US Malpractice environment reduces productivity

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
N

nexus73

Full Member
10+ Year Member
Joined
Nov 14, 2015
Messages
1,602
Reaction score
2,447
Points
5,896
Members do not see this ad.
I'm just thinking with the shortage of docs, pressure at my last job was to see more and more patients. I would see follow ups for 30 minute appointments typically, never scheduling shorter appointments. My main anxiety was about missing something, not having time for crisis management, making a mistake, and ultimately malpractice claim and/or board complaint. Longer appointments IMO also means better care, for the above reasons. However, if risk of malpractice was removed and expectation as a society was to provide higher volume of care if not top quality, I could have seen many more patients per day. Possibly 4 or even more per hour.

Does the malpractice environment cause a reduction in productivity as a consequence of the penalties it imposes on doctors? If so, does society explicitly understand this and accept it?
 
Last edited:
It's a more complex problem.



1) If you were paid $1000/hr, you could spend time with your patients, take phone calls, etc.
2) Reimbursement is lower and lower, despite rising costs of business. This means you have to increase productivity, just to stay the same.
3) But then, CMS, and by extension every insurance company, creates increasing documentation requirements for you to get paid. These are written by non-clinicians. Therefore, you are required to document in a way that can be judged by someone with a high school diploma. These requirements have no clinical utility.
4) Without those requirements, you could write a chart note in 2 minutes.
 
Last edited:
Liability risks:
  1. ECT manufacturers put "brain damage" on their devices now, or something to that effect because they passed on mustering up the cash to do the research to prove definitely it doesn't. So I'm not chomping at the bit to do ECT again with not wanting to have that discussion every consult.
  2. I won't work for Big Box shops anymore after seeing their ever increasing policies to reduce their risk and set doctors and "providers" up for failure and blame them for problems.
  3. There is a correlation of more severe/difficult cases with Big Box shops; see item 2, and those cases typically have poor paying commercial insurance, or medicaid and medicare which means their access to other higher levels of care to treat their symptoms, are proportionally less likely. So you are the one with the 'hot potato.' More risk...
  4. Big Box shops strive to tear down autonomy, and will request/demand you see anything they want you to see.
  5. I over document due to liability concerns. That takes time. It fuels burn out. Detracts from the ultimate goal of helping people. I now am more focused on my exit dream, being a rancher/farmer, than original dream of practicing until I drop or someone takes my license from me.
  6. I am now in private practice, cut out headache insurance companies, like medicaid, some medicare flavors and Disjointed Death Care insurance company. Focusing on better paying private insurance. I am still making a positive difference and numerous peoples' lives, but I am not practicing to the 'top of my license.' Each passing day I'm more okay with that.
  7. I don't do CAP because of liability, and not liking it, but liability is a big chunk of that reason.
  8. I have lost sleep on some cases, or reflecting on my top 1 or 2 or 3 patients of concern. I look forward to no longer worrying about that.
  9. Its a bit lonely thinking about the liability risk of things, and once I attempted to gripe to a good non-medical friend, no sympathy, "dude, that's why you make the big bucks."
  10. I used to fantasize about caps, or other liability reduction things nationally, but now what I see from Big Box Shop influences, and even ARNP/PA clinical messes, I hope liability system doesn't go away. Cause I fear our future care in the next 20-30 years, and am more worried a midlevel or Big Box shop is gonna kill me as I become geriatric. The lack of trust is already rising in healthcare. Covid Era policies and edicts didn't help either. Oddly, liability may be the vector to spawn future course correction.
But to answer your question more in depth, society accepts this. But no they don't fully understand it. ...we recently passed a law for "no surprise billings" which shows society doesn't understand at all, the healthcare system.
 
Last edited:
I think you’re right on the money and no society does not understand that trade off. Why did Dr miss this diagnosis? What “failed”? What regulation/additional step do we need to do in order to protect patients, society, etc.? No one considers that additional regulation, documentation, reviews, additional steps in any way is time away from taking care of patients, society, etc.

