Dr. Leo Damasco talks with Dr. Gita Pensa, as she shares powerful insights on navigating litigation, protecting your license across multiple states, reducing fear, and performing well as a witness while preserving your well-being and career.
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In this eye-opening episode of Telemedicine Talks, Dr. Leo Damasco welcomes Dr. Gita Pensa as she draws from her personal experience of being sued for 12 years, including two jury trials, to demystify the litigation process for physicians, especially those practicing telemedicine across multiple state licenses. The conversation covers the critical differences between lawsuits and board actions, why litigation is far more common than most doctors realize, the psychological toll of being sued, and practical strategies for performing well in depositions and trials.
Dr. Pensa also discusses the distinction between risk management and litigation performance, why most lawsuits don’t end in license loss or personal financial ruin, and how physicians can move from fear to empowerment through education and preparation.
Top 3 Takeaways:
About the Show
Telemedicine Talks explores the evolving world of digital health, helping physicians navigate new opportunities, regulatory challenges, and career transitions in telemedicine
About the Guest
Dr. Gita Penza is a practicing Emergency Physician with extensive experience as a medical malpractice defendant, including two jury trials. After 12 years navigating litigation, she became a coach and educator helping clinicians understand the legal, psychological, and professional realities of malpractice suits. She is the creator and host of the podcast Doctors and Litigation, The L Word, a regular contributor to EMRAP, and co-host of its UCmax program.
Connect with Dr. Gita Pensa:
About the Host:
Dr. Leo Damasco – Pediatrician and emergency medicine doctor turned telemeicine advocate, helping physicians transition to digital health.
Connect with Leo:
Website: telemedicinetalks.com
[00:00:00] Welcome back everybody to Telemedicine Talks. As always, this is your host Leo Damasco, and I'm super excited to have our guest today.
This is Dr. Geeta Penza. Now, Dr. Geeta is an emergency doc who spent 12 years as a medical malpractice defendant, including two jury trials, and she didn't emerge from that experience wanting to put it behind her. No, instead she emerged knowing what clinicians in litigation actually need, someone who understands the process from the inside and who can help them perform well, protect their wellbeing, and get through it with their career and sense of self intact.
now she is also the creator and host of Doctors and Litigation: The L Word, a podcast on legal, psychological, and professional dimensions of malpractice litigation, and a regular contributor to EM:RAP, love it, and co-host of its UC Max program. So Dr. Geeta, welcome to the show. Super stoked to have you.
Thank you , Leo.
I'm happy to be here.
Yeah. let's jump in it. Okay. you coach a lot of [00:01:00] doctors, in litigation and how to do that, right? Honestly, you say litigation, you say legal, it's one of the scariest things that doctors have to deal with or doctors have to contend with , right?
and in telemedicine it's super scary 'cause not only... it will take away everything, right? So right now I have 50 licenses, 52 actually, and if I get litigated and I get flagged on even just one of my licenses, all my states go down and I'm out. I'm out, and trying to build this up is gonna take money, time, and it's a nightmare.
So- Tell me more about that. what do you mean that your licenses go down?
Yeah, I'll readily admit that I practice telehealth here and there, but I don't- Yeah
I'm only licensed in one state. And and the legal climate is very different from state to state, and most physicians are very worried about something happening to their license, when they're sued, and there often is a Department of Health and Licensure investigation yeah. [00:02:00] But it's pretty rare to get your license yanked.
So tell me what you're- Well- Tell me what you're worried about.
Well, it could be yanked, right? But there's a lot of horror stories out there. So a lot of us- Yeah ... telemedicine doctors are, that make their primary living now out of telemedicine.
a lot of the approach is, hey, I'm gonna get all the licenses in all the states so I can practice everywhere, and it makes us more flexible. Yeah. And it actually worked pretty well. But, let's say my license gets flagged in one state, right? the other states will start to hear of it.
And then you have to report it, right? Yes. And your licenses will get flagged there too.
Yes.
Now, there
are- You do have to
report it.
But it's also so common, right? It- And so we have to, I think we need to make a distinction between a lawsuit and a license complaint. Yes. Like a board of licensure- Yeah
and discipline complaint, and those two can be interdigitated.
And so if there is an investigation, like yes, you will have to report that. if there's an action- Yeah ... certainly you'll have to report that. and sometimes it's hard to get a license in another state when you are under [00:03:00] investigation.
The thing is most lawyers are state-specific too. yeah. But I would, I'd be really interested in hearing the story that you've got around people not being able to practice or losing their license in another state when there's just an investigation.
