Season 3 Episode 6: Relias on Mission: Breaking the Stigma Around Litigation, with Dr. Gita Pensa

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Reliably Well brings you thoughtful conversations from those who are shaping the future of healthcare, focusing not just on the technical side of the industry, but on the human element, the stories, the struggles, and triumphs of individuals who are driving change. Join us for candid discussions that highlight both the challenges and rewards of working in a field where humanity and healthcare intersect.

Dr. Gita Penza is an emergency physician, educator, Brown University faculty member, and one of the country’s leading voices helping clinicians navigate one of medicine’s hardest and least talked about experiences: litigation. An adjunct associate professor of emergency medicine at Brown University and a fellow of the American Academy of Emergency Medicine, Dr. Pinsa has become a nationally recognized expert on malpractice litigation stress and physician litigation support.

Helping clinicians navigate not only the legal realities of being sued, but the emotional and psychological impact that often comes with it. She is the creator and host of Doctors in Litigation, The L-Word, an open access podcast curriculum used across medicine, law, and the medical liability industry to prepare clinicians for the practical realities of litigation and the human realities that accompany it.

Dr. Penza consults with medical liability insurers, hospital systems, and defense attorneys across the country and maintains a national coaching practice, supporting clinicians as they move through the litigation process. She is also the creator of the Defense LEAP Litigation, Education, and Performance Courses, now used by hospital systems and medical liability insurers nationwide to better educate support clinicians facing litigation for the first time.

Her work has been featured in Time NPR, South by Southwest, and the PBS documentary A World of Hurt: How Medical Malpractice Fails Everyone. We are truly honored to welcome Dr. Pensa to the podcast today, and especially excited to have her join us this September as the keynote speaker for our annual Relias Leadership Forum. And I have to say that as I’ve gotten to know Dr. Pensa through planning for both this recording and her upcoming time with us at Leadership Forum.

I’ve come to appreciate that she’s equal parts superhero in all of the great descriptions that I just read and her expertise and credentials, but also deeply human in her warmth and kindness and generosity. That combination feels especially fitting for the conversation that we’re going to have today at the intersection of medicine and humanity. So, Dr. Penza, welcome to the Reliably Well podcast. Thank you, Livo, for that overly kind introduction. I really appreciate that. And I’m happy to be here.

Yeah, Dr. Pence, I I it’s a great honor to to have you on our podcast. really have looked forward to to having you here. a couple of years ago, it seems like time has warped for me ever since COVID. I’m not sure if it did something to my brain or just all of time warped has happened or just getting older things things have evolved. But I can’t remember exactly when I saw the documentary.

But I remember seeing it and I remember saying, Man, I I really wish I could speak to you. So I’m having a you know, a a real moment here that I’m I’m getting to actually speak to you. But that was such a powerful documentary. I hope our listeners can get off of listening to this podcast if they haven’t seen it and and go and watch A World of Hurt. because it it it’s it it’s a really emotionally packed

documentary to to really I think translate what they may or may not have experienced if they’re if they’re clinical and certainly if they’re not clinical, what they haven’t experienced, what what this is. so I I would I would ask you what’s your story and maybe t tell us tell us all some of the other stuff, but but also more pointedly, how did it get you from maybe what you thought it was gonna be

To the point where you are working in this advocacy for clinicians in what’s some of the most difficult place that they can be where they we we all fear of of going someday. Yeah. So that that’s kind of a long story. but the the short version of it is that I myself was a defendant in a really long

malpractice case that wound up lasting twelve years and and two jury trials. And it was a really serious case. It was involving a young woman and I did not find a retebral artery dissection that presented in a really strange way. And then she subsequently had a stroke. and she was only thir thirty years old. She was an engineer. She was you know, had her the whole rest of her life ahead of her. And

