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?

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.

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.

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.

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.

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.

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.