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this post was submitted on 05 Oct 2023
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What is the medicine in question? Any other MD (or better, neurologist) here? As far as I know, most of the standard treatment for cluster headaches are safe for pregnant women...
She's not pregnant though so it wouldn't matter.
Commonly they dont recommend embryotoxic medication in woman of childbearing age, as unecpected pregnancies happen and the chance for severe birth defects increase. Sometimes these can only be detected late into a pregnancy, so if the person might want to keep a pregnancy it would be not to take it.
That should be the women's choice to make though. She doesn't want a baby, if she has an unexpected pregnancy she will abort, so she doesn't need to take all that into account. She should get her treatment and a prior warning about pregnancy issues that could occur
That's not how it would play out in a malpractice case.
Lawyer: You recommended my client take a medication that causes birth defects, when you could have recommended a medication that doesn't cause birth defects. Because of that, her child has birth defects.
Doctor: Yes, but she said she didn't want children.
Lawyer: Have you ever heard a woman say she didn't want children, who later went on to have a child?
Doctor: Yes, it happens sometimes.
Lawyer: So birth defects are a foreseeable result of the medication you recommended, even in women who say they don't want children?
Doctor: ...
Nice imaginary conversation, I'm sure you're a totally qualified doctor and lawyer... just have the patient sign a liability waiver dude
Liability waivers don't protect doctors against malpractice claims.
Yes they do. In new york (where this took place), and most places, doctors are protected by liability waivers if the patient has informed consent. Read this for more information if you want an actual informed opinion on this
https://sobolaw.com/medical-malpractice/signing-a-waiver-before-surgery-can-you-still-sue/
Your link literally explains how to sue a doctor for malpractice after signing a liability waiver.
Which is straightforward in this case. The standard of care is not to give valproate to women of childbearing age except as a last resort, and valproate is known to have a very high risk of birth defects.
This wouldn't be gross incompetence, it is a standard treatment that comes with pregnancy risks that the patient can choose to take knowing that they aren't going to give birth. All of those quotes youve selectively pulled are in reference to unexpected injury that isn't outlined in the waiver, so I'm pretty sure they wouldn't apply in this case. Neither of us are lawyers though, I wonder if any lawyer fed heads could chime in
The doctor prescribed a different medication for her. And doctors, not patients, ultimately get to decide which drug they prescribe.
I don't think her case is going anywhere. She is suing pro se, which means she couldn't find or doesn't want a lawyer to take her case.
If a doctor spells out a risk to a patient and then still gives something that ends up causing harm, it is really a bit of a grey area. I don’t think that the doctor is entirely free of guilt in general. That being said, denying a medication without offering a proper substitute on this basis seems egregious. One can, under normal circumstances, control if they get pregnant or not.
Not in this case though. Worst thing the doctor could ask for a confirmation that ge informed the patient about the associated risks. I'd imagine a conversation like this:
"I inform you that this medication can cause severe birth defects in any baby in case you are pregnant. If you are pregnant you should not take this medication"
"I am not pregnant and do not plan to get pregnant. If i should be pregnant without my knowledge i'll not keep the baby."
"Given the strong risk associated with possible birth defects from this medication, could you please sign here, that i informed you about the risk?"
The moral grey area here is the person that ends up with birth defects I think. Not sure I agree with the policy, but remove it with a large enough population you will end up with some women ignoring advice and carrying to term.
There is no person and would never be a person. In some other case, where the pregnancy is on the table, sure, maybe then we can talk about it. But this precrime bullshit is nothing more than just another strive to remove agency from women.
Based on the full context, I'm actually on the woman's side here. Even if I supported expanding fetal rights (I don't), those rights should never start before conception.
But this statement is not something we can know. I've known plenty of people who "aren't pregnant and wouldn't keep a baby if I were" that are now happy parents of that baby they wouldn't keep. I've also known people who wanted children and then flipped a 180 and opted for abortion.
Sure, but do not recommend is different than will not give.
Easy solution, prescribe birth control treatment in tandem. Require insurance to pay.
It's pretty simple really. If someone is taking a medication that creates problems if they become pregnant, and they don't want to become pregnant, give them treatment to prevent them from becoming pregnant!
But sir we have a lynch party here we can't just use normal reasoning.. that's boring for one and also snowballing hatred is our forte
Not a Dr. but enjoy a good scientific paper.
Intranasal dihydroergotamine is a category X. Aka it causes fetal damage.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3971427/
Also for those that don't know a cluster headache is a migraine on steroids. Also referred to as "suicide headaches" due to a common event prior to effective treatment.
Also, also referred to as exploding head syndrome
Exploding head syndrome is something different and a potential side effect of rapid discontinuation of SSRIs. I've had it and it's different from a migraine.
Upon refreshing my memory you are correct. I just must have assumed they referred to the same thing
wtf, that sounds awful
eta: "suicide headaches," "exploding head syndrome," I am so fucking upset that people suffer from things like this. Idk, I just hope you guys are okay. :(
You're right. There are other options though. Like oxygen therapy triptan, etc. I don't understand why didn't the doctor just prescribe the drug. Just let the patient sign an informed consent.... especially if the patient isn't pregnant and not planning pregnancy at the moment.
Because the doctor prescribed a different drug.