It wasn’t long after that that I was named in a lawsuit in which the initial demand was like twenty eight million dollars was the first number that I ever saw. And of course I had a million in coverage and then I was contending with or not contending well, I’ll say, but I was sort of contending with this mix of of of grief and guilt over what happened because I I felt responsible for what happened. and then this lawsuit that I didn’t know the first thing about. I didn’t know

anything about what to do once you were served with papers. and I think there was some magical thinking thing that I’d had going on that like I was, I thought I was a really good doctor and I followed all the risk management rules and I thought it wasn’t going to happen to me somehow. I just thought I would escape it. and I didn’t. And that was my entry into what turned into nearly a decade of

of terrible anxiety and depression and just not knowing how to deal with this and wanting to quit work but not knowing how and feeling trapped because I had loans and that was really the only reason I stayed. because I just couldn’t figure out how I was going to make enough money to pay off my loans. And so I’d, you know, pull up to the ER and I’d cry in my car and then I’d go work a shift. And it’s pretty impressive how long, you know, all of us in medicine have a lot of grit and resilience and it’s

Pretty impressive how long you can keep doing that. and I did that day in and day out for many, many, many years, all the way through a tri a four and a half week trial where I didn’t know what I was doing. I just showed up and did what they said. And there was a defense verdict, which was great, but I was still miserable. And then when it was time to, you know, I I I found out they were a gonna appeal and I was worried, but they told me that was standard, don’t worry about it. And then of course I went through all the layers of the courts in my state. And so

By the time twenty fifteen rolled around, my attorney called me and said I had to go back. You know, I was I was in a a terrible place. And what came out of that was though, this decision that I had to do better by myself. It was a real sort of sinker swim thing. And I decided to try to swim, see how far I got. and that was the best thing I’ve ever done for myself, I think.

And so, through a combination of like, you know, ex learning going outside of my own I think especially as doctors, we sort of feel like we’re supposed to have all the answers in our head. and recognizing like I didn’t, I didn’t I didn’t know how to deal with this, I didn’t know anything about the law, I didn’t know anything about how to contend with this, I’d never had instruction in it, I’d never had role models in it. Like what was I supposed to do other than just absolutely give up? and if I wasn’t gonna give up, how would I learn? And so I sort of

made a study then of getting better at it, feeling better, thinking about. And then by the time I got to a place where I really recognized, like, I don’t know if I’ve been thinking about this right all along. Like, I don’t know if we’re doing this the way that we really ought to be in medicine as a whole. and I really think that our

Ignorance or naivete, our refusal to talk about this stuff out loud, our refusal to teach about it. this whole pretense that risk management ends when you get served, and then after that it’s like cyanara and good luck. Like that whole thing to me was like, I don’t know if we’re doing this right. I started to change how I thought. And so, and then I decided to learn about the law. And in a sort of, you know, I didn’t go to law school, some people do, after this kind of

trauma, I’ll use the word. I sort of started to study it like an anthropologist. Like, what are they doing there? Why are they doing that? How why does this work this way? and the combination of those two things meant that when I went to trial the second time, I was a totally different person. I had fallen back in love with what I did as a career. I was highly confident about my ability to perform as a witness. I was highly confident in my ability to teach about this on both aspects, both

In terms of the the mindset required to deal well with this and the skill set required to perform well. I’d started teaching my residents about it. I invited my residents to come to trial. Like this is the the headspace that I was in was a completely different than for my first trial. And then subsequent to that, that really became my my main extra clinical focus. Like I just I I couldn’t wait to start teaching more about what I’d learned.

and the ways in which that that could be transformative for just a career in medicine in general and certainly how you face this process. Yeah, you know, Dr. Penza, as I’m hearing your story, it’s very evident that there is this grit and resolve in in the way in which you handled a really impossibly difficult situation. I’m curious, you know, is there part of your personal story that you feel like you’ve learned that ability to

To have the grit and the resolve to to navigate this? Is there part of your kind of personal support or personal story that really allowed you to do that? That’s a great question, Libo. And I think that I’ve always been kind of a gritty and resilient person. A lot of us in medicine are. What I didn’t know was where to apply it. And I think for a long time I was applying that grit.

would to just freaking show up and get through my day. Like I just like this is all I gotta do is just like show up one more time, practice some medicine, do the thing, et cetera, et cetera. And what I didn’t really do was shift my thinking to believe that I deserved to feel better and to start applying that grit and resilience to like, how do I get better at this process? How do I feel better in my own life? There was some part of me I think that felt like once this happened that I deserved whatever I got.