When there is an action, yeah, I'm not saying that it's not- Yeah ... it's not difficult. But, but just the initiation to a lawsuit is, horrifically common. and even in telemedicine I certainly have had a number of clients... we were talking before this show about how I have a lot of radiology clients, and I was asking like, "Is that telemedicine?"
It's not is that like actual telemedicine? But I guess it is. but and certainly other, primary care providers, things like that providing, an orthopedics, specialist who was, it was a televi- visit that was the visit in question. Like these are... It's very common. Yeah. so I- I'd love to, I just wanna get the heart of your question in terms of should you be scared or not scared?
I wanna tell people not to be as scared as they probably are.
Yeah. No, and actually this is good, a good start to the conversation because, I think you're trying to make that distinction, right? that hey, a legal [00:04:00] action, like you were saying, is not necessarily... it doesn't necessarily equate to a board action immediately, right?
and, and obviously I'm showing my ignorance, um, in this, right? Let's say I'm stated in a lawsuit and whatnot, right? And I start to, go down the legal route.
when will the board hear from it? when do I have to worry, right? when will that flag show up on the medical board? And, once that flag shows up on the medical board, then, me with many licenses, I'm scared that the other medical boards, I have to tell them.
And is it, am I gonna have a hard time renewing my license? it's... I guess the horror stories that I've heard are people, you're right, have had actions against them in one state, and then once that action showed up in one state, then the other states came suit, and that's when they got their licenses pulled.
And then they spent money, time, effort-
Yeah.
Okay ... to get it all
back. Okay. That, that does make a lot of sense, and I understand why people would be fearful of that. so we're [00:05:00] talking about two different systems that overlap sometimes. Yeah. And so medical malpractice litigation is its own thing in the civil courts, right?
And so It's a dispute resolution mechanism, is what civil litigation is, right? It's just, one person, the plaintiff, says that there was harm, and that this other person, who is the defendant, is responsible, and the remedy for that is going to be money.
Yeah.
That's it, right? And so in and of itself, it doesn't have anything to do with your license.
It doesn't have anything to do with anything, except that, yes, some boards look at this as a proxy for whether a care was good or not. And I make an argument that,m- litigation has, to some extent, become so capricious, that I don't think people should make anything about the legal outcome.
and that most of the time, when a physician is sued, probably, over half of the times it winds up being dismissed or a no pay case, right? But it takes some time for that to happen. It takes a number of years usually. And so during that time, there may be a board investigation opened because they will look at, those things have to be, they [00:06:00] are reported to the board.
And the Board of Medicine is gonna wanna take a look, and a lot of times they're waiting for the outcome of litigation- ... before they conclude any investigation. So it can be a long time where people are, in limbo. They feel like they're in limbo, and they do have to report that there is an ongoing investigation related to litigation.
Now, lawyers can help you if you ever have to craft a statement. you always have the right to craft a statement when you're applying for a license, or there's something that you can put in there to explain why it is that you're in there, right? And whether or not you feel like, you know, You feel like your care was good, you can make these little sort of like mini arguments in there just to talk about why it is that you're in there.
Yeah. But litigation is so common, that it is really not unusual for someone who practices telemedicine, to be involved in litigation at all, right? And so the, the numbers are wildly variable, but in terms of, your high-risk specialties, if you practice for 30 years, 90% of OBs are gonna [00:07:00] be sued at some point.
90-something percent of all general surgeons are going to be sued at some point, like if you practice for long enough. It's really a matter of numbers, right? Got it. It's, it is truly a matter of numbers. and we would have no doctors left- ... if everybody who got sued had their licenses yanked everywhere.
So that's not really, a straight line. But yes, if you do have an outcome, that is adverse, right? You lose at trial, or there is a settlement over, a certain amount of money, that raises everybody's attention. Now, of course, settlements are getting larger and larger- Yeah ... in this climate.
and so everyone's gonna have to revamp their thinking around that. But there are some things that will get the board's attention, and hopefully they will investigate this, kinda on their own. And 'cause there's usually doctors who are able to, you can present something to the board if you need to.
I, in my lawsuit, I'm being sued again right now, by the way. I have a deposition next month. Oh, wow. but a, a second lawsuit in my career. But, I got a letter from the board in my first lawsuit, and I was [00:08:00] terrified, because I didn't understand that was an automatic in my state.
