Just one year into her career, Louise B. Andrew, MD, JD, was thrust into one of the most harrowing experiences a physician can have. It was the late 1970s, and she had just completed residencies in internal and emergency medicine. She was acting director of the emergency department at Johns Hopkins’ Baltimore City Hospital when she got the news.
“I got sued,” Dr. Andrew said, noting that she had been the attending physician for a resident who was accused of malpractice. “It was over a patient I had never seen. Back then, residents had no obligation to share cases with attendings.”
While no attending physician would be put in quite the same circumstance these days, plenty of doctors still face litigation, with nearly one-third of U.S. physicians in 2022 reporting they had been sued.
“Everyone in the field would agree that being sued is one of the most stressful events in the life of a physician,” she said. “Because we go into medicine out of a desire to help, yet are accused of harm."
A fifth-generation physician who served as speaker of the American College of Emergency Physicians and former delegate for the AMA Senior Physicians Section, Dr. Andrew added to her credentials in 1991, earning a law degree from the University of Maryland Health Law Program. And since then, her avocation has been mentoring physicians who are undergoing litigation or regulatory stresses, practice dissolution or interpersonal issues.
An AMA member, Dr. Andrew also is a leader in the AMA Ambassador Program, which equips members with the skills and knowledge to confidently speak to the AMA's initiatives and the value of membership.
In an exclusive Q&A, Dr. Andrew discussed how she counsels physicians dealing with the stress of being sued. She also touched on the work she has done to help other older adults negotiate the aging process.
AMA: What should physicians facing litigation know right off the bat?
Dr. Andrew: Being sued isn’t fun for any doctor, but most likely you're going to prevail if you go to court—yet court is what most of us fear most. Also, cases are usually settled, sometimes purely for financial reasons.
The hardest part of my job is convincing doctors that the deck is not only completely alien, but stacked against them. You must learn to play the game, even if you did nothing wrong. So don't let that be a reflection on you. It reflects, rather, a very poorly designed compensation system, which is working to your disadvantage.
AMA: Was counseling physicians a skill you developed after being admitted to the bar or was it something you had been doing for a while?
Dr. Andrew: I was already doing it when I went to law school, I just wanted to understand the big picture.
AMA: What is the nature of the counseling you give? In a nutshell, how would you characterize it?
Dr. Andrew: You're the doctor. You've just been sued, you are worried, and you're totally out of your element. This certainly wasn't what you went to school all those years for. And what I have to convince you is that this happens to most of us, sometimes more than once. But litigation is survivable, and manageable, if you know the legal game and how it is played. You can even grow from it.
Ultimately, because you are a people person—that’s why you're in medicine—your role is to assist your lawyer in building your defense, and convince the jury (if you need to testify before them) that you are actually the person that they would want for their doctor. And most of the time you're going to win. A lot of cases will settle long before trial.
AMA: You’re now a senior physician, but your work isn’t done. How else have you been helping your peers? And how does being an AMA Ambassador fit into that?
Dr. Andrew: I love speaking and writing and have done so for many years. But in the last five years of my clinical practice, I transitioned into a new specialty called regenerative medicine, which aims to keep older people vibrant and pain-free. But my calling to physicians is broader than that. Since residency, another part of my career has been dedicated to wellness and burnout prevention, and especially suicide prevention for physicians.
I strongly believe that organized medicine is a way to prevent burnout, because in this realm you’re always looking for things that can make physicians’ lives better. They might not always work, but at least you’re working to improve our lot by banding together with people who might have the strengths, the staff and the resources to pull it off.
AMA: That’s interesting. Advocacy is often portrayed as something that is done against the odds—that, most of the time, advocates don’t experience a full win—and that can ultimately be quite discouraging. But you seem to be saying advocacy can have a restorative or mitigating effect. Is that right?
Dr. Andrew: Yes! Just being in the arena and fighting for what you, your peers and your patients need is energizing, far more than sitting there saying: “It won't work. I don't have the money. I don't have the power.” What we're doing is trying to brainstorm collectively: How might this work? What can we do together that could help make everything better for all of us—and our “progeny”?
That's something I say to medical students to get them involved with the AMA: You’re coming into a noble profession, but it has been battered in recent decades, and a lot of people are going to discourage you. There’s even a report that almost 60% of current medical students are not planning to practice medicine.
But rather than using your education as a stepping stone to something else—when you don't know that world either—stay with this noble profession and help make it better! And how do you do that? Well, you don’t do it by yourself. You can't. You do it by banding together with other smart, caring people who have resources.