And I I did that for a long time. And I think with a lot of the clients that I work with, there is this element of deservingness because you did let something bad happen. And you’re a doctor. You’re not supposed to ever let anything bad happen on your watch, right? You’re not, you’re not supposed to be blindsided. You’re not supposed to be bested by whatever, whatever the process is. Like a rock star would have figured that out. And apparently I wasn’t that day. And there had to be an element of of reckoning with like, what does it really mean to be?

A human being who is not perfect, practicing a science that is not perfect and expected to deliver perfect outcomes every time. And that math doesn’t math. And to what extent could I be compassionate to my own self and then apply that grit and resilience to getting better better at this process and learning about it and performing to the best of my ability within it? and to what extent can I use that to apply to really give language to

Like a lot of it compli the nuance in terms of like what’s expected of us? You know, do we have to pull a rabbit out of a hat every single time? Is it reasonable to expect that? Like what does reasonableness in in medicine mean? What does standard of care mean? Like what’s different about the law versus this? And so turning that lens in that direction, instead of just like, I’m just gonna get through my days because that’s all I deserve to do and that’s where I’m applying my grit and resilience. I think that for me was a real

That was a real shift. I didn’t I didn’t feel empowered to do that for a very long time. So you you had this transformation. that was an instant, I’ll say that. Like this wasn’t definitely like a slow thing happening. Yeah. But y you know, that that happened because of this really negative event to you. Is there is there some influence? Is there some support? Is there some mentors? Is there somebody who’s had some

shoulder that you lean on or some body who’s who’s there that’s been that that influence or that that guide for you through through some of these tough times or or just that person that you’re like that’s who I’m doing this for or or who who’s the poster on the wall for you? What a great question. No, I don’t know if anyone’s ever asked me that before. I will say a lot of people

as soon as I allowed myself to receive help, there were a lot of people who helped me. you know, my husband was great. Like I just, you know, I just but for for so long I I just was in my own like my own little echo chamber of a head and just thought, like, no, I have to this is me. This is my problem. but I will say that I so my father is ninety-six, almost. He’s ninety five and a half, right? This is where we start counting halves again.

and he was my dad was a monk for the he grew up in an an ashram in India and is left in his twenties to pursue science and he wound up coming to the United States in the fifties as a PhD student in organic chemistry. And then he became he became a chemist, right? And then he had two kids and we were we were immigrant kids and you know, a lot of our upbringing. So a lot of that grit and resilience I think is actually being like an immigrant kid.

but I will say that we grew up with a very I would say, philosophical and spiritual background in our home. And he is just like a highly philosophical man. and so he couldn’t understand what it was. I mean, he wasn’t a doctor, he didn’t understand what this was about. But certainly, and I didn’t really know how I mean, we have like one idea of what a good doctor is, right? And we’re all taught like this is the way that we behave.

And we’re also taught that like we are to be ashamed by this process and this is what medicine requires of us. And as soon as I became a a doctor and I knew how to be a doctor, everything else I ever thought I knew about like creativity, philosophy, spirituality, all that stuff like went out the window. Like it was just gone. Like I this is what a doctor does. I do a doctor now. That’s what I am. and it really wasn’t until late in this process that I was able to sort of step back and be like, wait, I know, I know more about myself than.

Than this, like what I’ve been allowing myself to I had these sort of blinders on to the other experiences in my life that probably would have been really helpful to me if I had sought to apply them or felt like I deserved to. And it really was sort of an expanding and letting in some of the things that like I know to be true about myself, and I know to be true about a human being in the world doing their best, right? Like, how do you that’s where a lot of it came from. and so certainly.

opening myself up to the things that I kind of already I knew that I had learned from him and then having him how do I how do I explain my dad? My dad is like you ever seen Kung Fu Panda? Yeah. Yes. My dad is is Master Ugwe. That’s my dad. I mean like you may not get like the lesson right away, but like the wisdom is there. Like if you’re willing to like sort of listen to it. But he’s just very kind and very patient and always has