Society almost never makes that decision consciously. It’s mostly unaware of trade offs. In economic terms it’s called concentrated benefit and diffused cost. The worst kind of economic burden. When the cost is everyone in society has to fill out a few more papers, check off a few more boxes, dot a few more i’s and cross a few more t’s then it doesn’t seem like much to every individual but on the whole that is a substantial time/money savings that could be spent taking care of more patients or having a better work/life balance.
 
psychemdoc said:
I think you’re right on the money and no society does not understand that trade off. Why did Dr miss this diagnosis? What “failed”? What regulation/additional step do we need to do in order to protect patients, society, etc.? No one considers that additional regulation, documentation, reviews, additional steps in any way is time away from taking care of patients, society, etc.

Society almost never makes that decision consciously. It’s mostly unaware of trade offs. In economic terms it’s called concentrated benefit and diffused cost. The worst kind of economic burden. When the cost is everyone in society has to fill out a few more papers, check off a few more boxes, dot a few more i’s and cross a few more t’s then it doesn’t seem like much to every individual but on the whole that is a substantial time/money savings that could be spent taking care of more patients or having a better work/life balance.
Click to expand...
Great point about the diffused cost. We really pooped the bed societally not have more economists designing/implementing policy.
 
psychemdoc said:
I think you’re right on the money and no society does not understand that trade off. Why did Dr miss this diagnosis? What “failed”? What regulation/additional step do we need to do in order to protect patients, society, etc.? No one considers that additional regulation, documentation, reviews, additional steps in any way is time away from taking care of patients, society, etc.

Society almost never makes that decision consciously. It’s mostly unaware of trade offs. In economic terms it’s called concentrated benefit and diffused cost. The worst kind of economic burden. When the cost is everyone in society has to fill out a few more papers, check off a few more boxes, dot a few more i’s and cross a few more t’s then it doesn’t seem like much to every individual but on the whole that is a substantial time/money savings that could be spent taking care of more patients or having a better work/life balance.
Click to expand...

It does come down to liability.
Those higher ups, and that definitely include clinicians, want to protect themselves by inserting x stupid documentation requirement so the liability does not fall on them.
Though this varies from system to system. Some are more reasonable and have kept the nonsense to a minimum.

But I think the OP was hinting at a different point. Jeapordizing quality of care for seeing more patients.
I don't agree with this approach and it's not because of liability.
The reality is that we need to talk to our patients to figure out what's going on.
Providing bs care for more people isn't an improvement in 'productivity' and will hurt our specialty in the long run.
 
I think this is true for most (all?) physicians but is especially important for psychiatrists. I don't believe you can adequately assess someone's anxiety, depression, ADHD, x, y, z by spending 10-15 min with them every few months. Will you get it right more often than not? Maybe. But you will also miss a lot and won't get to know your patients on a personal level - I think that higher level therapeutic relationship plays a significant role in patient outcomes. It's easy enough to use rating scales and all but I think you end up missing a big part of the patient's human experience - hard to treat someone thoroughly if you don't understand them as a human being.
 
The US spends the most on healthcare in the western world with less than optimal results for the vast majority unfortunately. I think the fear of getting sued interferes with the building of a therapeutic alliance which is essential in the healing process.
 
I think that the malpractice environment leads to over treatment and the practice of defensive medicine which is probably less pronounced in our field. It absolutely also leads to physicians trying to mitigate their risk by perhaps seeing fewer patients, certainly seeing fewer high-risk patients. We will absolutely not be able to achieve universal healthcare without addressing the issue of tort reform, which of course will never happen in this country. The other day I was contemplating volunteering my time at a free clinic, however, was dissuaded due to liability concerns.
 
the5thelement said:
The US spends the most on healthcare in the western world with less than optimal results for the vast majority unfortunately. I think the fear of getting sued interferes with the building of a therapeutic alliance which is essential in the healing process.
Click to expand...
Us also has the most amount of lawsuits and lawyers. So defensive medicine also costs more...
 
