June 6, 2011
Unrecognized Liability Danger
M. J. McKeown, MD, FACOG, FACS
Ignorance of adverse effects is no excuse in the law.
The last few years have seen many changes in the practice of medicine and more are to come at an accelerating rate. The costs of standard medical care have increased steadily accompanied by growing restrictions in procedures and therapeutics covered. These restrictions are supported by well founded statistical analyses of the effectiveness of any given procedure or therapeutic.
However with these growing standardchanges in health care there is a growing industry in alternative care. Many of these alternative care modalities themselves have studies supporting their effectiveness. In addition these alternative modalities are frequently not covered by health care insurance but are in aggregate less expensive than standard care. Thus there is a growing alternative healthcare industry.
The average standard care practitioner is not educated in this world of alternative care. However in the realm of liability for adverse effects of therapy this practitioner is responsible for adverse effects of his/her standard therapy in relation to any alternative therapy the patient is undertaking. In particular there are known adverse outcomes of standard therapy when the patient is using alternative herbs, vitamins or minerals.
If the standard practitioner prescribes a medicinal therapy or procedure that has an adverse outcome because of an alternative health care practice of the patient he/she could be liable if they cannot document that they questioned the patient about possible alternative health care practices that are suspected of acting adversely with the therapy they are prescribing.
It should be standard procedure for any health care practitioner to have as part of their standard intake information a section of questions about herbs, vitamins, minerals or alternative therapies the patient is using. Once that information is obtained the practitioner is obliged to evaluate it for possible adverse outcomes related to the standard therapy prescribed.
However where and how is such information available? There are sources available in print, on the internet and in the mobile information world that contain drug-drug interaction, drug-food interaction and some drug-other alternative therapy interactions. But will these sources fulfill a solution to the following scenario?
The practitioner is discussing therapy with the patient and at that discussion the practitioner has available the intake questionnaire and any additional information gathered from other discussion with the patient. In that situation what resource does the practitioner have recourse to that allows checking for reported adverse effects of the patient's alternative therapies on the standard therapy the practitioner is about to prescribe?
It has been mentioned above that there are printed and electronic sources of the information the practitioner seeks however how many know of these sources or how to access them with particular guidance to the therapy they are about to prescribe? Logic would lead one to believe that the simplest system would consist of an electronic database of all the therapies the patient is on with remarks on possible adverse interactions and then the practitioner would simply query this electronic database with a new proposed therapeutic addition and await an analysis and answer. However, to my knowledge, there is not such a versatile and informative electronic database available.