Just this, like, you know, a real circumspect, you know, like the the answer is usually acceptance, right? And this is a Buddhist principle, right? The answer is usually acceptance and then and then what, right? I could not accept my circumstances. and not being able to accept them and just sort of in the fighting with reality constantly was what kept me trapped. And learning that.

the acceptance of the circumstances and then that will help you sort of move into this, okay, now what? that was stuff I already knew, but I just been I had been fighting it for a decade really. but still to have those those really steady, quiet influences in my life. And I have my kids, you know, I I think that there was a time when my thinking started to get very dangerous. and if I didn’t have those anchors, like I don’t know what I would have done. But I know, like to speak frankly, like

I don’t I it did suicide cross my mind? It certainly did, but would I have done it? I really don’t think so. and first and foremost were the people that I love and who loved me that I didn’t want to betray. But I certainly felt trapped enough that and suffered enough that like those sorts of things would cross my mind. But I wouldn’t do it. I didn’t do it. And so eventually I figured out like I gotta do something else. I can’t just live in this limbo anymore. And what do I have to call upon? that would help me.

But thanks for asking that. No one ever asked. I never get a chance to talk about my dad, but I he sounds fascinating and and and I think you obviously you can see that you can see a little bit of that master Ugwe coming through on you that he that he I mean i i he the lesson wasn’t learned easy, but eventually it it it came out. It was taught. It was it so sank in. Yeah. Eventually it did. And so and so yeah, so he is a true inspiration to me. and he, you know.

He’s just his his breadth and depth of all sorts of philosophy to me is just sort of staggering. and so I pull on that a lot actually when I talk to people about coaching and I bring a l I bring a lot of other stuff into into it and we often have a lot of conversations, like really deep, meaningful conversations about I don’t know, about life and medicine and what it is to be human. and I think people are hungry for those conversations. That’s right.

In hearing your story, there was a a few things that that struck me, this this sense of being trapped and feeling trapped. And then I love the way you said you allowed yourself to receive help. that allowance is a is a huge key and a major step. And so my my question to you initially was what do you think is the biggest challenge to the clinician today? but I I’d love for you to answer that, but also this idea of

You I can’t help but think there are clinicians listening to this that fall into two categories, right? They either have been served papers and are facing litigation, or they are ever present that that’s a reality and living in this constant state of anxiety. so what would you say to them that allowed you to actually take that first step of allowing to receive help? I decided that I didn’t need to be ashamed.

That was that was a real that that you know that was sort of sort of a domino one piece, but shame is the is the running element through all of this. And we create the shame. So shame is a is a societal tool, right? That’s how people in a society know what the norms are. If you wouldn’t want someone to know something was happening, right, that’s because you’ve been taught like to feel shame around that thing. and in medicine, our refusal to talk

openly about litigation, except in this very abstract like risk management. Like, let’s see what the doctor is wrong in this case. Like, not that. I mean someone being able to say out loud, like, this is happening right now. I am being sued. This is how I’m contending with it. Like this is the, you know, this is, and I will talk, we can talk in a minute about the whys. Like, yes, there are some prescripts prescriptive things that people tell you, like, don’t talk about it. Right. But more than that, I think in medicine, we have made it a taboo

thing. And somehow with that is this inference that like if it is happening to you, you did something wrong and you are bad, right? Instead of and you could say, like, look, if you’re a surgeon, OBG ON, ER doc, like you practice for 30 years, like you’re there’s no getting out of it. It’s gonna happen. It doesn’t matter how good a doctor you are. It’s just a function of how many patients you see and how many years you practice. Like those are the main drivers of litigation and how high a risk your specialty is. And risk, I decided

One day to me is mathematical. Like risk is a math problem. It is. This is statistics, right? Like risk is just like if you do a thing enough times, you will fall on the wrong side of risk. It’s math. And should math have shame with it? I don’t think so. but we have we just have so many thoughts about, you know, and we’ve been conditioned to think so many things in terms of medicine. It really was the ability to sort of parse out all of these things that.