Heist said:
Us also has the most amount of lawsuits and lawyers. So defensive medicine also costs more...
Click to expand...
It does, it's a problem, and I generally have nothing positive to say about malpractice attorneys, however every cost study I have ever seen, done by big name MDs that have no reason to prop up JDs, is that this is a tiny portion of overall healthcare spending. It pales in comparison to the administrative bloat or executive pay or private equity profits or end-of-life care in the system.
 
Merovinge said:
It does, it's a problem, and I generally have nothing positive to say about malpractice attorneys, however every cost study I have ever seen, done by big name MDs that have no reason to prop up JDs, is that this is a tiny portion of overall healthcare spending. It pales in comparison to the administrative bloat or executive pay or private equity profits or end-of-life care in the system.
Click to expand...
Yes but that's all part of why is healthcare is so expensive
 
Merovinge said:
It does, it's a problem, and I generally have nothing positive to say about malpractice attorneys, however every cost study I have ever seen, done by big name MDs that have no reason to prop up JDs, is that this is a tiny portion of overall healthcare spending. It pales in comparison to the administrative bloat or executive pay or private equity profits or end-of-life care in the system.
Click to expand...

I think that it probably plays a bigger role than that. Last I checked the biggest expense in medicine came from ordering of unnecessary tests, consults, etc. followed closely by administrative expenses. Idk what the breakdown of the cause for excessive testing is and can think of many reasons (incompetence, research, clinician anxiety/'thoroughness'), but I do imagine that there would probably be a solid decrease in excessive orders if there wasn't such a perceived need to CYA.
 
The shocking thing for me is how little of the judgement goes to the plaintiff at the end of the process, once the attorney's fees and costs have been deducted.
 
I have a friend who is a malpractice attorney. Sues doctors for a living. When I first started I asked him how often he sues psychiatrists and he just hit me with a "Lol. Never." So I pushed him on it and asked him how many times he had sued psychiatrists in his career. Between him and his two partners at the firm (>20 years experience in the oldest partner alone), he said "Maybe once or twice. There's no money in that. It's a waste of my time." I think we greatly exaggerate the risk of getting sued in our minds, especially in psychiatry. Granted, this is the south so your miles may vary.
 
psych_0 said:
I have a friend who is a malpractice attorney. Sues doctors for a living. When I first started I asked him how often he sues psychiatrists and he just hit me with a "Lol. Never." So I pushed him on it and asked him how many times he had sued psychiatrists in his career. Between him and his two partners at the firm (>20 years experience in the oldest partner alone), he said "Maybe once or twice. There's no money in that. It's a waste of my time." I think we greatly exaggerate the risk of getting sued in our minds, especially in psychiatry. Granted, this is the south so your miles may vary.
Click to expand...
This is also what the data says but similar to our patients we are very neurotic, disregard the data, and continue to catastrophize
 
psych_0 said:
I have a friend who is a malpractice attorney. Sues doctors for a living. When I first started I asked him how often he sues psychiatrists and he just hit me with a "Lol. Never." So I pushed him on it and asked him how many times he had sued psychiatrists in his career. Between him and his two partners at the firm (>20 years experience in the oldest partner alone), he said "Maybe once or twice. There's no money in that. It's a waste of my time." I think we greatly exaggerate the risk of getting sued in our minds, especially in psychiatry. Granted, this is the south so your miles may vary.
Click to expand...
what kind of cases does he take if not suing doctors?
 
psych_0 said:
I have a friend who is a malpractice attorney. Sues doctors for a living. When I first started I asked him how often he sues psychiatrists and he just hit me with a "Lol. Never." So I pushed him on it and asked him how many times he had sued psychiatrists in his career. Between him and his two partners at the firm (>20 years experience in the oldest partner alone), he said "Maybe once or twice. There's no money in that. It's a waste of my time." I think we greatly exaggerate the risk of getting sued in our minds, especially in psychiatry. Granted, this is the south so your miles may vary.
Click to expand...
There are only a handful of malpractice attorneys who do most of the suicide malpractice cases in the country. Other than that, it's plaintiff's attorneys who usually do other things (other medmal and personal injury cases) who pick up the odd psychiatric case. There is far less money in psychiatric malpractice cases than orthopedic cases, OB cases, etc. As a forensic expert I am often asked to review malpractice cases that aren't actually about psychiatric malpractice but where there are neuropsychiatric complications of negligent treatment.

