SERVICES AGREEMENT Welcome to my practice. This document (the Agreement) contains important information about my professional services and business policies. It also contains summary
Do You Have a Case? Truck Accident ebooklet Andrew Miller 201 South 3rd Street Logansport, IN 46947 P: (574) 722-6676 www.starrausten.com Disclaimer No attempt is made to establish an attorney-client relationship
PROFESSIONAL SERVICES CONTRACT Welcome to my practice. This document contains important information about my professional services and business policies. Please read it carefully and jot down any questions