made me recognize, like, I don’t think I need to be ashamed about this. And that freedom allowed me to start letting people in, to say, like, this is happening. Like, I need to learn ways to contend with this. Talking to lawyers, I am this is happening. I need to understand what it is that you know. reading books and allowing myself to even that felt like weird and self indulgent to me. Like I was not a self help

person. Like to me, you know, I went to med school in the nineties. self-help was not a like, if you you would make fun of people who were reading self-help books, right? Like it was just like woo and weird and whatever. And then I became an absolute self-help like devotee. Like just I, you know, I I read one book about it was called When Good Doctors Get Sued. And I loved that it said that you could be a good doctor and get sued. And then

From there I was at least I allowed myself to notice, like, wow, I kinda I got something out of that. Like maybe maybe I should read some more. and then I, you know, I and I did, right? It wasn’t in medicine then. It was just like all sorts of other stuff that was there for the taking. And I think when a doctor is given permission to really learn widely about something, we’re pretty good at it.

And so I moved into this real studious aspect where I would like I’d highlight stuff, I’d taking notes, I’m trying the trying the exercise with like it’s in a way that I would never have like a decade before that at all. and then finding lo and behold, like there’s something to this. How about that? that was, you know, it was very freeing. And, you know, as they say, there’s no zealot like a convert, right? And so I was I was an ab I became like an absolute zealot, like, wow, this stuff works.

But freeing myself of that shame was really liberating. and it allowed me to then accept the help that I that I needed, whether whether it came from a book or whether it came from finally talking to a therapist or whether it came from like letting my friends know that this was happening or telling the nurses at work like this is this is what’s happening. and being able to receive from them, you know.

Like, hey, we think you’re a great doctor. Like the validation of like, don’t don’t pay any attention to that. Like we we know who you are. Like just forget about that. It was really helpful. but I would say one thing that we just all need to work on is this the shame that we have around it. We just have to rid ourselves of this concept that it shouldn’t happen. It happened because I’m bad. It happened because I am a terrible doctor. Like, you know, for most of us that

do good work most of the time, right? We have to give ourselves grace that not everything can go right every single day. It just can’t. It’s again, it’s math. that’s a big sticking point though for a lot of us. Yeah, it’s the it’s the scarlet letter that people feel like they’re wearing if they’ve if they’ve been named, I think and we don’t want anybody to see it.

We can change that. I mean, imagine y I mean, if you think back in time about things that were once shameful, like it was once in a while that having cancer was was shameful. Right now, cancer is a lot of things, but it’s not shameful, right? You you didn’t you didn’t do anything wrong to invite this, right? Like there are five Ks that people walk around around for for for awareness. Exactly. Right? Like they are holding you up as a champion, right? And great.

That’s how it should be. Yes, you are a survivor. You are battling this. Like, but that’s not how we always thought about it, right? This is society has the has the right to they you decide based on how you talk about something and how open you are about it. And, you know, whether or not there are visible role models doing it. That’s how you decide whether you have to be ashamed about something or not. And so we have the power in medicine to, I don’t know what the word is, de-shameify this whole.

experience for the people coming up behind us simply by being unafraid to talk about it out loud, right? Is there a difference between inactive litigation talking about all of your case detail? Like, no, but we can learn how to do that. That’s a line you know how walk, right? But like the fact that this is happening, what’s in the complaint is public record. My deposition is next Tuesday. In fact, I do have a deposition. I’m being sued again. I got a deposition on July thirtieth, I think is the date. But I mean

And here I am talking all about litigation, right? And what it does. I

I just think that if we could shift the way that we all talk about it out loud and then and talk about it out loud at all, it would make it very different for the generation coming behind us, just like it is different for people now talking about cancer than it was for our grandparents. This is a cul this is cultural and culture is malleable. Yeah. So we just need people to start changing it.

