Saturday, January 22, 2011

This Medicine Might Kill You, But....



We all believe in Informed Consent and ClinkShrink likes to write about it. See Is It Malpractice to Lie...or better yet, read our book when it comes out where Clink talks all about the history of Informed Consent and many other such things. And one of the things people get angry at doctors for (? and shrinks in particular?) is when they have side effects or adverse reactions, and the doctor hadn't told them this might happen. People seem to get really mad about this, especially on blogs or on anti-psychiatry sites (sorry, no links here, find your own anti-psychiatry sites).

So I've wondered, does it matter if a patient is forewarned that they may get a side effect? There are many icky responses people have to meds, some are not very common, and sometimes it's hard to tell if it's the medicine causing the problem. And side effects can be uncomfortable, are they less uncomfortable if you were forewarned? You need a procedure and they make you sign a form saying that you know you could get an infection, hemorrhage, or die. Everyone has to sign or no procedure. If something bad happens, you can still sue, but if you're dead, you're dead. It's become so rote that it almost lacks meaning.

I do tell people about the more common side effects of medications. The pharmacist gives them a longer list. Google has it all for the curious, and I certainly don't discourage Googling, I sometimes suggest it. But I've wondered, does informed consent change things? Here's what my non-scientific observations have revealed.

There a medication that is associated with a rash that can be fatal. I tell people this, and the precautions they need to take to avoid croaking---slow titration, stop med/call if there is any rash at all. A shrink friend prescribed the medication to a patient who had a rare ?never heard of reaction and ended up in an ICU with liver toxicity and nearly died. The patient didn't die, made a full recovery, but the shrink was pretty traumatized and said she wouldn't use the medication again. After my friend's patient had this problem, I told every patient I prescribed this medication to this story. No one flinches. No one has said, "I don't want to take that medication that nearly killed someone." On the other hand, if I say, "This medication is associated with weight gain in some people," the resistance becomes huge. Even though weight gain is gradual and can be monitored, and I tell people they must get weighed twice a week and we can stop the medication if their weight increases by 4 pounds (that's my non-scientific cutoff for beyond the realm of fluid fluctuations). And I know skinny people who take lithium and zyprexa and stay skinny; not everyone gains weight. And I know people who feel so much better that they are willing to tolerate some weight gain.

Just my thoughts this chilly Saturday morning. By all means, tell us your stories.