It's different in every state, but it's an automatic in my state. and then I never had to do anything about it again. there was a... My lawyer prep-prepared some sort of response, and I never heard about it again. The case eventually, over 12 years, it went away, and this whole thing was cleared, and I didn't have to worry about it anymore.
and so it may just be something that simple. But if it's a board action of a different sort or if there was a truly catastrophic outcome or a catastrophic- ... error, which we all know happens, then there, there may be consequences to that can affect your license. And I can see the concern because yes, that is something that you do have to report, and some other state licenses will look at that and say, "Okay, is that a reason not to..."
And that is, yeah, it does require, it will require some time and effort to clarify that. But while it's in limbo and the majority of lawsuits, aren't involving some sort of catastrophic error with a catastrophic outcome, most times, things are gonna work out in your favor [00:09:00] eventually or in a way that doesn't cause you, absolute financial ruin.
but these are things everyone should understand their risk in certain things. So yes, the threat to licensure is something that people are very- ... very afraid of. and then people are worried usually about how they're insured and then, an excess judgment. So you have a $1 million policy, say, and then there's litigation and, maybe you go to trial and the j- you lose, and the jury comes back with a $3 million.
Who's paying for the other two million? and a lot of that's gonna depend on your policy and your employer and who you work for and how your lawyer strategizes post-verdict. And, there's a lot to know about your risk, but the main thing I can tell you is it's very rare. it's pretty... It's really rare, for in the end, someone to either lose their license or to, Have to pay anything out of their assets.
it, I'm not saying it won't happen, but it's pretty rare.
Yeah. It's pretty- that, that's reassuring to hear, to be honest, right? Yeah. [00:10:00] 'Cause, again, showing my ignorance in this is, it's just to me in my mind, it's like, hey, you get named in a lawsuit and, it's game over, right?
It's- No ... it's a nightmare, right?
No. no.
it's something that you're like, "Oh my God." Okay. but yeah.
so what I'm guessing is that you are uninitiated, like you're not part of the club yet of people who-
You know- ...
have been named in lawsuits.
Th- there was actually one lawsuit I was named in way back, I'm gonna date myself, i- in my pediatric residency. So I, we were talking before peds and ER So this was 20 plus years ago. 20 years ago. And I, literally my intern year in peds and, I got this notice and it was like, you're in this lawsuit."
And, freaked me out.
Yeah, I'm sure
it did. Right? Of course it did. Yeah. And reassuringly, knock on wood, haven't been able, haven't been involved in anything hopefully ever again. And what happened
with that? did you get dismissed? Did you have to-
Uh, I think it was dismissed
move to someplace again, settle for it? Yeah.
Yeah, no, there was no [00:11:00] settlement. it got dismissed- Okay ... I believe because I heard nothing about it. And really- my program director at that time was like- This bird faded into the sunset ... "Don't worry about it." It did. It did. And I was so busy with residency and everything else that, you know-
Yeah
it just became a non-issue.
So how mu- how much further could you get from game over?
a, a lot obviously. I was still in practice and
like- Yeah, right? It's like, "Oh, I don't know, we kinda forgot about it." Like
nothing
ever happened.
it's funny too because y- I guess my training specifically too, it was one of those things, right?
I had the fear instilled in me. Then when I went to- Sure ... ER residency, one of my attending's favorite game was like, "Hey-" Imagine yourself in front of the jury and how are you... You know, right?
yeah.
Can you protect yourself- Oh, I got that one ... in front of the jury?
How, when-
Imagine it's going up on a big screen, your documentation- Exactly. Exactly ... you're telling your dictation error. and none of those things are wrong. like-
...
that is what they do. they do pick it all apart, right?
Yeah.
but he may as well have just said, like, "Imagine you have to present a case at M&M."
Right? you will. you're [00:12:00] just gonna
at some point. Yeah,
But if we made that, like, that's the boogeyman, right? of course, it's gonna amp up your fear about M&M if you expect that, the expectation is you won't have to do that. The way we talk about litigation, or not, right?
We only talk about it in the abstract. you never get to see somebody do it, right? You never get to an attending that specifically tells you about, "This is how I managed talking about this particular pain point in my chart at my trial." they don't do that. I will say that in my second trial, and I did invite my residents to come to trial because by then- You did?
I, yes, I did. Because I, at that point, I was starting to educate around it, and one of the things that I really think does us all a huge disservice Is that we have no role models in this at all, right? And this is where this fear comes from, because it is so easy to catastrophize in the absence of any good information, right?
