A doctor is sentenced to 9-months in jail after prescribing Prozac to a teen who later committed suicide.
The contract physician, who had a restricted license in Colorado, prescribed generic Prozac for the patient after reading his questionnaire online. It’s one of the first criminal convictions for a doctor practicing medicine over the phone or internet.
This is one of the dangers of prescribing drugs, sight unseen. It’s true that a fair number of office visits can be handled over the phone or e-mail, but that’s mostly follow-up visits for established patients. When it comes to diagnosing and treating new problems, a physical exam and face-to-face meeting is imperative. Especially with patients you don’t know.
Something to keep in mind as more are pushing for “virtual” telephone or web-based patient encounters.
Related posts:
- Does telemedicine reduce malpractice risk?
- E-mails and telephone calls to the doctor cut down on patient office visits
- How much would you pay to e-mail your doctor?
- Should homebirth advocates continue support a doctor convicted of sexual exploitation?
- A doctor without an office
- Waiting for the doctor
- How the physical exam can affect the doctor-patient relationship
{ 5 comments }
I thought all SSRI’s had a black box label warning for an increased risk of suicide? I thought a black box label warning was, in some ways, meant to protect the physician. Other drugs have somewhat mild BBW. Does this mean a patient can sue for side effects experienced due to medications?
Back on topic, I think telemedicine and internet consults will give our profession a negative view. I can easily see this causing further belief that physicians only practice ‘for the money’. In medical school we had extreme emphasis on doing a through and complete physical exam. I think the value of the PE is invaluable to formulating a diagnosis.
I think the “for the money” argument goes both ways. As an example, when someone grabs their neck or back and says “Will you pop it?” out in public I give them a card and invite them in for a consultation and exam. They’ll look at me incredulously, yet it’s my responsibility to them to, as put so well above, perform “a thorough and complete physical exam.”
How could they ask for anything less?
"This is one of the dangers of prescribing drugs, sight unseen."
You weasel a false dichotomy: Please define what you mean by "danger." Is it that you're more likely to be legally ensnared by "sight unseen" than if you did a full onsite H&P and the patient still killed himself?
I'm not trying to moralize to you Kevin, but the real tragedy is that someone died. You usually do better than vaguely reporting with a CYA tenor.
For what it is worth, I think telemedicine is a bad idea for everyone.
Telemedicine is a really bad idea. There is a reason the patient does not want to actually see a doctor.
Doctors are supposed to recommend drugs to patients, not the other way arround.
Telemedicine should be an option patients can use, just like anything else. It is for the convenience of the patient that this option should exist. In many cases, the physical exam is overemphasized. But, if honest, a telemedicine physician will realize that certain complaints and diagnoses are best left for a face-to-face visit with a physician exam.
I think, to argue against telemedicine, you would have to argue that a treating physician would not have prescribed Prozac to this patient and if not, why not? Psychiatry is actually quite suited to telemedicine, if the problems are not too complicated. If/when they become too complicated, the patient can be asked to see a physician for a face-to-face evaluation.
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