Recently, a doctor treated his patient for erectile dysfunction and decreased sexual drive. The patient had multiple reasons explaining these two conditions. He was on a SSRI. He had a history of alcohol abuse. And several other medical issues. What was also clear was that he had low free testosterone levels for his age cohort; and he had clinical hypogonadism.
The doctor discussed treatment with exogenous testosterone. They discussed the risks, benefits, and options – including low sperm count and fertility issues. The patient said he understood and gave his blessing to proceed.
His symptoms improved.
And he was happy.
And he was appreciative.
One little minor detail. The patient never told his wife. She had her heart set on another baby. And they were unable to conceive.
His wife went to see a fertility specialist. One thing led to another and the wife understood she might need several rounds of IVF treatment. Not an inexpensive endeavor.
Well, the wife eventually learned about the testosterone treatment. She was livid. Not with her husband. But with the doctor.
She barked that the testosterone treatment caused the low sperm count. Had that treatment not been initiated, she’d be pregnant and never would have needed fertility treatment. Yes, I know, there are several details the wife seemed to be missing. Regardless, the husband demanded he be reimbursed by the testosterone prescriber for his wife’s impending treatments – or he’d alert any number of authorities.
Ouch.
Let’s deconstruct this. Who’s the doctor’s patient? The husband or the wife? The doctor never saw the wife. To the extent the doctor was even aware there were fertility concerns, the doctor explained in detail the risks, benefits, and options for the testosterone treatment. With full informed consent, his patient elected to proceed. The doctor’s duty was to HIS patient.
Next, most fertility evaluations involve both the woman and the sperm donor (often, but not always, the wife and her husband). If the patient had a low sperm count, this should have been addressed early in the fertility evaluation. And, a history would have identified that the husband was on testosterone replacement. An important detail. If the husband chose to withhold this fact, then the husband is culpable for the outcome. Even so, it’s not clear that the exogenous testosterone was the cause of the low sperm count; that the low sperm count was the cause of the infertility; or that even fully “fixed”, whether the patient’s wife would have conceived and brought a baby to term.
What is clear, though, is that the demand to make payment or a complaint will be filed sounds like extortion, a criminal offense.
Whenever your treatment affects a third party, there is a chance that third party will spew venom on you. But, unless your patient brings that third party into the discussion, you generally do not owe that third party a duty of care. I say generally because this rule has occasional exceptions. In some states, doctors have been held liable for prescribing medication to their patients that caused their car to crash into another. The injured third party successfully sued the doctor. And, in some states, psychiatrists may be liable if they fail to warn third parties of an imminent and detailed threat by their patient. Again these are exceptions and not the rule. Your primary duty is to your patient.
It’s unfortunate the patient in this vignette wasn’t candid with his wife. That is also probably not an exceedingly rare occurrence.
This demand/extortion is no different that the claims of marital discourse, loss of employment of the spouse, hardship claims that we all receive with increasing frequency. Most certainly, this claim will cost the defendant the limits of his deductible to defend. This will be recorded in his loss ratio and he will pay not only the deductible but with increasing annual insurance rates thereafter for the next three to five years. The system is DNR and cannot continue.
Until and unless we countersue the plaintiffs–not merely their lawyers–and get judgments, there’s no negative feedback to dissuade them from being assholes. I’d go after the plaintiffs as well as their representatives–their lawyers. Mean-spirited of me? Maybe. But it’s a practical solution. Without negative feedback in a loop, behavior tends to diverge [read: get worse] rather than converge [read: improve]. It’s the engineer in me….
Does treating “Low T” with exogenous testosterone typically cause irreversible testicular damage such that cessation of therapy might lead to a lower than pre-treatment sperm count? My hunch is no.
Sounds like cessation of T may have left this patient a bit limp, and unable to perform his manly duties necessary to produce offspring. This may take the cake as the most outrageous demand and accusation from a patient.
I would be interested in knowing how the urologist handled the case, whether his wife got pregnant and conceived, and whether or not the patient was capable of having a “happy ending”.
On a side note, the only phrase I dislike more than Low-T is: “Guard your manhood.” With a diaper. Really? 🙂
E
According to the way you penned this article, the low sperm count and fertility issues with low sex drive predated the testosterone treatments.
My two cents- ask the wife to put into writing what she is spewing, then call authorities and file criminal charges on her. Do it with an attorney.
The husband is the patient here, not her. His consent, as you implied was informed, and as such, would have stated that it would further decrease sperm count, therefore, it is incumbent upon him to tell the wife. If he isn’t honest with her (and it sounds like I understand why), he is culpable, not
I agree with JH above. I am sick and tired of being a helpless target of unreasonable assholes with no recourse except to mount a defense. When do we get to go after these assholes for being crazy assholes blaming us for their disappointments in life? We are just trying to help them, ease suffering, and make life a little better for them.
sek
I am not a medical professional, but wouldn’t a data system that held each patient’s medical history that was mandatory and accessible by ALL MDs alleviate these issues? Or am I being naive to think that would ever be available?
I’ve been reading about voluntary online medical record keeping now for our blog.
We should probably put something into our consent-to-treat forms that says if a frivolous lawsuit is threatened or commenced (my summary; the definition of “frivolous” needs some detailed explanation and this is simply a rough idea), then the complaint and any relevant details and consequences go into the medical record.
Also, permission to release any part of the medical record is permission to release the lawsuit details. Permission to release medical records or parts of them can be granted and withheld, but the right to release details about frivolous materials is to be irrevocably granted whenever any part of the medical record is to be released, and can be rescinded only by canceling the authorization to release any part of the record.
If this method gets used widely, then problem patients will be identified promptly and can be tossed out of our practices immediately, before subsequent problems begin.