So on that, you know, the the the the dark picture that we have, you know, burnout rates, emergency medicine high highest of any specialty. And it seems like every time they survey it goes up. I think we’re all burned out. and you know, I I saw the Kaiser study that the average age of folks that are leaving

medicine now, 48. 48. I’m overdue. I should have retired. me too. I’m mid fifties now. I should have been gone a long time ago, right? Yeah. So 1900. Yeah. so and and obviously the the malpractice, the litigation risk pours into that because of, like you say, the shame, the fear that that’s going to happen to me and what how what the ripple effect of the malpractice suit is in my

In my ongoing practice, how it’s going to change it, and how it’s gonna ripple out into my family life, into my social interactions, into whatever else is is going to come from it, the picture that you painted of how you entered into it in twenty fifteen, all of that fear that people have of what it’s going to do if I ever get there. so let’s let’s change that. What what gives you hope? What gives you energy?

Going forward, how can we how can we flip this or or what are you seeing that tells you this is turning? That that we’re changing the narrative here, that we can turn this this from this is taboo, this is a scarlet letter to this is just math, as you say. This is just this is the thing that happens and and that maybe we can change this too from

Look, this is you know, that this is this is math. This does happen. Let’s quit making it this thing that we hide and we never let anybody see it to let’s investigate it like the NTSB. Let’s figure out why good this happens to good doctors so it doesn’t happen to good doctors. Because let’s be real about it. The bad doctors do this stuff all the time. I was just reading somebody on one of the Facebook groups talking about.

Somebody who has continued to go back to one of these med spas, getting GLP ones to take a patient down to a BMI of sixteen and nobody’s reporting this person who is taking this person. You know, there’s no malpractice there. Yeah, yeah. There’s no pro malpractice there, but there is malpractice when when just bad things happen in routine life.

And that’s where malpractice happens. And it can be a great doctor, but it’s a bad situation that happens to a 30 year old. and and we just need to figure out how we make safer systems, not whack a mole, you were the you were the person who was there. So let’s let’s say you’re bad because you were the you were the person who was there when that happened. Are you seeing anything that’s changing to where we can say, okay, this was not me. Let’s just learn how to make the system safer.

So that it doesn’t happen to the next patient who comes. There there are, right? So there are I I see nowadays much more desire to to create systems of support, first of all. Like I’m a huge advocate for peer support and particularly litigation-specific peer support, like that, because I think it’s a different animal and it has different considerations. But the willingness, first of all, for organizations to recognize that they’re coming along, that they actually

Not it’s not just a nice to have, like there is an organizational responsibility to its workforce to protect them from the fallout from chronic stress. I actually was just in a work group that just released a paper about this. Like there are legal implications, like thinking OSHA-wise about because chronic stress has been shown now to show it causes physical changes in the brain, right? The things that create burnout conditions at work. I think it’s an organization’s responsibility to

one address those, but two, also to offer offer support and for the things that people need to sort of alleviate those stressors. That’s one thing. And so I think the conversation is evolving. Second, like, you know, I I do hope that, you know, the the podcast and talking about litigation, I I f I feel like I hear more people talking a little about their how difficult litigation was for them or

Not really in real time yet, but I do I’m I’m starting to hear that conversation a little more as we start talking more about burnout and wellness. I we’ve got a long way to go in that regard. but it’s starting, right? And so and I I feel good about that. What I what I hope is that the podcast is, you know, has been the thing that made it safe to talk about. And I do think it’s safe to talk about. You have to learn how not to be, you know, when I talk to residents about that, I’m just like, look, don’t don’t go out and be dumb.

And then say Dr. Pence told you to do something stupid. Like, please don’t do that, right? But you can learn how to walk this line where you’re t I mean, feelings aren’t facts. People like that’s coaching 101, right? And so, yes, talking about your feelings, holding the facts close, but talking about your feelings or the fact that the legal events are happening, like, yes, you can talk about those things. You should talk about those things because that is the best way to process some big traumatic event in your life. But we don’t want to talk about it because we’re ashamed and we’re all perfectionists and

And so we don’t want people to know that things are happening to us, right? And oftentimes there’s not a system of support. So I do think that we’re just when I so when I ask you like, what do you has turned? Because it hasn’t yet. It we’ve not reached a tipping point yet. I but I do think that the conversations are starting. And I think the more people feel empowered to have those conversations, we will eventually get to a tipping point where it becomes the norm. Everyone knows that this thing is.

going to happen and and what they will do when it does. Like that’s another thing that we’ve got to address is that people have these giant gaping holes in understanding. So when I go to audiences and I tell them like you should all know how to be a good defendant. People are like, that’s so weird. I don’t want to think like that. Like I don’t want to be in that club right now. Like you should know how to be a good you should be good at it.