The actual psychiatric malpractice cases I've reviewed have almost always involved either suicide or homicide though I reviewed one case which was predicated on wrongful diagnosis and treatment which plaintiff's estate claimed had led to irreversible decline (there was no case in my opinion there as even though she had been wrongly diagnosed it wouldn't have changed the outcome and a general psychiatrist would not have picked up the correct diagnosis). However, other issues that come up are adverse drug reactions or sexual boundary violations. Wrongful commitment is another one but it almost never goes anywhere even when there is a legitimate case. I reviewed one case like of wrongful commitment which completely baseless (plaintiff was in denial). I've also occassionally had psychotic patients call me up asking if I can be an expert witness for them claiming their antipsychotic caused all manner of things!

A new area I've also seen is lawsuits alleging negligent supervision of NPs. In order to testify in such cases you must supervise NPs and you need to opine on the standard of care of NP supervision.

Psychiatrists have the lowest malpractice risk of all specialties because we see fewer patients, have stronger relationships with said patients and family members, the low standard of care in the profession, the lack of clinical guidelines, psychiatric patients are seen as "unreliable narrators", and there is less money in the payouts which means it is not as attractive for lawyers. But you can still get sued, and the typical psychiatrist should still expect one lawsuit in a 40 yr career.
 
Last edited:
To add on, if you really want to know how likely docs are to get sued, just look at malpractice premiums. OB/GYN and some surgical specialties like Neurosurgery lead the way and it's easy to see why, with the former having annual insurance premiums well above $100k in some states. Geography also matters, less so in psych because our premiums are relatively miniscule compared to some other fields, but can be tens of thousands of dollars difference for some fields. Links for examples:

www.beckersasc.com

How malpractice premiums vary by specialty — anesthesiology, surgery & more - Becker’s ASC

Specialists' annual malpractice premiums are significantly higher than those of primary care physicians, according to the Medscape Medical Malpractice Premium Report 2019.
www.beckersasc.com www.beckersasc.com
www.nerdwallet.com

How Much Is Malpractice Insurance? - NerdWallet

The cost of malpractice insurance depends on factors such as industry, specialty, state and coverage type, as well policy per-claim and aggregate claims limits.
www.nerdwallet.com www.nerdwallet.com
 
splik said:
There are only a handful of malpractice attorneys who do most of the suicide malpractice cases in the country. Other than that, it's plaintiff's attorneys who usually do other things (other medmal and personal injury cases) who pick up the odd psychiatric case. There is far less money in psychiatric malpractice cases than orthopedic cases, OB cases, etc. As a forensic expert I am often asked to review malpractice cases that aren't actually about psychiatric malpractice but where there are neuropsychiatric complications of negligent treatment.

The actual psychiatric malpractice cases I've reviewed have almost always involved either suicide or homicide though I reviewed one case which was predicated on wrongful diagnosis and treatment which plaintiff's estate claimed had led to irreversible decline (there was no case in my opinion there as even though she had been wrongly diagnosed it wouldn't have changed the outcome and a general psychiatrist would not have picked up the correct diagnosis). However, other issues that come up are adverse drug reactions or sexual boundary violations. Wrongful commitment is another one but it almost never goes anywhere even when there is a legitimate case. I reviewed one case like of wrongful commitment which completely baseless (plaintiff was in denial). I've also occassionally had psychotic patients call me up asking if I can be an expert witness for them claiming their antipsychotic caused all manner of things!

A new area I've also seen is lawsuits alleging negligent supervision of NPs. In order to testify in such cases you must supervise NPs and you need to opine on the standard of care of NP supervision.

