The Perils of Prescribing Medication and the Goldilocks Principle: Defending Related Claims of Malpractice

By Durney, Peter M.; Lebov, Harrison L. | Defense Counsel Journal, October 2019 | Go to article overview

The Perils of Prescribing Medication and the Goldilocks Principle: Defending Related Claims of Malpractice


Durney, Peter M., Lebov, Harrison L., Defense Counsel Journal


ADVANCES in medical science and pharmaceutical engineering in the United States have given rise to an increasing number of claims of abuse related to the prescription of medication. Regulatory and public scrutiny of prescribing practices have increased, 1 as has patient awareness. As a result, medical practitioners authorized to write prescriptions have come to be exposed to liability for claims not only for their having over-prescribed medication, but also for their having under-prescribed medication; that is, having prescribed less than an adequate dose of an otherwise effective medication. 2 Simultaneously, a rising percentage of such malpractice claims involve troubled individuals exhibiting drug-seeking behavior, 3 or instances of so-called "doctor-shopping" by drug dependent patients. 4 This patient profile presents a real conundrum for treating physicians. A doctor observing that his or her patient is exhibiting drugseeking behavior, or has been doctor-shopping, may feel conflicted about how best to effectively treat that patient, or be distracted by the need to remain hyper-alert to steering clear of allegations of over-prescription or under-prescription of medication, 5 both of which theories are currently being used as bases for allegations of medical malpractice. 6

Where pharmaceuticals are concerned, trial and error may ultimately dictate the best course of treatment. But with different prescription regimens comes risk. How much prescription medication is too much? How much prescription medication is too little? This conundrum fits squarely within what has been colloquially referred to as the "Goldilocks Principle," taken from the popular children's story. In essence, the Goldilocks Principle describes the internal tug of war between competing concerns, in an effort to arrive at the best solution for whatever problem one is facing. That sounds innocuous enough. However, where the end of the children's story finds Goldilocks asleep in Baby Bear's bed, having evaluated her options before ultimately choosing which bowl of porridge to eat and where to sleep, the issues addressed in this article are anything but lighthearted. The potential consequences for the prescribing physician or nurse accused of malpractice are much more serious than those faced by the Goldilocks story's young protagonist. In medicine, which all would agree is not a "perfect science," the best choice is rarely immediately apparent, consequently deciding the proper course is not easy. Therein lie the challenges addressed by this article. In the context of prescription medications, finding the optimal dosage of a medication for each individual patient 7

The essential steps in achieving [balanced prescribing] are (a) careful attention to the history, examination, and investigation of the patient's condition and drug therapy, (b) accurate diagnosis, (c) detailed attention to prescribing the dosage regimen in the light of the therapeutic goal, (d) careful writing of the prescription and (e) regular monitoring of therapy, including attention to beneficial outcomes, adverse reactions, and patient adherence. The two major requirements in determining the dosage regimen are (1) understanding the pathophysiology of a health problem and matching it to the mechanisms of action of the relevant medicines and (2) assessing the benefit to harm balance of the therapy, although the difficulties in doing this in the individual are great. Id. (emphasis added). See also Parker v. Fidelity Security Life Ins. Co., No. CIV F 06-654 AWI DLB, 2007 WL 2688811, at ·3 (E.D. Cal. Sept. 12, 2007) (highlighting the difficulty in properly prescribing medication to a person with mental health problems who "regularly took either too much or too little of his medication, and [] was difficult to keep [] on his prescribed level of medication," thus compounding the already present difficulties). mandates an awareness of the balance between over-prescription and underprescription, along with an appreciation for potential addiction and habituation. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

The Perils of Prescribing Medication and the Goldilocks Principle: Defending Related Claims of Malpractice
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.