If all you ever heard is that this thing's it's out there, and it's coming to get you, and if [00:13:00] it comes and gets you, then game over, right? That, that's basically what you get, right?
People think that- and that's the messaging that comes out, right? Yeah,
right?
Obviously I got that message or that's the way I interpreted
it.
Of course. You are-- as much as you, like this is, me too. when I start-- the reason that I do what I do now is because, one, I had this very long evolution and spent probably the first seven or eight years of it in abject, like depression, anxiety, fear, not sleeping, missing my own life, hating my patients, not knowing what else to do with my life 'cause I couldn't figure out how to quit ER 'cause I had loans, 'cause-- but I felt very trapped and victimized-
Yeah
by the process, right? And
now-
and this
one case took 12 years? Yes. I can only imagine.
Yeah. Yeah. It was a big deal case. it was a missed, um, vertebral artery dissection in a young woman.
yeah.
I had my own feelings about that. she wound-- she presented very atypically. and now I can give myself some grace and say "Nobody was gonna find that thing." yeah. it just didn't, it didn't make any sense. It didn't add up. but then when [00:14:00] she left my care, she was only 30 years old, and she had a massive cerebellar stroke like an hour and a half after I discharged her.
Oof, yeah. So this turned into a case where I was the f- whole, only person in it, like I was the face of it, but my group was named- Yeah ... my hospital was named. And, at the time I had private insurance, so I had a $1 million limit, and the initial number they threw out was $28 million, right? So where am I gonna get- Yeah
I didn't know how this worked. I was Like- ... "How am I gonna get $27 million? Like, where's that gonna come from?" and I knew nothing. I understood nothing, and I'd been taught nothing. the implication is, when you're taught nothing, is that this is something that ought not to happen to you.
And if it does happen to you, you should be ashamed, like, 'cause no one's talking about it.
No, absolutely. It, yeah I don't know what course was included. I, that definitely was not in my med school courses or anything like that.
No. Oh, you didn't, you got nothing. I, I- Yeah, ... I guarantee you, you got...
Or if you got anything, sometimes they'll bring in somebody, they'll bring out a lawyer in or someone from risk. we're gonna talk about the differentiation between risk management and litigation [00:15:00] performance. But-
Yeah ...
maybe they'll bring somebody in and say, "These are the, the four elements of negligence," right?
there's a duty to treat.
And then we're have, right?
that's- We've done that talk, yeah. Yeah. And it's meaningless. it's- Right ... not meaningless to lawyers, but, to us it's meaningless. Because what you don't understand is, when you get that lecture and they say, "This is what you need to prove negligence," what you feel like is that somebody oughta prove all those things before they sue you.
And no, anybody can sue anyone for just about anything if you can find- ... a claim, take it, and you can find an expert to support it. That's another thing. But, what the whole lawsuit is about is establishing those four things, right? And, being able to tell a jury at the end of it-
do you find this person liable? did they have a duty to treat? Did they, were there damages? Did this person cause the damage? the- ... all of that stuff is what you're gonna fight over the whole time. And we have this belief that, no one should sue us for unless they, unless it's really clear, cut and dried, and that's because we don't know how to think about this like [00:16:00] lawyers.
we come into this f- just completely, again, uneducated, not understanding anything about the realities of how it works. No one has told us about how it works. No one who's actually been-- so you hear a number, but you don't know anybody. no one's said, no one who teaches you talked about this is, what it was like, and this is how I contended with it, specifically, right?
What you get sometimes is, an abstract thing about here's a case where there was a lawsuit. Now, what can we learn about what the doctor did wrong in this lawsuit, right? that's like the most you get, right?
Yeah.
and it's really wrong. It's really wrong-headed because this is a process that is, again, oftentimes, the suit is because of an adverse event, and it doesn't distinguish between normal accepted risk and complications in medicine and actual negligence.
it will at the end, right? But you're gonna spend a lot of time in the proving of that. And most of the [00:17:00] time, a lot of cases, if they're not dismissed, then the next biggest bucket is they're settled, where there's no admission of liability. It is something that has to get reported to the data bank, right?
So that is something you'll have to report. But, and then if you go to trial, the doctor wins the majority of the time. When you go to trial in civil litigation, it's usually because somebody believes in your care, and the insurer wants to put money into... It's expensive to go to trial, and they feel that you can pull it off.
And so part of that is being able to be a good witness on your own behalf. and there's a lot to that. And we come in with a lot of misconceptions about what that is. and because we're doctors, we feel like we should be experts about everything, and it's gotta happen our way. And we are literally at the top of Mount Stupid in this whole Dunning-Kruger graph.
