Autores: JosepArimany-MansoabMartaVizcaínoaEsperanza L.Gómez-Durán


Complaints of alleged malpractice are a concern for doctors, however the impact these complaints have on them receives little attention. We present a systematic review of the scientific literature by searching the MEDLINE database, without no time limit, of manuscripts on doctors’ reaction to a malpractice claim, carried out in Spanish, English and French. Their methodological quality was evaluated, and the results were analyzed. The search identified a total of 18 articles, mostly without empirical sample analysis, which described the clinical judicial syndrome construct, its symptomatology, prevalence, etiopathogenesis and issues of prevention and approach. The literature on this subject is very scarce and has poor empirical foundation. However, the available data underscored the relevance of the impact that these complaints have on doctors and highlight the need to establish preventive measures and approaches to the so-called clinical judicial syndrome.


Las reclamaciones por presunto defecto de praxis resultan una preocupación relevante para los facultativos, sin embargo, el impacto que las mismas tienen sobre estos recibe escasa atención. Se presenta una revisión sistemática de la literatura científica mediante la búsqueda en la base de datos MEDLINE, sin límite temporal, de manuscritos en castellano, inglés o francés, sobre la reacción de los facultativos ante una reclamación por negligencia. Se evaluó su calidad metodológica y analizaron sus resultados. La búsqueda identificó un total de 18 artículos, en su mayoría sin análisis de muestra empírica, que describían la sintomatología, el constructo de síndrome clínico judicial, su prevalencia, etiopatogenia y aspectos de prevención y abordaje. La literatura médica al respecto resulta muy escasa y con una pobre fundamentación empírica. Sin embargo, los datos disponibles subrayan la relevancia del impacto de las reclamaciones sobre los facultativos y urgen a instaurar medidas de prevención y abordaje del denominado síndrome clínico judicial.


Claims for alleged malpractice are a concern for doctors.1 Litigation is extremely stressful and entails an inevitable physical, emotional and behavioral response.2, 3 This subject has been dealt with in the medical literature, although scarcely, with different denominations and from different perspectives, however it is little known in our environment and lacks empirical data. So far, medical, political and judicial corporations, as well as professional or patient associations, the media or society in general, have not shown sufficient interest in this issue despite the distress that these alleged malpractice claims produce in health professionals.4 In an international context of increased claims, some people point to an epidemic of this syndrome among professionals in the coming years.4

The present manuscript aims to address the concepts related to the construct of the clinical judicial syndrome (CJS), its etiopathogenesis, clinical characteristics, prevalence, prevention and approach through a systematic review of the medical literature.

Section snippets


A literature search was carried out in the PubMed digital repository during the month of November 2017 with the terms “clinical judicial syndrome”, “malpractice stress syndrome” and “litigation stress”, as well as a complementary search that combined the term “second victim” and different terms related to the claims for alleged medical professional responsibility, yielding the results shown in Fig. 1.

The articles located by means of this literature search were reviewed, those that did not

History of the concept

Litigation was identified as a factor of stress for doctors in the USA at the end of the 1980s.5 In 1993, the Argentine Medical Association group, led by professor Elías Hurtado-Hoyo, coined the term “clinical judicial syndrome” in reference to all the alterations that modify the state of health of an individual who is subjected to judicial proceedings from inception (citation, legal claim), during its different stages (conciliation-mediation, court case, sentence) and/or after having completed


The medical literature on the impact of claims on doctors is very limited and with poor empirical foundation, made up of mainly narrative reviews and special or opinion articles. However, we consider that the CJS describes correctly the reaction of doctors to judicial proceedings, regardless of possible criticism of the diagnostic consistency and its close relationship with the concepts of adjustment reaction disorder or post-traumatic stress syndrome.

There are no empirical data published in

Conflicts of interest

The authors declare no conflict of interest.

References (20)

  • J. Arimany-Manso et al.

    Un modelo integral y de gestión directa del aseguramiento de la responsabilidad profesional médica en Cataluña

    Med Clin (Barc)

  • S.C. Charles et al.

    Physicians’ self-reports of reactions to malpractice litigation

    Am J Psychiatry

  • S.C. Charles et al.

    Sued and nonsued physicians’ self-reported reactions to malpractice litigation

    Am J Psychiatry

  • E. Santoro

    Clinical–judicial syndrome: how a doctor becomes a patient through general indifference

    Updates Surg

  • S.C. Charles et al.

    Physicians on trial—self-reported reactions to malpractice trials

    West J Med

  • E. Hurtado-Hoyo et al.

    El síndrome clínico judicial

    Rev Asoc Med Argent

  • A. Fileni et al.

    Malpractice stress syndrome in radiologists and radiotherapists: perceived causes and consequences

    Radiol Med

  • N.J. Johnson et al.

    Litigation stress in nurses

    Nurs Manage

  • P. Young et al.

    [Clinical judicial syndrome] Spanish

    Medicina (B Aires)

  • L.H. Strassburger

    The litigant-patient: mental health consequences of civil litigation

    J Am Acad Psychiatry Law

There are more references available in the full text version of this article.

Cited by (0)

Please cite this article as: Arimany-Manso J, Vizcaíno M, Gómez-Durán EL. El síndrome clínico judicial: el impacto de los procedimientos judiciales en los médicos. Med Clin (Barc). 2018;151:156–160.