Sued for side effects

Massachusetts is allowing a new form of malpractice lawsuit to go forward:

A woman wrecked her car, killing an innocent bystander. Now the bystander’s widow is suing the woman’s doctors, arguing that they should have warned her not to drive while taking the pain medicines they prescribed.

The problem is, a majority of medications can lead to lightheadedness and dizziness, which in theory, can impair the ability to drive. Blood pressure and diabetes drugs for instance. Should patients taking these medications be warned not to drive?

At the very least, I would be very wary of prescribing any form of narcotic medications if these types lawsuits were to succeed. Patients lose again.

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  • Christian Sinclair, MD

    I just posted about this case over at Pallimed for those who are interested in more questions this new kind of liability brings up.

    The biggest implication is how this changes medication education. It may focus so much on avoiding liability that the patient does not actually get the information they NEED while taking a medication.

  • Fred Clay

    If the patient herself felt confident driving, then why should the doctor advise her against it. I think it was sufficient for the woman to know how her medication could impact her, the rest of the responsibility was hers. And to hold the doctor accountable for the wreck is incredible, and uncalled for.

  • Anonymous

    We already warn patients of common or severe side effects, but this will just add even longer and more specific “don’t run with scissors” type CYA documentation on our notes. It’s already frustrating how much of our notes are for auditors and lawyers rather medical information for other clinicians.

  • PharmacistMike

    This is absolutely the worst thing that I have ever heard. Yes, the patients lose again and the lawyers get a percentage. Consequences of side effects should be accepted as part of the inherit risks of using medications and not be liable for any kind of lawsuits.

  • SarahW

    Overeaction is your plan? How about warning patients adequately? Is that not an option?

    Why should you be leery of liability with a narcotic (or any other) prescription that could impair driving, if you tell the patient that use of the medicine could make them a danger on the road, and to excercise caution?

    I don’t see the lawsuit succeeding, as the pharmacy information and warnings on the bottle likely warn of an impaired ability to operate motor vehicles or machinery.

    These fanciful notions that liability would ensue from a medicine given with proper warning and guidacme is making me wonder – is the goal to be able to prescribe without warnings?

  • SarahW

    And Dr. Sinclair… don’t patients need to be warned about the likelihood of impaired function affecting ordinary activities like driving?

    How does such a warning interfere with other necessary information?

  • Christian Sinclair, MD

    SarahW,

    I do not disagree with adequate warnings, but the real conundrum is how do we (the medical profession and the public) determine what constitutes an ‘adequate warning’? Does written information suffice? Does just saying ‘Be careful about driving with this medication.’ count for good counseling?

    If clinicians over-counsel patients (for example if all the doctors who saw a patient kept saying’ be careful when you take medicine x’) the real ‘hidden message’ that is heard is ‘don’t take this medication. Then doctors can be potentially penalized for not reaching ‘pay for performance’ standards because there patients are non-adherent and don’t reach target goals.

    Also there is the possibility of too many warnings, making it difficult to see what is the true threat. When everything is listed as a risk or a threat, one lacks the ability to prioritize, and decisions can be paralyzed.

    A similar lawsuit has already succeeded. See the post (linked above) over at Pallimed (www.pallimed.org) to see how that one turned out.

    Unfortunately time in health care is such a precious commidity, that there is frequently little time to cover ALL the things that the patient or the doctor would like to.

    No doctor/nurse/pharmacist wants a patient to hurt themselves or others while taking a medication, but how to avoid that is what your questions and these discussions hopefully can help us figure out a better way. A lawsuit like this strikes makes health care much more defensive and that does not always benefit the patient.

  • Anonymous

    I realize this is Kevin’s theme for all things he doesn’t like in medicine, but how exactly do “patients lose”?

    All that’s happened is that one case has been kicked back down to the trial court by the court of appeals. No trial yet to our knowledge, no idea if a jury will even find a doc liable.

    Tell your patient, document it, and go on. There’s no downside to this. At this point, there’s no sense in doing anything different.

