COMMENTARY

Malpractice Watch: Keep an Eye Out for Side Effects

Jeffrey A Lieberman, MD

Disclosures

August 31, 2010

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Hello. This is Dr. Jeffrey Lieberman of Columbia University speaking today for Medscape. Recently I heard advertisements on the radio and television from a personal injury law firm saying, "Have you taken Seroquel®?" and "Have you taken one of the newer antipsychotic drugs and have suffered any side effects such as diabetes? If so, give us a call. Maybe we can make a claim for you." This was really disappointing to hear, but not entirely surprising. After all, we've seen medical malpractice cases repeatedly trying to find new opportunities in the context of the side effects caused by new medications or as medications become increasingly used. But it's disappointing in the sense that we as physicians, unfortunately, make ourselves easier targets for medical malpractice lawsuits by not being sufficiently vigilant in telling our patients about the risks for side effects and documenting this in the medical record, and also by monitoring for the emergence of side effects in the context of ongoing treatment.

We learned this lesson painfully years ago with the introduction of the first generation of antipsychotic drugs -- originally called neuroleptics -- when tardive dyskinesia evolved after the initially observed signs of extrapyramidal symptoms occurred. This took us awhile to really recognize, understand that the causal agent was antipsychotic drug exposure, to determine how this could be monitored and detected, and hopefully prevented from occurring and treating patients more judiciously with lower doses. Now the new antipsychotic drugs such as clozapine, olanzapine, risperidone, and quetiapine, among others, have a propensity not for causing neurologic side effects, but for causing weight gain and metabolic side effects including hyperglycemia and potentially diabetes.

We need to inform patients when they start a medication of the potential risks and the reasons why the benefits outweigh the risks. Then on an ongoing basis, we need to evaluate patients for whether they are experiencing side effects, such as with weight assessments and laboratory studies. If there are side effects, we need to take action by making changes in dosing, medication, or in treating the side effects in terms of using medications that will reduce blood glucose, or in the case of effects on cholesterol and lipids, that may reduce cholesterol. Included in this is not just treatment with medications, but also in terms of lifestyle, diet, and so forth. All in all, physicians need to be more attentive to potential side effects of medications that are being administered and monitoring patients on an ongoing basis. This is not just a good defensive medicine practice, but also a practice that will promote the health of the patient overall.

Thank you for today. I wish you a good day for Medscape.

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