Although not an Indigo case, a recent medical malpractice verdict in GA illustrates the importance of documentation and closer patient follow up around new medication regimens in the family practice clinic, particularly in the treatment of depression and anxiety. Patients should contact their healthcare providers for follow-up to ensure safety and monitor any changes in their condition.
I’m no clinician but 25 years managing thousands of medical malpractice claims has taught me a thing or two about evaluating these kinds of risks. A recent trial involving a family practice doctor got my hackles up! Consulting a mental health professional is crucial for proper diagnosis and treatment of mental health conditions.
Mental health conditions, such as depression and anxiety, are complex disorders that can significantly impact a person’s mood, feelings, and ability to function in daily life. These conditions arise from a combination of genetic, biological, environmental, and psychological factors.
For instance, a person might experience depression due to a family history of the condition, coupled with stressful life events and certain biological predispositions. Understanding these multifaceted health conditions is crucial for providing effective treatment and support, as it allows healthcare providers to tailor their approach to each individual’s unique circumstances.
By recognizing the intricate interplay of these factors, family physicians can better address the mental health needs of their patients, ultimately improving their quality of life.
Recognizing the symptoms of mental health conditions is essential for timely and effective treatment. Symptoms can vary widely depending on the specific condition, but some common indicators include:
By being vigilant about these symptoms, family medicine physicians can intervene early, providing the necessary support and treatment to help patients manage their conditions effectively.
Mental health conditions are influenced by a complex interplay of genetic, biological, environmental, and psychological factors. Some of the key risk factors include:
Understanding these risk factors allows family medicine physicians to identify patients who may be at higher risk and provide preventive care and early interventions to mitigate these risks.
A 27 year old single male visits a family practice clinic having just moved in from out of state. He has started a new job and is struggling with being stressed out to the point of having panic attacks. Antidepressants are often prescribed to help manage symptoms of depression and anxiety. After taking a comprehensive history and ruling out any other risk factors for anxiety and depression, the physician prescribed Xanax & Citalopram at the suggested starting doses, emphasizing the importance of monitoring the dose.
He also advised the patient of potential side effects and the importance of not abruptly stopping the medication to avoid withdrawal symptoms. He then made a follow-up appointment for 90 days to ensure the effectiveness of the treatment and to address any issues in treating his mental health condition. A month later, after an evening date with his girlfriend where he became intoxicated, the young man took his own life.
The relationship between physical health conditions and mental health is bidirectional, meaning that each can influence the other. Common health conditions that can affect mental health include:
Addressing both physical and mental health in patient care is crucial, as managing one can often lead to improvements in the other. Family medicine physicians play a vital role in providing comprehensive care that considers the whole person.
Patient education and support are fundamental components of effective mental health care. Educating patients involves:
By providing thorough education and support, family physicians can help patients navigate their mental health journey, ensuring they have the resources and knowledge needed to manage their conditions effectively.
The malpractice claims alleged that the physician failed to properly advise the patient of potential side effects of the medication, failed to warn him that alcohol was contraindicated and failed to schedule closer follow up at two weeks, or even a month. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants that require careful monitoring due to their potential side effects.
The physician disputed the claim on the first two grounds and testified that 90-day follow-up was reasonable and within the SOC for the patient. Without proper follow-up, symptoms of depression can become worse, leading to more severe outcomes. The jury returned a verdict in favor of the patient, finding that closer monitoring was required. The jury also found the patient shared responsibility because he became intoxicated and took his own life.
Although I have my own doubts about the appropriateness of the jury verdict, there is always a lesson to take away from an outcome like this one. Regardless of whether follow up at 90 days met the standard of care, if the physician had monitored the patient more closely and scheduled him in at two weeks or 30 days, rather than 90 days, the chances are the jury would have returned verdict for the defense. Of course, this also assumes that even despite closer follow up, the patient would still have taken his own life, a point that was no doubt disputed in the trial.
Family practice tends to be a lower frequency, lower severity specialty in the world of medical malpractice but according to ten years of data from one large malpractice insurer, the management and monitoring of medication is the top driver of claims in this specialty. According to the study, from 2012-2021, 78% of cases against family practice physicians arose from allegations of improper management and monitoring of medication. 20% of those cases involved antidepressants.
The take-away then, particularly when it comes to new cases of anxiety and depression presenting in clinic, is that if you want to not only be able to defend your care but also win your case, set up tighter, more timely follow up protocols around new medication regimens and follow them!
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May you enjoy all the success and fulfillment you deserve in this ever-changing landscape of healthcare litigation and remember... the devil is in the details and the documentation!
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Photo by Drazen Zigic from iStock.