    Don’t be so hysterical.

  • Supremacy Claus

    Anonymous: If you drive in Mass, no more pain meds for you. Don’t be so hysterical about your agonizing pain.

  • Anonymous

    “Tell your patient, document it, and go on. There’s no downside to this. “

    Sorry, but there’s only 15 minutes in a 15 min. appt. If I’m increasing the documentation of more detailed medication warnings, then I’m able to do something else. Maybe I’m not reminding them about their overdue colonoscopy, I’m not looking at the “oh by the way” skin lesion today, I don’t have time for the upcoming hypertension lab orders because I’m counseling and documenting more. This adds up to more visits for the patient or less medical care. There is NO free time in my day already and that’s typical of family docs around here.

  • Anonymous

    Then you’re back to the question of whether you’re adequately serving your patients, or yourself for that matter, with the compensation method you’ve chosen to utilize. If you lack the time to even tell the patient about the everyday risks of what you’re prescribing, how much good are you doing them?

  • Family Med Resident

    Often patients exhort that we should tell them about all potential side effects, common or uncommon. So next time I prescribe an opiate, do you want me to spend your entire session with you explaining the many potential risks of the medication? For instance, for Vicodin:

    This medicine may impair your ability to drive. It may also make you lightheaded or dizzy. It may also cause respiratory depression (which means your brain may not get the right signal to breathe as much as it should). It may also cause nausea or vomiting. It may also cause hearing impairment. It may also cause constipation. It may also cause a rash or itching. It may also cause your body to not make enough blood cells. In rare instances, it may cause your body to stop making enough white cells, which may cause a serious infection or even death. It may also cause you not to be able to urinate enough. It may also cause mood changes, drowsiness, or addiction. It may also cause addiction.

    If you are taking any of the following drugs, please discuss the potential interactions with me: other narcotics, antihistamines, MAO inhibitors, antipsychotics, anxiety medications, any other antidepressants, or any other medications containing acetaminophen.

    Your 10 minutes are now up (I need to use the other five to excruciatingly document that I have explained all of these potential interactions). You can make another appointment with me to discuss any of these side effects. I’ll see you then.

  • Anonymous

    If you’re a smart physician who is billing me by the hour, then you’re happy to allay my concerns.

    If you’re not, you should photocopy your paragraph above, and have me initial that I received it. Easy enough, eh?

    You guys have got to start being more creative in the business sides of your practices.

  • Anonymous

    “…with the compensation method you’ve chosen to utilize…”

    Remember this when you’re making a fuss because we don’t take your commercial insurance, Medicare or Medicaid and ask you to pay cash.

    You’ll probably be the first to whine about those greedy primary care docs.

  • ERMurse

    Whats the big deal about giving the patient written instructions advising them not to drive while under the influence of narcotics that you prescribed? Kind of makes sense to me. Its pretty standard when the Narc’s are prescribed from the ED. I dont administer Narcs to patients who are going to be released home until the issue of who is your designated driver clarified to my satisfaction. There is no right to drive while medicated even if you feel you can handle it. There is an obligation to provide basic education and it really is not a burden.

  • Diora

    If you’re not, you should photocopy your paragraph above, and have me initial that I received it. Easy enough, eh?
    Whats the big deal about giving the patient written instructions advising them not to drive while under the influence of narcotics that you prescribed?

    These instructions are written on the paper/package insert you get from your pharmacy with your medication. I am not a doctor, I am a patient like you, but I am yet to get a medication from either local or mail order pharmacy that didn’t include a write-up on side effects.

    Surely you should be interested enough in how what you take can affect you to read it? I sure am. I always read it. I also read it for my parents on their prescriptions – to know what to expect, to double check on the web how the drugs may interact, to know when side effects are serious enough to call the doctor. It is really not rocket science.

    As to narcotics, isn’t common knowledge that they may intefere with driving? Some OTC drugs can make you drowsy too, if you read side effects on those, why prescription drugs are any different?

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