Soundings Soundings

Does litigation make you ill?

BMJ 2001; 322 doi: (Published 31 March 2001) Cite this as: BMJ 2001;322:805
  1. Kevin Barraclough, general practitioner
  1. Painswick, Gloucestershire

    It's often well into the consultation when their lower lip begins to quiver. This is the physical sign that alerts us astute physicians that something is up, and that it might be a long morning. However, when they start to speak of “my case,” you know that they are suffering from WLD and you reach for the Prozac pad. There are in fact two variations of the condition: WLD—whiplash, litigation, depression—or its variant, WLBBD—whiplash, litigation, breakup with boyfriend, depression. The sequence of events from the bent bumper to the reports of the orthopaedic consultant, pain consultant, and psychiatrist stretches out with the tenuous causal certainty of a domino line.

    Now I know that an association does not prove causality. However, the recurrent juxtaposition of “my case” with the quivering lower lip does give cause for thought. All I need, to label my observation “Barraclough's syndrome” (or, more modestly, to get a friend to do so), is to come up with a plausible biological mechanism for causation. Well, I can do that.

    Vulnerable twenty-something (a difficult decade anyway) gets shunted in the boot at the roundabout and hurts his/her neck. A series of helpful friends, then lawyers and doctors explain that you are actually a “victim” and have “rights” to compensation. You have been “wronged” and “hurt” and you were a “helpless victim,” like some poor child napalmed in Vietnam. What is more, the amount of money you will receive increases the more severe your symptoms are, and the longer they last. As you are examined and questioned recurrently, the pain, like any prodded and examined pain, gets worse, and the sense of personal grievance against the world rises. And, to paraphrase Bertie Wooster, it's never difficult to distinguish between a litigant with a grievance and a ray of sunshine.

    The trouble is that, when anything bad happens to you there are two ways you can respond. You can examine how you feel about it, the emotional and physical hurt, and the world that might have been (a dangerous place at the best of times). Or you can say “Sod it” and get on with your life. Rather worryingly, it is becoming much more lucrative to be a helpless victim than a resilient coper.

    Maybe I could become an expert witness in WLD? Now there's a lucrative thought.