Psychiatrists have the lowest malpractice risk of all specialties because we see fewer patients, have stronger relationships with said patients and family members, the low standard of care in the profession, the lack of clinical guidelines, psychiatric patients are seen as "unreliable narrators", and there is less money in the payouts which means it is not as attractive for lawyers. But you can still get sued, and the typical psychiatrist should still expect one lawsuit in a 40 yr career.
Click to expand...
We just get beat or shot more than most medical specialties.
 
Sorry for reviving this thread. Anyone here who had a malpractice case?
 
Never had one, but some of my attendings talked about their hx. One involved the attending being too nice and prescribing something not within pstchiatry scope. Patient had side effect and sued (it was a common medication and nothing crazy).

The other I don't remember, but it was also something dumb. Both won but it took them years.
 
Yeah, but let's not forget about the investigations and audits we have to face. That surely has some negative effects. The TMB investigation is the worst, in my opinion.
 
Last edited:
The only one I have ever heard of was for a co-resident of mine soliciting sexual favors from patients. Another was someone defrauding Medicare. I have yet to hear of someone being sued for frivolous reasons like the fear-mongering on forums (sometimes) like this would suggest.
 
psych_0 said:
I have yet to hear of someone being sued for frivolous reasons like the fear-mongering on forums (sometimes) like this would suggest.
Click to expand...
expertwitness.substack.com

Suicide After Wife Requests Divorce

Case #189
expertwitness.substack.com expertwitness.substack.com

This case is technically not a Psychiatrist but I think it’s easy enough to assume that a Psychiatrist would have been named had they been consulted
 
HemeOncHopeful19 said:
expertwitness.substack.com

Suicide After Wife Requests Divorce

Case #189
expertwitness.substack.com expertwitness.substack.com

This case is technically not a Psychiatrist but I think it’s easy enough to assume that a Psychiatrist would have been named had they been consulted
Click to expand...

A big part of the plaintiff's case here was that the patient needed to be evaluated by a psychiatrist before being discharged, so I'm not so sure they would have filed if it had been a psychiatrist. Certainly much weaker case on its merits at that point.
 
brosa said:
Never had one, but some of my attendings talked about their hx. One involved the attending being too nice and prescribing something not within pstchiatry scope. Patient had side effect and sued (it was a common medication and nothing crazy).

The other I don't remember, but it was also something dumb. Both won but it took them years.
Click to expand...

This is why strong, clear boundaries are important. Being "too nice" (or "mean") to any particular patient is an indicator that decisions are not quite professional. As a professional, every action must flow from objective judgment, rather than one's own countertransference. We should politely refuse to overstep, whether it is the patient or our own emotions calling for us to push against our boundaries.

Objectively, it is better for patients to establish with a PCP (or appropriate specialist). Can an ENT diagnose and prescribe for something as common as eczema? Yes, but they won't. It should be no different for an outpatient psychiatrist.

psych_0 said:
I have yet to hear of someone being sued for frivolous reasons like the fear-mongering on forums (sometimes) like this would suggest.
Click to expand...

Off the top of my head, I know of one sued for obesity side effects after 30 days of an antipsychotic. I also know a handful sued for murders, suicides. In my opinion, probably frivolous as I can't say standard of care wasn't met. Regardless, the amount of years and stress consumed by a lawsuit is nonfrivolous.
 
HemeOncHopeful19 said:
expertwitness.substack.com

Suicide After Wife Requests Divorce

Case #189
expertwitness.substack.com expertwitness.substack.com

This case is technically not a Psychiatrist but I think it’s easy enough to assume that a Psychiatrist would have been named had they been consulted
Click to expand...

Given the conditions, most EM docs and ED social workers would reflexively get the legal paperwork rolling for hospitalization. The only call made to psychiatry is whether a bed is available. Regardless of whether the EM doc fell below the standard, it's difficult to comprehend why he didn't recognize the situation. Even the cops, who are generally averse to paperwork, red flagged and removed his guns.

