Plaintiffs bringing medical liability cases commonly contend they have experienced pain and suffering. Many physicians could say the same about being dragged into the litigation process.

Karen Kohatsu, MD, a San Diego-area obstetrician-gynecologist, was confident she would prevail when she was sued a couple of years ago, but isolation and sleepless nights still reigned throughout the process. The suit was eventually dismissed.

"Self-doubting occurs when you read the summons and depositions from the other side," she said. "The other side makes it sound like you are a terrible person for missing a diagnosis. You feel really alone and have to turn everything inward because you don't have anyone to talk to about it."

Dr. Kohatsu is not alone.

Experts say litigation stress syndrome is a real phenomenon, and one that has a significant impact on physicians. Various emotions, including anger and depression, can strike, along with an inability to concentrate.

When physicians are counseled by their lawyers not to talk about the case, most take that to mean they can't talk about the experience at all, experts said. But increasingly liability insurers and professional medical societies are instituting programs designed to help physicians deal with the emotional rigors of litigation stress.

"In the big picture, we want to normalize the experience of litigation," said Ronald L. Hofeldt, MD, a psychiatrist in Salem, Ore. He serves as a consultant to medical liability insurers and other organizations, helping design retreats and wellness programs that give doctors a venue to air their litigation concerns and help them develop coping skills.

"The myth is, if you are a good doctor and you are perfect every time, you will never get sued, which is wrong. Getting sued doesn't mean you are a bad doctor. It's really just the cost of doing business," said Dr. Hofeldt, also director of physician affairs at Physicians Insurance A Mutual Co., a medical liability insurer based in Seattle.

Lawsuits often tap into doctors' fears of losing their reputations or their careers, he said. Such feelings often exacerbate doctors' unwillingness to let others know they've been sued or to discuss the emotional toll.

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