Third-Party Sues Clinician for Failing to Warn Patient Not to Drive

[Ahamis]

Third-Party Sues Clinician for Failing to Warn Patient Not to Drive

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[medicool]

This is an old one from a Massachusetts supreme court case. Google - Dr. Florio, Sacca.

 

[wolfvgang22]

Here you go: Physicians’ Duty to Prevent Harm to Nonpatients | Journal of the American Academy of Psychiatry and the Law

My response: Never tell a patient they can drive. Always warn patients about sedation and not to drive if taking sedating medication. Tell patients never to drink and drive and never to mix meds with alcohol. Avoid prescribing benzos. Document all this.

 

[Armadillos]

How explicit does documentation need to be? I always talk about this stuff with patients, but it would take my whole day to write an entire paragraph outlining it in every note.

Does "Discussed medication risks, benefits, alternatives and precautions" cover this? Or we literally need to be writing a paragraph of warnings at bottom of each note?

 

[wolfvgang22]

How explicit does documentation need to be? I always talk about this stuff with patients, but it would take my whole day to write an entire paragraph outlining it in every note.

Does "Discussed medication risks, benefits, alternatives and precautions" cover this? Or we literally need to be writing a paragraph of warnings at bottom of each note?

That is too vague for me. I try to document I discussed the most common and most potentially severe side effects of each medication I prescribe, and I give written educational information about every medication I prescribe and spend time answering the patients questions and document all of it. It is very burdensome. I hope to avoid being crucified by a plaintiff's attorney as much as possible, though in today's society that is not easy.

 

[WisNeuro]

How explicit does documentation need to be? I always talk about this stuff with patients, but it would take my whole day to write an entire paragraph outlining it in every note.

Does "Discussed medication risks, benefits, alternatives and precautions" cover this? Or we literally need to be writing a paragraph of warnings at bottom of each note?

Do you use Epic? If so, couldn't you have a smartphrase for your commonly prescribed meds with more significant side effects, just drop that in at the end of a note?

 

[Armadillos]

That is too vague for me. I try to document I discussed the most common and most potentially severe side effects of each medication I prescribe, and I give written educational information about every medication I prescribe and spend time answering the patients questions and document all of it. It is very burdensome. I hope to avoid being crucified by a plaintiff's attorney as much as possible, though in today's society that is not easy.

You attempt to list the side effects you discuss specifically? I'm always worried if I do that and leave out something I discussed then the assumption is I didn't discuss it even if I did. But if I wrote something more general it would have covered everything I discussed.

 

[Armadillos]

Do you use Epic? If so, couldn't you have a smartphrase for your commonly prescribed meds with more significant side effects, just drop that in at the end of a note?

I've gotten a lot of notes like this in records requests and seems obvious a whole bunch of stuff has just been pasted onto bottom for CYA, that really hold up in court?

 

[WisNeuro]

I've gotten a lot of notes like this in records requests and seems obvious a whole bunch of stuff has just been pasted onto bottom for CYA, that really hold up in court?

I imagine it'd make it a lot easier to hold up in court than if the information is not in the note. Could be worth a quick call over to legal where you work. Ours has been great about fielding small hypotheticals.

 

[Mad Jack]

I've gotten a lot of notes like this in records requests and seems obvious a whole bunch of stuff has just been pasted onto bottom for CYA, that really hold up in court?

They should only have access to the patient in question's note, so how would they have any way of knowing?

 

[SomeDoc]

Our duty to warn/protect has gotten quite expansive over the years, some landmark case decisions to be aware of:

Duty to warn/protect a foreseeable...
-yet unidentified third party v- Lipari v. Sears
-victim from a prior patient- Naidu v. Laird
-victim in the context of a patient's nonadherence to medication- Petersen v. Washington
-victim in the absence of a specific threat - Jablonski v. US

 

[Ahamis]

Never tell a patient they can drive. Always warn patients about sedation and not to drive if taking sedating medication. Tell patients never to drink and drive and never to mix meds with alcohol.

But then the patient will request a medication that does not interfere with driving...Especially if he needs to drive to work ( the majority of Americans). Or, the patient will not be adherent to medication.

 

[hamstergang]

You attempt to list the side effects you discuss specifically? I'm always worried if I do that and leave out something I discussed then the assumption is I didn't discuss it even if I did. But if I wrote something more general it would have covered everything I discussed.

A forensics psych I worked with once told me to write that we discussed potential risks and benefits, "including but not limited to" so you can list the biggies while being able to claim you discussed more.

 

[birchswing]

I had to start driving when I was 16 because I went to a school that was far away (I really did not want to drive). I was on 2 mg of Ativan at the time, and I specifically asked the psychiatrist about the issue of driving while taking it. He told me with great certainty that I was safer driving with the Ativan because I wouldn't be anxious/panicked (I still was).

I know New Zealand and Great Britain have regulations on driving while on benzos, but as I recall there aren't specific dosages that are not allowed. It's more of a know it when you see it type thing and then they test you if you are deemed to be impaired:
Questions and answers on law to combat drug impaired driving | Ministry of Transport

 

[DD214_DOC]

I discuss and document discussing the most common side effects (I talk about them and document each one individually in the chart; I have macro for it, so it's pretty quick to document), the unlikely but really bad side effects, and also that it is impossible to predict how -- at the individual level -- anyone will respond to a medication, and that many other things may be possible. The last part covers me for the 150 other ADE's that are listed but impossible to remember or discuss individually.

 

[Jules A]

A forensics psych I worked with once told me to write that we discussed potential risks and benefits, "including but not limited to" so you can list the biggies while being able to claim you discussed more.

I use this also for the biggies such as SJS with Lamictal, teratogenicity with VPA, delirium/falls/dependence with benzos etc.