Anyway, seems like wife got 100% of his estate plus a nice payout to start her new life.
 
psych_0 said:
The only one I have ever heard of was for a co-resident of mine soliciting sexual favors from patients. Another was someone defrauding Medicare. I have yet to hear of someone being sued for frivolous reasons like the fear-mongering on forums (sometimes) like this would suggest.
Click to expand...
One of my consult co-workers was sued last year for not tapering prolixin 5mg in an elderly patient with dementia. Prolixin was stopped, family claimed that several weeks later patient became more confused and fell because the prolixin was stopped too abruptly. Like I said, case went nowhere but my colleague had to work with a lawyer and several meetings were held before the case got dropped.
 
Candidate2017 said:
This is why strong, clear boundaries are important. Being "too nice" (or "mean") to any particular patient is an indicator that decisions are not quite professional. As a professional, every action must flow from objective judgment, rather than one's own countertransference. We should politely refuse to overstep, whether it is the patient or our own emotions calling for us to push against our boundaries.

Objectively, it is better for patients to establish with a PCP (or appropriate specialist). Can an ENT diagnose and prescribe for something as common as eczema? Yes, but they won't. It should be no different for an outpatient psychiatrist.



Off the top of my head, I know of one sued for obesity side effects after 30 days of an antipsychotic. I also know a handful sued for murders, suicides. In my opinion, probably frivolous as I can't say standard of care wasn't met. Regardless, the amount of years and stress consumed by a lawsuit is nonfrivolous.
Click to expand...
Ergh, I know a specialty surgeon who was trying to be helpful and refilled a patient's blood pressure medication, pt had a hypotensive event and sued, not sure what happened with it, but wouldn't be surprised at all if they needed to settle. Residency is there to teach people how to stay in their scope of practice, I strongly recommend trainees figure it out and stick to it. Outpatient psychiatrists can prescribe some medications that might not appear psychiatric at first blush with training that are appropriate (e.g. Metformin with antipsychotics, probably the GLP drugs at some point in the not super distant future), but you definitely need to have a justification and know what you are doing.
 
Stagg737 said:
One of my consult co-workers was sued last year for not tapering prolixin 5mg in an elderly patient with dementia. Prolixin was stopped, family claimed that several weeks later patient became more confused and fell because the prolixin was stopped too abruptly. Like I said, case went nowhere but my colleague had to work with a lawyer and several meetings were held before the case got dropped.
Click to expand...
This case seems stupid of course. And the attorney seems really stupid. What a waste of everyone's time.

presumably there was a psychiatrist 'expert' on the other side of this completely appalled at the negligent care...someone who was probably 85 years old and hasn't provided patient care since 2002

Or the states that require a certificate of merit signed by an expert, and some experts are in the business of simply signing the statement that was written by the attorney themselves
 
Merovinge said:
Ergh, I know a specialty surgeon who was trying to be helpful and refilled a patient's blood pressure medication, pt had a hypotensive event and sued, not sure what happened with it, but wouldn't be surprised at all if they needed to settle. Residency is there to teach people how to stay in their scope of practice, I strongly recommend trainees figure it out and stick to it. Outpatient psychiatrists can prescribe some medications that might not appear psychiatric at first blush with training that are appropriate (e.g. Metformin with antipsychotics, probably the GLP drugs at some point in the not super distant future), but you definitely need to have a justification and know what you are doing.
Click to expand...

I have definitely started prescribing GLP-1 agonists where appropriate in the past year, so I agree that this is likely to become a more standard part of our armamentarium given how often we make people gain large amounts of weight. I am seriously considering pursuing an obesity medicine certification, though, in part because it would definitely make it hard for anyone to argue this was outside my scope of practice.
 
