Deprescribing: is the law on your side?

[helvella]

We have seen all too many patients have various medicines deprescribed. Often suddenly and without any warning whatsoever.

This has long appeared to be ethically and legally questionable - to say the least. So I have looked for some medicolegal opinions and found this freely accessible paper. Below are the abstract and summary - follow the link for the rest of it.

I fear the context tends rather more towards the case of people on multiple medicines having the prescribing mess sorted - rather than the obvious examples of removing liothyronine or even levothyroxine. But the principles are mostly identical. Mainly:

all decisions must be informed by full and frank informed patient consent

Original article

Deprescribing: is the law on your side?

Free

1. Nina Barnett1,

2. Orla Kelly2

3. Correspondence to Orla Kelly, Healthcare Litigation Solicitor and Pharmacist, Cantillons Solicitors, 38/39 South Mall, Cork, T12 W522, Ireland; [e-mail]

Abstract

Deprescribing can feel risky: prescribers need to consider the consequence of stopping a medication medicolegally, particularly where there may be a guideline or accepted practice that suggests its use. This review aims to provide reassurance and encouragement to safely deprescribe. Experience suggests that for many patients the prescribing of multiple medicines is the norm. In the right setting and at the right time, deprescribing provides a real opportunity to minimise side effects and unwanted interactions through patient-centred conversations. How does the prescriber stand if they stop a medication for which there is an evidence-based guideline to use it? This review explores the concepts of clinical negligence and informed patient consent in the context of deprescribing. Using examples from UK case law, the review discusses the legal tests which are applied to establish an action based on clinical negligence and lack of informed consent. It describes the recent changes in law which reinforce the importance of providing information focused on what is material to individual patients. The use of prescribing tools to support safe deprescribing and informed consent are also discussed. When deprescribing is undertaken in partnership with patients, supported by the knowledge, skills and experience of both patient and clinicians and the patient's values and preferences based on clinical skill, judgement and evidence-based medicine, law presents no barriers to deprescribing.

dx.doi.org/10.1136/ejhpharm...

Summary

Legally deprescribing is no different to prescribing (within the UK's legal system). Ongoing review and monitoring of all decisions based on patient and medication-specific factors is required for safe patient care and all decisions must be informed by full and frank informed patient consent. As deprescribing becomes the norm practitioners who fail to consider deprescribing and fail to advise patients of the potential benefits and options may expose themselves to clinical negligence claims. Patient consent to stop, start, change or reduce a medicine must be based on full disclosure of all material risks to that patient. In support of the ‘ordinary sensible patient’ we encourage all prescribers to consider discussing the risks and benefits of continuing a medication and the options for deprescribing at the time of prescribing and throughout the patient journey. In the absence of deprescribing guidance as part of evidence-based guidelines, use of deprescribing tools and models are encouraged to support safe practice and improve clinical outcomes. When deprescribing is undertaken in partnership with patients, supported by the knowledge, skills and experience of both patient and clinicians and the patient's values and preferences based on clinical skill, judgement and evidence-based medicine, the law presents no barriers to deprescribing.

ejhp.bmj.com/content/24/1/21

Rayray81

[london81]

thanks for this both useful and interesting

[shaws Administrator]

As we are aware helvella, many hypo members are being persuaded to switch from NDTs or T3 and it is all down to cost. Nothing to do with patients improving their health.

I am glad you posted the above details.

[LindaC in reply to shaws]

And likely costing more over the long run in health care!

[shaws Administrator in reply to LindaC]

Most probably and I think those who decide that thyroid gland replacements that have proven their worth, are rejected by them - who do not have problems with their thyroid glands and seem to work on a theory alone. Do they listen to patients? Do they prescribe the type of thyroid hormones that used to renew health? No! is the answer. NDTs withdrawn through misinformation and it saved lives since 1892 onwards and T3 due to cost.

Woeful decisions by those one would think were more kowledgeable than many on this forum who have had to fight their way through a spider's web, it seems to me.

We want more Dr Skinners and Dr Peatfields and others trained as they were upon clinical symptoms alone and a trial of NDTs or T3 or T4.

Also if some good Endos could (or do) prescribe they could be under threat of losing their livelihoods so have to toe the line.

[LindaC in reply to shaws]

Absolutely! Hypothyroidism will surely go down as one of the biggest scandals within medicine. Some of the endos + GPs I've seen/discussed 'my thyroid sitution' with, seem to have been under the impression that everyone falls over and listens to anything Drs S & P said!? No, not the case at all! They knew their stuff, were approachable and LISTENED... something that should predominate in this 21st C.

Yes there's a hard-core bunch, determined to ensure that their pitiful 'little pet theory of T4 is all there is to it' will take over the UK... and beyond, tendrils reaching out. 👺

[LindaC]

Thank you helvella, most interesting. 👁️‍🗨️

[Yeswithasmile]

Thank you Helvella.

It’s very subjective isn’t it and also cointradictory. Either there are legal implications for not gaining full and informed patient consent or they are simply encouraged to discuss and what actually is a ‘ordinary sensible patient’?

You would like to hope that doctors simply use their common sense combined with their knowledge. Sadly we are presented too many times with evidence that some may not have much of either.

[nellie237 in reply to Yeswithasmile]

I think 'discuss with patient' is code for lay out all the negatives, and brush aside the patient's concerns.

[Yeswithasmile in reply to nellie237]

Lol. Yes. Talk down to your ordinary sensible patient in condescending manor and if ordinary sensible patient attempts to voice opinion, remove all eye contact and suggest moving forward with anti depressants.

Gosh. I appear to be a complete doctorist!

[nellie237 in reply to Yeswithasmile]

😂😖😂

[tattybogle in reply to Yeswithasmile]

i've got no chance then... i've never been 'ordinary' ...... or 'sensible' ....and i'm damn well not starting now !

[shaws Administrator in reply to tattybogle]

You will go speedily 'up the ladder then' in your desired occupation

😅