You should be good at it. It’s a good thing to be good at it. and that hasn’t like that hasn’t sunk in yet, but eventually I’m convinced we’ll get there. and what that means is you’ve got to know about your role. You have to know how the system works, you have to understand how the money moves. That actually is quite liberating. You have to understand the motivations of these systems, and that’s the way that you’re gonna understand what could change in this system and begin advocating.

So what we also need is to your point, like, I mean, civil litigation is a it’s a dispute resolution mechanism. It was never set up to adjudicate care. It can’t do it, right? Because the jury doesn’t understand medicine, the judge doesn’t understand medicine. Nobody, nobody in this thing, except for you and a couple of experts on both sides were paid for their opinion. Nobody in there understands medicine. They don’t. This is not what it’s set up to adjudicate. And so what you said before.

About there are bad doctors out there, and we’re not that’s how we got into this mess because we have advoc we totally abdicated our responsibility to actually weed out the bad docs. And we know who they are, right? And so we need medical boards who actually pay attention to those things. It’s actually remarkably hard sometimes to get them to, you know, sink their teeth into things where we’re just like, we know these things are happening, but we never built a system like that. And now we are paying the consequences. We have a system.

That we’re using as a proxy for whether or not care is good, that is a completely insufficient system for it. And now that thing, because of just the influences of business and the way the plaintiff’s bar works and the fact that litigation is a huge industry in the United States. I mean, it’s like approaching trillions of dollars a year in terms of just what tort, you know, payments are in a year, not just malpractice, but all of it. And it is running amok. And plaintiff’s attorneys are in most state legislatures.

Right. There’s like a direct pipeline between the plaintiff’s attorneys and state legislatorhood. And they are expert lobbyists. And we are not, right? We feel like, we’re too busy over here in our clinical world. And I’m too busy doing it. And medicine is, you know, we’re keeping our hands clean over here. And I’m sorry. This is not the system that we’re in. We are gonna have to roll up our sleeves and start working to actually be loud and advocate for changes in the system. We have lost.

Control in a lot of ways. and it’s hard to turn a ship, but it’s time. Yeah. Yeah. I you know, I love that. And as I I hear you, it’s clear you have the passion for advocacy and you’re a natural educator in the work that you do. I I’m thinking all of the conversations that you have with clinicians, I’m curious, is there a pattern of kind of this one thing that you feel like clinicians are surprised to learn in the coaching or the conversations that they have with you?

do you see a theme in that that there’s a wow, I never thought of it that way. Yeah. I mean, well, there’s a lot. But the most consistent thing is that people feel like when they they don’t know what they’re talking about when they talk about standard of care, right? And they also feel like this whole thing is about whether or not you followed standard of care. I mean, ostensibly on the surface, that’s what they say, right? Like that’s what you should follow, but it it stops being about that. Like once you get into the dispute resolution process, right?

It stops being about like, yes, following standard, like follow if there is even a standard of care. But I mean, practicing good and reasonable medicine is yes, your first defense at not being involved in litigation. And yet, bad things will still happen because risk, math, right? It does happen. And then you are gonna fall back on like how strong is my documentation? That might not save you or keep you out of a lawsuit, but it’s certainly gonna help you when you’re in it, right?

There are all these sort of layers of of things, but most people think I could just explain my reasoning to somebody and they will see that my medicine was sound and then I will get out of this thing. Or that I did practice the standard of care. So somebody should be guarding the gate and saying that they can’t sue me because I was I I practiced good medicine. And that just shows a complete misunderstanding.

Of civil litigation. Like in civil litigation, anybody can sue you for anything. You just need a bad outcome, some kind of damages, a plaintiff’s attorney who’s willing to take the chance, and an expert to say, Yeah, I’ll back it up. That’s it. Right. And all of it is going to be about what kind of a story can we create around the facts. And that’s kind of it. so yes, the biggest misconception is that this is.