clausewitz2 said:
I have definitely started prescribing GLP-1 agonists where appropriate in the past year, so I agree that this is likely to become a more standard part of our armamentarium given how often we make people gain large amounts of weight. I am seriously considering pursuing an obesity medicine certification, though, in part because it would definitely make it hard for anyone to argue this was outside my scope of practice.
Click to expand...
Guidelines are there for metformin, I am sure they will come around for the GLP drugs as well. I have no issue with anyone doing it before it becomes part of standard practice if they have really familiarized themselves with the medications but we are already seeing a lot of side effects emerge. I certainly feel much more comfortable with metformin (as a CAP no less, I have had to use it plenty given how bad the weight gain with Abilify is in children), but I know I am going to need to get there with GLPs in the future. At the very least, it's hopefully a straightforward conversation with a PCP to collaborate if psychiatrists aren't ready to prescribe them right now.
 
clausewitz2 said:
I have definitely started prescribing GLP-1 agonists where appropriate in the past year, so I agree that this is likely to become a more standard part of our armamentarium given how often we make people gain large amounts of weight. I am seriously considering pursuing an obesity medicine certification, though, in part because it would definitely make it hard for anyone to argue this was outside my scope of practice.
Click to expand...
I am too, especially being a C/L psychiatrist who sees these all the time. I'm just debating if it's really worth it since I rarely ever prescribe them myself.

Merovinge said:
Guidelines are there for metformin, I am sure they will come around for the GLP drugs as well. I have no issue with anyone doing it before it becomes part of standard practice if they have really familiarized themselves with the medications but we are already seeing a lot of side effects emerge. I certainly feel much more comfortable with metformin (as a CAP no less, I have had to use it plenty given how bad the weight gain with Abilify is in children), but I know I am going to need to get there with GLPs in the future. At the very least, it's hopefully a straightforward conversation with a PCP to collaborate if psychiatrists aren't ready to prescribe them right now.
Click to expand...
This is where my concern lies. They're still a pretty young drug and I'm sure we're going to see a lot of new info coming out with Phase 4 (I'm having talks with endocrine colleagues to possibly start some myself). I'm hesitant to use them because I'm worried that if they have a major medical side effect (my wife is on one and we recently went to an ER because of this concern, she's fine though) and the potential liability of prescribing a med that causes a severe medical side effect when the med is not considered psychiatric at all yet.
 
Stagg737 said:
I am too, especially being a C/L psychiatrist who sees these all the time. I'm just debating if it's really worth it since I rarely ever prescribe them myself.


This is where my concern lies. They're still a pretty young drug and I'm sure we're going to see a lot of new info coming out with Phase 4 (I'm having talks with endocrine colleagues to possibly start some myself). I'm hesitant to use them because I'm worried that if they have a major medical side effect (my wife is on one and we recently went to an ER because of this concern, she's fine though) and the potential liability of prescribing a med that causes a severe medical side effect when the med is not considered psychiatric at all yet.
Click to expand...
If those drugs have serious side effects I don’t think you’ll see them go after the individual docs, you’ll see them go after the drug companies for the big bucks.

I am reminded of that frog-looking lawyer on late night TV when I was a kid urging me to call him if I ever took Vioxx
 
HemeOncHopeful19 said:
If those drugs have serious side effects I don’t think you’ll see them go after the individual docs, you’ll see them go after the drug companies for the big bucks.

I am reminded of that frog-looking lawyer on late night TV when I was a kid urging me to call him if I ever took Vioxx
Click to expand...
See my post before the last one. Doc got sued for not tapering Prolixin 5 mg. You think somoene wouldn't go after the doc if they could put more money in their pockets? Not saying it would for sure happen, but it would be a lot easier to win that case or at least get a settlement when the doc is prescribing something outside their field.
 
Stagg737 said:
I am too, especially being a C/L psychiatrist who sees these all the time. I'm just debating if it's really worth it since I rarely ever prescribe them myself.


This is where my concern lies. They're still a pretty young drug and I'm sure we're going to see a lot of new info coming out with Phase 4 (I'm having talks with endocrine colleagues to possibly start some myself). I'm hesitant to use them because I'm worried that if they have a major medical side effect (my wife is on one and we recently went to an ER because of this concern, she's fine though) and the potential liability of prescribing a med that causes a severe medical side effect when the med is not considered psychiatric at all yet.
Click to expand...