Like- ... we don't understand anything. and yet we re- have very strong feelings about what we want. Yeah ... but what we want is not to be in it. but if you don't have any understanding about how the system works, or even,the stages of it or what you're gonna be required to do or what a deposition [00:18:00] is, it will be normal for your brain to just run off into all the catastrophic scenarios when most of the time that's not necessary.
It's like believing every time it rains that you're gonna get struck by lightning, and that's not usually how it works.
No, how does somebody prepare for that then? so bam, you get this letter, "Hey, you've been named in this lawsuit." what- ... after the fear, the abject terror, and "Oh, what the hell do I do?"
Yeah.
What
is the f- what do you do? I do have a... Can I say I do have a course? this is something I teach.
No, that's amazing.
where can we find this course? I do a course and a podcast, right? this is what all this work is for-
Yeah ...
is to teach people. and the, the podcast is free.
and the LEAP course, which stands for Litigation Education and Performance, is meant to just soup to nuts give you, the whole overview of both, the psychological stuff that you're gonna have to address as well as the practicalities of, like, how does this work? What do you need to do at a deposition?
Like, how do you prepare for that? Like, when you... What happens if you're gonna go to trial? How do they [00:19:00] decide whether a case is gonna get settled? Can I decide? H- how do I know what I can decide? What's my policy? What does this mean? So those things are the things- Yeah ... that we cover, in a, a CME course, right?
But, and the podcast does a lot of that too. that's what it's meant for, is that I, as a, I've, I'm a medical educator, and when you recognize, wow, there is a lotta, there's a lot of teaching and a lot of... Just a lot of gaps that needs to happen, that need to be filled, around this, and just thinking about creative instructional ways to fill those gaps because the fear is overpowering for so many people.
And you don't even realize the ways in which it is altering your behavior every day in terms of the way you document or the way you talk to patients or the way what you order, what you don't order. risk is infused in there. Yeah. and you're taught risk management as though risk could be totally managed.
it's a, it's not a, it's, they, it's a... [00:20:00] I don't like the name, right? You can call it risk mitigation. You can call it risk reduction. But there's no managing it. There's always risk in medicine, and risk is a mathematical problem, right? It's, it is math. If you do something that has risk for long enough, one day you will fall on the wrong side of risk.
It's math
that's a great point. That's a great point. that's why ER doctors love CTs, right? Yeah.
CT
everything. now- Donut
of truth.
It's because of this risk. I am trying to manage my risk. But, you- Yeah ... earlier you talked about, the difference between risk and litigation, right?
can you go further into that?
Sure. All right. So the, the weird thing is, we're taught all this stuff about risk management.
risk management, we get a lot of, and somehow s- it all stops. And as soon as,then your name's in a lawsuit, and then it's like crickets.
you don't know anything- ... about what happens for, the rest of the story, right? So the implication is, it shouldn't happen to you if you [00:21:00] follow all the nice risk management rules. You must have done some- you must have done something wrong if you wind up in this scenario. And yet you look at the numbers, and the majority of us are gonna be in this bucket at some point, right?
are we all bad doctors? How does that work? And I think that we need to think of, risk as, a whole continuum, right? It's not just what happens before. It is also what happens, during and after and making sure that this person, this, this doctor, this clinician, is a good witness, is able to articulate well on their care, is able to communicate clearly, is not, so emotional that they're gonna...
Which was me for part of it. they were like, "This case is defensible, but this doctor's gonna tank all of it. she's just, she's such a mess." Oh, right, right. Right? Um, not being that person, right? Because how good a witness is, how well that doctor is able to articulate their thought process and what they were thinking with compassion and clarity- All the numbers depend on that.
What the legal outcome [00:22:00] depends on that. How fat the settlement is depends on that. Whether you win a trial depends on that. So it's a weird thing. they're treating it like, like a football game where you only play the first half, and then you just ignore everything after the halftime. they're...
Then we just, "Oh, okay, then, now you're on your own." what is that? That seems ludicrous to me. and so there's so much for us to learn and to catch up on. We all should be good at this. We should all understand it, and we should all be good at it because most of us are gonna have to do it. And traditionally, the way that doctors deal with anxiety is by learning, and here we are deprived of the resources.
