It’s a unique relationship based largely on knowledge and trust. Doctor’s not only have to rely on their medical knowledge, but they need to apply that to their knowledge of the patient. Knowledge that often develops overtime through trust. Patients want and need to be able to trust their doctors. Sometimes patients share information with their doctors before anyone else in their lives. It’s a consensual relationship but it’s also a fiduciary relationship where the doctor takes on certain obligations. And, it’s a relationship that has been evolving over the last several decades which numerous influences such as managed care, direct-to-consumer advertising, internet medical information. Things that can interfere in the traditional doctor-patient relationship. Some of that, like more knowledgeable patients who want to partner in their healthcare, can be good developments. Managed care – removing a patient’s choice of physician or a physician’s choice of treatment – perhaps not so much.
Here, in the DDL world, we are firm believers in the independent practice of medicine. Doctors making patient-specific medical decisions based on all known and available information, but not dictated by either drug/device manufacturers or the FDA. That means doctors are free to use drugs and devices in ways other than their approved uses. Doctors can use drugs and devices off-label. And, that is what is at the core of the decision in Smith v. Surgery Center at Lone Tree, LLC, 2020 WL 6066273 (Col. Ct. App. Oct. 15, 2020).
This is a hospital liability case. Plaintiff received