Yeah for now I think religiously following the recommendations for monitoring and contraindications in the prescriber information is probably wise. It is very hard to say you were negligent if you are following the insert's guidelines to the letter.
 
Merovinge said:
Outpatient psychiatrists can prescribe some medications that might not appear psychiatric at first blush with training that are appropriate (e.g. Metformin with antipsychotics, probably the GLP drugs at some point in the not super distant future), but you definitely need to have a justification and know what you are doing.
Click to expand...

I'm ok with Metformin for SGA weight gain or PDE inhibitors for SSRI erectile dysfunction. But no more than a 30 or 60 day supply, with the caveat that patient needs to follow up with PCP for further work up, recs, and refills. We can't act like psychiatric patients and assume every issue is related to our meds.
 
Candidate2017 said:
I'm ok with Metformin for SGA weight gain or PDE inhibitors for SSRI erectile dysfunction. But no more than a 30 or 60 day supply, with the caveat that patient needs to follow up with PCP for further work up, recs, and refills. We can't act like psychiatric patients and assume every issue is related to our meds.
Click to expand...
There's definitely some patient dependent factors. 25 years old in great shape and anxious? I'm on board with a psychiatrist who knows what they are doing continuing to regularly prescribe low dose PDEi's (in fact, I've done this for a 17 year old with significant SSRI induced ED). If the patient is a 55 year old vasculopath, definitely needs to be working on that with PCP and/or urology as even if the SSRI is tipping someone over into ED, there are likely cardiovascular concerns to be considering. The penis preludes the heart/brain.
 
Merovinge said:
There's definitely some patient dependent factors. 25 years old in great shape and anxious? I'm on board with a psychiatrist who knows what they are doing continuing to regularly prescribe low dose PDEi's (in fact, I've done this for a 17 year old with significant SSRI induced ED). If the patient is a 55 year old vasculopath, definitely needs to be working on that with PCP and/or urology as even if the SSRI is tipping someone over into ED, there are likely cardiovascular concerns to be considering.
Click to expand...

There's always weird stuff going on. Who knows if that 25 y.o. has HOCM, etc.? There's a reason why PCPs use a stethoscope, and even EKGs, as part of their exams. Psych patients have higher rates of medical illnesses, so they really need to form long term relationships with their PCP.
 
clausewitz2 said:
Yeah for now I think religiously following the recommendations for monitoring and contraindications in the prescriber information is probably wise. It is very hard to say you were negligent if you are following the insert's guidelines to the letter.
Click to expand...
True, but sometimes lawyers and judges don't care. In residency I wasn't allowed to prescribe propranolol for social anxiety or akathisia at one of the CMHCs I worked at because a provider (can't recall if it was NP or MD) was sued for prescribing it because "it's a blood pressure med". They lost their minds when I tried to prescribe a guy viagara for his SSRI-induced side effect.
 
Stagg737 said:
True, but sometimes lawyers and judges don't care. In residency I wasn't allowed to prescribe propranolol for social anxiety or akathisia at one of the CMHCs I worked at because a provider (can't recall if it was NP or MD) was sued for prescribing it because "it's a blood pressure med". They lost their minds when I tried to prescribe a guy viagara for his SSRI-induced side effect.
Click to expand...

At the end of the day there is no way to make yourself immune to someone suing you for very silly reasons. All you can do is take reasonable steps to make it very hard for the case to prevail.

I would not have lasted very long at that CMHC. They're not my psychiatry dad.
 
You must log in or register to reply here.

Similar threads

S
Practice Environment and Values
Replies
15
Views
2K
Candidate2017
C
I
Malpractice insurance
Replies
7
Views
1K
moto_za
M
P
Malpractice insurance
Replies
1
Views
988
splik
splik
M
Buy own or use hospital malpractice insurance
Replies
14
Views
1K
Geraltofrivia
G
A
Malpractice insurance
Replies
5
Views
1K
milesed
M
Top Bottom