Electronic Letters to:
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eLetters: Electronic letters published:
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Side effects and interactions of drugs: another area of potential negligence
- Sanjoo Chengappa (30 May 2006)
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Communication, "compliance" and convulsions
- AJESH JANKI (22 June 2006)
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Sanjoo Chengappa, SHO in Psychiatry Richmond Royal Hospital, Kew Foot Road Richmond TW9 2TE
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sanjoochengappa{at}yahoo.co.uk Sanjoo Chengappa
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Dear Sir, Another area of practice where claims of negligence could be brought is around the information given to patients concerning side effects. This is particularly important in psychiatry for a number of reasons. Long term use of medications is common in our speciality. Even if information regarding drug side effects is given to patients often this is when they are acutely unwell and at times when they are treated under compulsion (particularly in the case of inpatients) . It can be argued that during these periods capacity to register and decide upon information is impaired. Hence the development of any serious side effects in the future could lead to claims of negligence. It is only infrequently that we hand out information leaflets to patients to take home which caution them of the common and the more dangerous side effects of drugs and also possible interactions with other medications (particularly with over the counter medications for example NSAIDs taken with lithium). Good practice requires that we do this routinely. NICE guidelines for schizophrenia do mention considering advance directives regarding future treatments; discussion with the patient and family regarding medications, their side effects, and other alternatives; and also clear documentation of these practices in case-notes. There is a strong case for applying these recommendations equally to other illnesses and treatments. |
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AJESH JANKI, SHO, psychiatry
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shaunjanki{at}aol.com AJESH JANKI
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The role of effective communication in patient care cannot be overemphasized. Poor communication is often cited as a factor in patients' decisions to pursue claims of medical negligence. I am reminded of a patient I encountered as a medical officer running an epilepsy clinic at a rural South African Hospital. An obvious hurdle was that the doctors at the hospital did not generally speak the language that the patients did. My patient had been prescribed three anticonvulsant agents by my predecessors but worryingly still had a convulsion on most clinic visits. An assumption had been made that she was either refractory to treatment or just not taking her medication. On careful review of her history, I discovered to my chagrin, that she had been taking her medication in an unusual manner. She believed that she had to take the first agent on day one, the second on day two, the third on day three and then repeat the cycle. The communication difficulties had resulted in her taking three agents, all at subtherapeutic doses. The incident highlighted the role of effective communication in enhancing treatment outcomes and serves to this day as a reminder to check that my patients' understanding of clinical information is accurate. |
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