The Psychological Consequences of Medical Negligence
One of the central tenets of good medical care is: “first, do no harm.” It is a core part of the Hippocratic Oath and a principle that all healthcare professionals strive to uphold. Very occasionally, however, doctors and nurses fall short of this goal, and they end up causing physical or mental harm to their patients. In these cases, they may be guilty of what is known as medical or clinical negligence.
Medical negligence often causes immediate damage to a patient, but it can also have long-term psychological effects. In such cases, a plaintiff may be able to claim compensation for the psychological consequences of medical negligence.
In this post, we look at the different types of medical negligence, as well their potential effects on a person’s mental health. We also look at some of the major medico-legal considerations in negligence claims.
What is medical negligence?
There are many different forms of medical negligence. We outlined one particular example in our post on obstetric negligence, which is harm caused to a mother who is pregnant or has just given birth. In general, though, clinical negligence can result from any injury that is caused or exacerbated by a healthcare provider. Some examples of cases where clinical negligence claims arise include:
A medical professional failing to diagnose a condition correctly or making the wrong diagnosis, leading to either a lack of treatment or an unnecessarily invasive treatment.
A surgeon making a mistake during an operation, leading to unnecessary complications.
A person gaining consciousness during surgery due to problems with their anaesthesia (known as accidental anaesthesia awareness).
A patient being prescribed the wrong drug or being given the wrong dosage.
A patient not being properly informed about the risks involved in a procedure, or a doctor not obtaining a patient’s informed consent.
In 2019, the NHS reported that they had received a total of 10,678 clinical negligence claims. The departments that received the most claims were emergency medicine and orthopedic surgery. While such claims are undoubtedly significant, it is important to remember that they are also vanishingly rare. It is estimated that the NHS deals with more than 1 million patients every 36 hours, so 10,678 claims over the course of a year represents a percentage close to 0.
What are the potential psychological consequences of medical negligence?
As with all kinds of personal injury, cases of medical negligence can have long-lasting psychological effects. A person who suffers from medical negligence may develop anxiety, not wishing to undergo future procedures, or they may become depressed in response to their treatment. They may even experience the accident as a traumatic event, leading them to develop symptoms of post-traumatic stress disorder (PTSD). Here are just some of the potential psychological effects of clinical negligence.
Psychological reactions to ongoing pain
A mistake during a surgery or a misdiagnosis can cause a patient to suffer unnecessary and avoidable pain. In severe cases, the pain may be ongoing or chronic, which can lead to frustration and depression as patients struggle to live with it. The link between ongoing pain and depression is widely acknowledged. Studies have shown that anywhere between 25% and 50% of people who complain of chronic pain also report being depressed, and 65% of people with clinical depression experience ongoing physical pain. When this pain results from poor medical care, it can be even more frustrating and psychologically debilitating for patients.
Anger at poor patient care
Anger and resentment are also common responses to medical negligence. When a person has been the victim of a sudden and preventable injury, it is common for them to feel a sense of injustice about the life they have lost. They may blame the clinicians for what happened, making it difficult for them to accept and adapt to their new life.
These feelings of anger and frustration are not just limited to the patient. Sometimes, friends and family members may also feel upset by the effects of the poor medical care their loved one received. Obviously, in the most severe cases, medical negligence can lead to death, which can be deeply upsetting for family members. As well as making a claim for the bereavement and the funeral expenses, a family member or friend may be able to claim for the psychological pain caused by an unexpected death.
Self-blame and regret
More surprisingly, the victims of medical negligence and their families can also end up blaming themselves for an accident. Even if a medical professional was clearly at fault, victims and their families may feel that they could have done more to notify people that their situation was worsening. A 2007 study by Tom Delbanco and Sigall K. Bell found that just as clinicians often blame themselves for accidents or injuries, patients and family members sometimes “have similar or even stronger feelings of guilt.” This can lead to self-blame and regret, both of which can make it hard for people to move on and accept what happened.
PTSD
PTSD can result when a person has experienced or witnessed an extremely distressing event. As such, a traumatic experience that results from medical negligence would certainly have the potential to lead to PTSD, and the link between negligence and PTSD has been clearly established by previous studies.
The most common symptom of PTSD is re-experiencing the traumatic event. Thus, patients who suffer from medical negligence may relive their injury in the form of flashbacks, nightmares, or repeated sensations. As we discussed in our post on obstetric negligence, mothers who undergo a traumatic birth as a result of poor treatment sometimes develop PTSD symptoms. In cases of infant mortality, mothers can feel robbed of their children and can end up reliving the painful experience again and again.