There's, really not a lot out there, right? Like I had nothing. we're deprived of the resources. We're taught that it's shameful to talk about or think about or learn about. Like, why would you- Oh, yeah ... wanna do that? it's
totally insane. Yeah, it's all ostracized. it's just- Yeah
shame that you've been named in a malpractice suit, right?
Yes, this is crazy when, it's so common, [00:23:00] right? And this is... It's nonsense. It's absolute nonsense. Everybody should be good at this. Everybody should recognize the ways in which your fear is absolutely sapping your enjoyment of your practice.
Yeah. Everyone should be able to you do things that have risk every single day. You get in a car, and you drive, right? And of course, you know what the worst-case scenario is, but you also know, like, how to be safe and how to, like- ... and what will happen if you have an accident and that.
most accidents are fender benders, but okay, yes, you have all that in there, and yet you get in your car, and you love going for a long drive, right? You can enjoy your practice. You can enjoy medicine. If you learn about litigation, your relationship to it, what you'll do if this happens, what you'll do if that happens, how to be safe, how to,yes, risk management and litigation performance .
And when you have all of that, and you have a deep understanding of all of it, then, you're good. You're good. You can just lean into [00:24:00] enjoying the drive.
Yeah, I don't know if that... I've enjoyed any of that drive I mean, you know, involved in any litigation. That is one drive-
but I mean enjoying your practice
I really don't
wanna sign up
for. I mean enjoying your practice. It's the... I mean enjoying your pra- no one enjoys- Got it ... a car wreck, right? But- but enjoying, the pra- because what it does is rob people of their enjoyment of medicine.
Oh, absolutely. It- And you mentioned this process takes forever, right?
Yeah. Well- 12 years in your case.
it's- 12 years ... that's an outlier. That's- Yeah ... that's weird. But yes.
But just hanging over. ... now, bringing it back to-
But it doesn't have to be. Like, Isaac, I'm being sued again, right? My deposition's next month. I know what I need to do. I need to prepare for it.
Most of the time, it's not something that I'm really dwelling on.
Yeah.
It's really not. I know what I'm supposed to do. I know that I will... Like I said, I'll set aside time. I have time prepared with my lawyer. I feel like our care was good. I know how I can articulate it. Sometimes in the back of my head, I'm like, "All right, if they ask this, then I would say this."
but it's not at all when I went through it the first time and knew nothing.
A- and the difference is this [00:25:00] time you're educated, right?
The difference is- You know ... that this time I'm educated. Yeah. This time I know. I know what I'm doing. the person... I was like a social experiment, I like to say, but like the trial A...
so I had two trials. I won at the first one, and then there was an appeal, and they overturned my verdict- Oh ... which was absolutely devastating for me. and it was after that I decided, I've... this is a sink or swim moment for me- yeah ... 'cause I've spent all these years like this. And so what if I decide to swim?
I gotta learn how to swim. I don't know what that even means. Yeah. And so part of it was figuring out how do you dig out of a hole, like emotionally, where you've been in it for a long time, and part of it was, what the heck is... I've been in this thing for eight years and I don't understand it. what the heck is happening?
Yeah. and making myself not... I didn't go to law school, but I became a student of what is, like in an anthropologic kind of way- ... like what is happening over there? Why are they doing these things? What is this for? What does it mean to... what do these words mean? and getting good at it.
and then getting good enough at [00:26:00] it that I was like, "Oh," put me in coach." "I'm ready." Yeah. And so that was what enabled me to get, to tell my residents, "Show up, man," "You're gonna... You will never have an education like this one." and it's sort of like coming, asking someone to come and watch you give a talk or something.
Like sure, you're a little nervous, but like you have a feeling you're gonna do pretty good, right? Yeah. If you practice enough- Yeah ... you know what you're doing. and that was very valuable to them. The junior residents were like, "Could you do that again like next year?"
C- can you please get sued again so- Like, no.
Yeah, Just
gonna skip that. but there is a very different feeling when you have a sense of,there's no perfection, I f- I knew I could go in and be excellent.
Yeah.
and that's what we're going for. this process has so many twists and turns, and when you start to understand All the other, the points of view of everybody else who's in it, right?
what motivates them? What, how does the money move in this ecosystem? Like, why is the plaintiff attorney interested in X, Y, Z, right? Why will they let this person out but not that person out? Why did he sue all of these people but not that person? Like, all of [00:27:00] these things have reasons, that don't make sense to you medically.
but if you start to understand the very... You know, if you watch one of the shows like Succession, Billions, Game of Thrones, whatever, like then you get a sense of oh, like this is how there's so much going on here that isn't related to your care. Litigation is a bajillion dollar industry in the United States.
