When we think about medical malpractice, we usually think of a fairly limited set of scenarios – errors during surgery, prescribing mistakes, and even the failure to diagnose a condition, resulting in permanent poor health. And doctors, well, they think of their high malpractice insurance, litigious clients, and the concern that under-treatment may be interpreted as mistreatment.
More formally, Murphy Law Firm defines medical malpractice as including, “Surgical errors, medication errors, misdiagnoses, birth injuries, and… When a medical error results in a patient receiving substandard care, the situation may devolve into one of medical malpractice.” But while we understand these definitions, more patients are beginning to wonder whether it’s not always and only under-treatment that’s a problem, but also overtreatment.
Taking back pain and its close associations with today’s opioid epidemic as a key example, we need to reconsider how we frame even the most basic prescribing practices. Is addiction a potential consequence of malpractice? If so, doctors and the pharmaceutical industry could have a serious class action suit on their hands.
The Problem Of Back Pain
Many people get off on the wrong foot when it comes to back pain, ignoring it or taking narcotic drugs instead of OTC anti-inflammatories for the pain. Unfortunately, since much back pain is chronic, patients whose doctors opt to prescribe opioid pain medication are highly likely to become addicted to the drugs.
Now that we know more about addiction, more doctors prefer to treat back pain without drugs, opting instead to recommend physical therapy or chiropractic care for their patients. For those with severe pain, some doctors will even consider back surgery for patients before providing opioids.
Despite changes in prescribing practices, it’s already too late for patients with addiction issues. And this is where the question of medical malpractice comes in.
Overprescribing And Medical Malpractice
Obviously, not every opioid prescription is a case of overprescribing and not every prescription leads to addiction. Rather, in order for patients to make an accusation of malpractice, they must consider factors such as medical history, diagnosis, testing, and the doctor’s experience. The patient should also examine the level of prescribing compared to the diagnosed condition and the amount of medical follow-up they received when renewing prescriptions.
Some of the recent guidelines for opioid prescribing include the fact that most emergency and urgent care professionals don’t provide opioids for take-home use and even patients who have had surgery are typically given only 3-5 days worth of opioids upon discharge. Rather than prescribing a week or more of opioids, which can incline a patient to addiction, doctors are keeping prescribing to a limit.
Drugs And Consequences
Limited prescribing is a direct result of how overprescribing brought on the drug epidemic, but that doesn’t mean doctors have outrun the risk. One Iowa physician was recently accused of “gross malpractice” by industry regulators on the basis of a 2014 lawsuit. Numerous patients under his care, all of who were receiving opioid prescriptions, died from drug overdoses. Many more are living with addiction.
Right now, there isn’t a foundation for charging doctors with malpractice on the basis that patients are struggling with addiction – and its health consequences – due to overprescribing. However, if the national government rather than individual cities, can move to declare the opioid epidemic a national emergency, the chances of pursuing consequences for doctors who overprescribe will increase.
Any changes are also dependent on taking a harm reduction approach to the epidemic at a legislative level, rather than leaving patients to flounder. Right now, doctors escape blame because patients are viewed as lawbreakers or drug seekers who can’t be trusted to take medication as prescribed, rather than as vulnerable individuals given medically mediated access to a powerful drug.
It’s not a popular approach but as the opioid epidemic hits closer to home for a broad population, change is possible.