Monday, September 08, 2008

What Didn't I Tell You?


It's not specific to psychiatry, but this caught my eye, first in the Wall Street Journal, and then through their link in the Boston Globe.

So a woman in her 70's is getting chemotherapy. She is also on painkillers and complains to her doc that she's dizzy. Fourteen times. She then has a car accident and kills two people. The relative of one of the people who was killed sues the doctor who prescribed her medications for failing to tell her not to drive. The claim is that if the doctor had specifically told her not to drive, she wouldn't have. A similar case went to court last year.

I don't know the details of the case, it's just what I read in the on-line articles, and we all know the press sometimes presents things in interesting ways. The question gets to be, however, what exactly is the doctor responsible for when a medication is prescribed? Side effects may or may not happen: bottles are labeled by the pharmacy, should everyone be pre-emptively told not to drive? And once some does have a side effect, and knows they have it, is it still the physician's responsibility to state the obvious: you're sick, you're on a sedating medication, it's making you dizzy, don't drive or operate heavy equipment? Is it the physician's responsibility to even ask if the patient drives, or to absolutely ascertain that he doesn't? Is saying "don't drive" enough? Should the family be brought in and the keys be taken away? What about the not as obvious: the doctor never said to give up gymnastics on the balance beam. Or not to rock climb (...ClinkShrink!) which may be hazardous, meds or not.

So the striking thing about this story is that the suit wasn't filed by the patient, but by the survivor of the victim's behavior. So, like, if an engineer takes a medication and has an accident, can the family members of every one injured on the train sue the doctor who prescribed the medication that the engineer took? And what about the pharmacy? It's all kind of confusing.