Yeah. Tort-
Yeah ...
law, right? Like civil litigation, like the most recent numbers I have are from like 2022, but it was like almost a half a trillion dollars, exchanging hands in a, it is a business. This has, there's, private equity invests in it, private equity from abroad, right? there's third party litigation investors that fund cases.
There's litigation going now or there's, you know-
That just sounds dirty. That just, that's just-
Oh, it is ...
that whole idea in itself. Yeah. You have litigation- I know ... investors like- I know ... counting on
you being sued. it's crazy, right? That's a- Yeah. Oh,
yeah ... that's
a crazy idea.
Oh my God, and they'll [00:28:00] bankroll the plaintiff's attorney until,
Oh my
gosh. So there's so much that people just don't know and understand. Yeah. We are like willingly have our heads in the sand about all of it because it feels so, it feels dirty, it feels shameful.
I don't wanna get my hands dirty thinking about it or talking about it, but guess what? This is an integral part of medical practice in the United States, and you may find it distasteful, but it was there before you, and it's gonna be there after you, and honestly, you should learn about it.
Yeah. And there, there's good cold areas to that too. You, you know, so ER doctors, right? we don't know what's coming in, right? Yeah. And a lot of times people ask me, "Hey, how do you stay calm in this situation?" And "How do you," "How do you get through that, physically, emotionally traumatic situation?"
It's just 'cause we've learned, right? Yes. We know how to handle ourselves, so forth and so on.
Yes. And
why not
do the same thing? how are you gonna spin like a, a resuscitated hysterotomy , right? Like- I'm gonna knock wood. I've never done one, [00:29:00] right? And if I had to, if I was called upon, like I would be scared out of my mind, but I would do it.
I would know what to do- Absolutely ... because someone taught me. And I would just, I would see it as we have to move this from a predator-prey situation- Yeah ... which is how we all think of it, to a situation of a challenge between equals, right? Like you are the doctor. Yeah. You have expertise. Most litigation doesn't involve mistakes.
Yeah.
It just doesn't, right? And so acknowledging that, like most litigation doesn't, and guess what? Once in a while, the, even the things that we call mistakes, a lot of times were just judgment calls that could have gone either way and then they went another way, and your problem was you didn't have a crystal ball.
Like that's-
That's such a great point. That's such a great point ... just reality. and that's, I think a lot of the shameful aspect of that is because a lot of people equate litigation to mistakes. You- And they're wrong ... are litigated because, you must have sucked.
Yes. You were horrible . And that's wrong.
It is wrong. It's wrong. It's [00:30:00] not true. Yeah. It's wrong, right? it's like we love to blame people for things, right? but there... I'm trying to think of a proper analogy. It's like saying, "You caught a cold and so you must have done something..."
Y- like this whole, "You must've done- Yeah. Yeah ... something bad because, this happened." no, they're not related. a- sometimes they are, right? there, there are lawsuit. There, there is a such thing as patient harm. It does happen.
Yeah.
It is a small minority of litigation actually, right?
And sometimes we do ourselves this disservice of confusing what's reasonable medicine with what's perfection, right? So we are our own worst critics much of the time when we look back and say, "This thing happened and I made the wrong call at the time," even though it was, like, eyes wide open, or I was really trying my best.
'cause nobody wakes up on any given day and says, "I'm just gonna go in and screw everything up for this patient," right?
No. we're- I hope not ...
we're trying so hard, to do everything now- Yeah ... and now with, less and less [00:31:00] time and worse systems and all of that. But, but everything in medicine has risk, right?
And so we have to accept that this is going to happen, and there will be times when, because you didn't have a crystal ball, you chose B and maybe... who's to say A would've been any better besides the plaintiff's attorney who believes that- Yeah ... it was? And then your own self, who goes back and beats yourself up relentlessly because, you did something that at- Yeah
at the moment seemed reasonable.
Yeah. Yeah.
and so I would invite everybody, if you have a situation where there's litigation going on, one of the things when I work with people one on one and we're talking about, the reasonableness of care, the way I'd like you to think about reasonableness is if nothing bad happened, if nothing bad happened, and someone said, "Hey, will you look at this case?"
and everything was fine at the end. Is there anything in there that you looking back at what you did, you would be like, "Oh, God," "I, I can't believe I did that. I... it's by the grace of [00:32:00] whomever that nothing happened"?
Yeah.