Once it starts, that it remains all about your care. It does not. There are a million other variables that go into this whole thing. And another is that settlement is actually like means you did something wrong. And increasingly now, so few cases go to trial now. and the majority, and there are many, many cases that are dismissed, but one, a lot of times you’re not making that decision.

And that’s something that we just have to accept. You have to understand how your policy works and who’s making the decisions about settlement and the fact that most of those people making those decisions are making it like based on a lot of factors that don’t have anything to do with your care. And again, a lot of it comes down to math, right? Like and math and odds and numbers of like how big, how little, how big a check, what do they want? What this is like a whole negotiation process and how strong is your story. And we just have such firm beliefs about

like justice and there’s a right or wrong answer and someone should look at this and throw this thing out. And it is not how the law works. It just is not. You can want it to be that you could argue with it all day long, but if you don’t accept how the law works, then you’re never gonna figure out how to actually operate within it. Yeah. We have a lot of we have a lot of misc and I had them all. I don’t judge anybody for having them because I had all the same ones. I had all the all the same

things in my head that had to like get systematically beat out of there before I understood, like, wait, my gosh. Like we’re not doing this right. Yeah. Yeah. You know, and Dr. Prenta, I I feel like I speak for both Dr. John Z and I when I say we could listen to you talk all all afternoon, just of the ways in which you’ve interacted with clinicians, cared for clinicians, abdicated for them. this conversation just makes me

Even more excited about leadership forum and the time that you’re gonna get to spend with our people. You know, we try to kind of wrap up questions that kind of focuses on you as a person and our kind of whole avenue of humanity in medicine. we just spent talking for a few minutes on what surprises clinicians from a litigation standpoint.

But I can’t help but also wonder what would our listeners be surprised to know about you? Maybe not just as a professional and an advocate and an educator, but just the human Dr. Penza. What’s something that might surprise our listeners? Hmm. that’s a great question. what would surprise them? I was gonna be a classical musician for a hot minute. tell us more. I was I played the Oboe and English horn.

all through well, I played all the way through medical school. but I was very, very serious about it. And I was also kind of like, I kinda wanna be a doctor too, but like, I don’t know, if like if if music doesn’t come through, then I guess I’ll be a doctor. and I I actually, talking about perfectionism, I set myself up so that I was gonna audition to to one

quite famous and actually it wasn’t it wasn’t Juilliard, but I was gonna apply to Curtis. and if I got into Curtis, this is how I d how I made the decision, like in my own life. If I got into Curtis, then I was gonna be a musician. And ’cause Curtis was free, when you when you if you if they let you in at the time. and so I auditioned and I did not get in. I was and I applied to a bunch of other pla I mean

What happened was I wound up using that as like a way to get into, you know, into colleges and to, you know, to other places. But I had this weird and a teenagery kind of way. Like, well, if I get into Curtis, then I’ll s then then I know I’m I’m meant to be a musician. And it didn’t happen. and I mean, obviously retrospectively, like, well, that was dumb. But but that was how I thought at the time ’cause I couldn’t make up my mind. so then I but I did play, like music was a big part of my life. I minded in music and I played in like a

a trio all through all through college and I played in an orchestra. Then I played in an orchestra at Penn in my first two years there. And then when I got into the clinics I had to there I just couldn’t I just couldn’t make rehearsals. And now I don’t play as an adult. I really don’t. I do a lot of other musical things and my kids are all musical. So I’ve had a lot of fun with that. but I don’t play the Obo anymore. But yeah I don’t know it’s

sorry this the right way, but the Curtis Admissions Department, I think we all have a huge debt of gratitude to them for helping you make the decision that you did because what an advocate and a gift you are to so many. and we just appreciate your time. We appreciate just your advocacy and your heart for caring for the whole clinician and certainly cannot wait to have you.

in a few short months in September as a part of our leadership forum. I’m excited for it. Thank you so much. This has been really fun. Yes. Great. Thanks. Thanks for your time.

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