Furthermore, PTSD can also lead to a host of other behaviours. PTSD sufferers will often try to avoid places that remind them of the traumatic event—in cases of medical negligence, these places are typically hospitals or treatment centres. People with PTSD from medical negligence, therefore, may try to avoid further treatment, or they may become angry and irritable when forced to interact with hospital staff.
As mentioned above, it is not just patients who can be affected in this way. Family members and friends can also develop PTSD in the wake of traumatic medical experiences. In fact, a widespread study conducted in the US found that people who experienced the unexpected death of someone close to them were more likely to develop PTSD symptoms than the general population. If that sudden death were the result of medical negligence, then family members might be able to make a claim for compensation for their PTSD symptoms.
Legal considerations in medical negligence cases
There are several things that both Expert Witnesses and the courts must bear in mind in medico-legal cases involving negligence claims.
Firstly and most importantly, as we have discussed in earlier posts, medical negligence is very difficult to prove. Even if a person sustains an injury as a result of medical treatment, that does not necessarily mean that they have been the victim of medical negligence. There are two main tests used to decide whether or not a healthcare professional has acted negligently: the Bolam Test and the Bolitho Test. To pass the Bolam Test, a healthcare professional must show that they acted “in accordance with a responsible body of medical opinion.” The Bolitho Test states that the medical opinion that was followed must have been logical. A person can only be found guilty of clinical negligence if a court finds that they failed both of these tests. For more detail on this, please see our posts on the Bolitho Test and the Bolam Test.
Secondly, when it comes to psychiatric assessments in medical negligence cases, it should be remembered that the complexity of each individual case means that it is difficult to make generalizable assumptions. People who experience a traumatic event due to medical negligence will not all react in the same way. For example, one study has reported that out of five cases of couples who were referred for assessment following stillbirth or neonatal death from negligence, only one couple had parents who both showed signs of PTSD. In the four other cases, the father who had witnessed the stillbirth presented with PTSD, whereas the mother experienced either normal grief or clinical depression. It was thought that the reason for this was that the fathers were more likely to have witnessed the gruesome aspects of the birth, and gruesomeness is a significant predictor of PTSD. It shows, however, that the same traumatic event may be experienced differently by the people involved in it. No one sequence of events can be expected to produce the same psychological effects for all people at all times. In medico-legal cases, therefore, a Psychiatric Expert Witness will be asked to make an assessment of a plaintiff’s symptoms on a case-by-case basis.
Finally, another complicating factor in these cases is that cause and effect can be very difficult to establish. It is generally assumed, for example, that PTSD symptoms will develop within three months of a traumatic event, but there are reported instances of symptoms developing much later. In such cases, therefore, it can be difficult to demonstrate definitively that the symptoms were caused by the negligent actions. In general, a Psychiatric Expert Witness will be asked to assess whether a person is presenting with PTSD symptoms, but the ultimate question about causation will be a matter for the courts to decide.
Summary
Though undoubtedly rare, cases of medical negligence can be deeply traumatic when they do occur. Not only can they cause immediate, short-term damage, but they can also have long-lasting psychological effects. Some of the most common effects of medical negligence are anxiety, depression, and PTSD. In cases where patients experience ongoing pain, they often resent their lower quality of life. They may feel angry at their clinicians or even blame themselves for what went wrong. In severe cases, they may experience the negligent action as a traumatic event, causing them to develop symptoms of PTSD. The same is also true of the friends and family members of the victims of medical negligence.
That being said, it is also important to recognize that not all people who suffer accidents or injuries as a result of medical care are the victims of negligence. Negligence is difficult to prove, and it is often hard to establish cause and effect when assessing the psychological consequences of medical negligence. Therefore, each medico-legal case must be treated on its own merits, and the courts will often be obliged to make a decision based on several possible interpretations of the facts.
This post is provided for general information purposes and is not intended to cover every aspect of the topics with which it deals. It does not constitute medical, legal, or professional advice, nor is it necessarily an endorsement of the views of Professor Elliott, the U.K. Centre for Medico-Legal Studies, its employees, or its affiliates. Though we aim to ensure that all information is accurate at the time of posting, we make no representations, warranties or guarantees, whether express or implied, that the content in the post is complete or up to date.