Is there something in there that's like that? Okay, that probably is, maybe that's substandard.
Maybe you shouldn't have done that thing, right? But if we all fall into this trap where we judge the medicine by the outcome... And no, reasonableness isn't about the outcome. Reasonableness is about what you did in the moment at the time with the information that you had. And if that was, if it made sense, if it seemed reasonable, if, you had the same set of facts and probably the same thing had happened tomorrow,or the week- Yeah
before-
Good point ...
then it's medicine you should defend. Yeah. And you should know how to defend it. You should.
No, this is a great conversation. Honestly, it could go forever. but no, we're actually at time. no, this is amazing, right? It definitely dispelled one, uh, my initial ignorance of it, right?
and I love how you made that distinction, right? versus,the civil suit ver- litigation versus, the whole [00:33:00] license and the medical board, so forth and so on. But also, I w- what, has stuck out for me the most is also the, the focus on how this affects you as a whole, like psychologically as well.
totally understand that. one last question I always ask everybody is, hey, looking back, think about, if you had the little time machine and you could go back to your intern self, day one, July 1st, anything at all, what would you tell that person?
Oh, it is July 2nd today that we're talking.
It
is. Oh my gosh. Happy Intern Day.
Happy Intern Day. And now I'm like a, what am I? A PGY, God, 30, uh, yeah, I'm up there.
Wow. Yeah.
so anyway, I... as it relates to litigation, I will tell everybody that- Or
as an F-
Yeah, or nothing. But no, e- everybody that comes into medicine, like you've got a contract with medicine.
Like I don't mean a written contract, like we are, we dedicate our lives to this, and the reason you signed up for it is because, you want a front seat to humanity, you wanna use your [00:34:00] skillset, you wanna help people, you wanna do good work, and you are gonna do all of those things. Medicine is gonna hold up its end of the bargain.
But there are two things in the fine print that nobody really talks about that are going to get cashed in at some point, right? And one of them is that one day something bad will happen and they will blame you. And another time something bad will happen and it will be your fault.
And sometimes those things will overlap and sometimes they don't.
Sometimes they're separate. but not a person I know in medicine who gets through a whole career without the fine print coming at some point, right? And so I think you should start your career, yes, you wanna guard against that as much as possible, but with the understanding that everything we do has risk, and you're gonna reduce that risk the more you learn, the more you practice, the more you practice thinking like a doctor, all- the more you practice your communication skills, which are [00:35:00] every bit as important as your medical skills.
The more you learn how to care for people compassionately and to enjoy the work and to love the work and to work in service of the patient, that is all amazing. Those two things will still happen. And so I think having real meaningful conversations with people about how do you handle that when it happens, even though I don't want it to, and I'll do everything to keep it from happening.
But how do you process that grief? How do you move forward? What do I do when I get sued? I'd say when, not if. and how am I gonna take care of myself? Because you do deserve to. you deserve to. you deserve to get back up and keep on going, 'cause those things were always coming. It's just that nobody really drew your attention to the fine print.
So now they can focus on,the main contract, which is,come and get what you came for. Like, come get that amazingly rewarding career , right? And rewarding medicine, and the patient interaction, and all of it. Squeeze it all out of there, but just, hold a little space for the fact that at some point you're gonna have to do that.[00:36:00]
No, amazing. thank you so much, Dr. Geeta Penza. Check her out on her podcast, Doctors and Litigation, the L word. socials, how do they find you on that?
doctors_and_litigation on Instagram. I'm not usually active socially, but I'm gonna try to do a little more posting. But, and doctorsandlitigation on, I'm on LinkedIn.
I have a very baby YouTube channel. Yeah. I am hoping to post more, but, that's,I'm still working too much Clinically. I gotta figure that out. It's a whole different job ... but, yeah. Yeah, but the website is doctorsandlitigation.com, and they can find all the resources through there.
So it's all one word, doctors and, A-N-D, litigation.
Cool. Thank you so much for taking your time. This has been one of my favorite conversations by far.
I'm so glad ... totally helpful. I- the thing that you, are so scared of. See,
it's actually- Oh, ex- absolutely ...
fun to talk about ... absolutely. No,
it is, it is interesting to talk about.
Fun may not be the right word . I think it's fun to talk about.
no, and, I, I love your gusto [00:37:00] in it, and, it definitely shows that, hey, yeah, you definitely wanna help people out, so absolutely. Thank you so much for your time. Thanks for having me. And super enjoyable.
Thank you.
All right. Take care.