Quick, prescription question.

[SueC]

Usually he gets a friend to call it in for us, but a few times he's called it in himself.

This makes me wonder...what do state medical boards use as guidelines for determining ethical behavior and doling out discipline? I think the state legislature gives the board of medical examiners authority to make rules...but I wonder if they look to any national standards for that (like those cited above).

Ahhh...from the Colorado Board of Medical Examiners newsletter Examiner:

Prescribing for Family and Friends
Ned Calonge, MD, MPH, President, Colorado Board of Medical Examiners

While he likely was not the first to say it, Sir William Osler is perhaps the most famous physician credited with the phrase, “A physician who treats himself has a fool for a patient.” This statement could also be applied to the treatment of family members and others with whom the physician has significant emotional relationships. Both the American Medical Association and the American College of Physicians have position statements against such care provision. The AMA position states, “Physicians generally should not treat themselves or members of their immediate families,” and the ACP statement reads, “Physicians should avoid treating themselves, close friends, or members of their immediate families. Physicians should also be very cautious about assuming the care of closely associated employees.” Both groups raise similar concerns about loss of objectively in medical decision-making, inadequate history taking, and physical examination, and possible discomfort on the part of either or both the physician and patient in sharing sensitive information or undergoing intimate exams. The AMA also raises concerns about treating conditions beyond the physician’s expertise or training, loss of patient autonomy and informed consent, and impact on personal relationships that could accompany negative medical outcomes. Finally, both groups recognize that there may be emergency or isolated settings where there is no other qualified physician available, but state firmly that care should be transferred to another physician as soon as practical. While there may be situations where routine care for short-term, minor problems is acceptable, physicians should not serve as a primary or regular care provider for immediate family members and should resolve requests for care from employees, family members, or friends by assisting them in obtaining appropriate care.
Despite these strong position statements, studies have found 50 to 80 percent of physicians report self-treatment, and nearly 100 percent report treatment of non-patients.
The Board of Medical Examiners has a keen interest in these issues of treatment for self, friends, and family. First, prescribing Schedule II substances, except in the case of an emergency, for one’s self or a family member represents grounds for disciplinary aaction by the Board under state statute. The Board also discourages self-treatment or treatment of family or others with whom significant emotional relationships exist for all controlled substances. Finally, the Board feels that these practice limitations should apply to all medical and surgical care unless in the setting of minor illnesses or emergencies.
We review several cases each year where a physician has had difficulties arise due to self-treatment or treatment of family, friends, or employees. Some involve controlled substances, some inappropriate or substandard care, and some represent boundary violations. Probably none of the cases we review involved emergency situations where no other physician was available to provide care, and most cases involve ongoing treatment. There are even some very concerning cases involving surgical treatment. Often care is provided as a matter of convenience, but note that convenient care is not always quality care.
If care is provided to one’s self, family, or others with whom the physician has a significant emotional relationship, the Board recommends that a proper, complete written medical record documenting the care, including medications prescribed and indications, be prepared for each interaction, just as for any other patient. It is substandard to not appropriately document medical care, and too often record keeping is neglected or ignored in managing such cases.
The Board believes that in most cases, physicians should defer the care of themselves, their family and their friends to other qualified physicians. The Board is considering adopting a policy statement regarding this issue, in order to provide licensees with specific guidance. We welcome comments and suggestions.

[Phoebe]

DH has written a couple scripts for me over the years only when it was a prescription I use often and the dr. office wasn't available. He has had a co-worker write for things on occassion. For our kids, it was twice when I was out-of-town and one of the kids developed an ear infection.

Jennifer

our attorney (MD/JD who only works w/docs) STRONGLY advises against it and has been published on the subject (his name is John Irwin if you want to try to find it). He used to be general counsel for The Cleveland Clinic Foundation.

[spotty_dog]

I don't think the ethical guidelines that Alison provided prevent short-term, one time non-emergency care.

The sidebar of the article I quoted pointed out that if you prescribe or treat someone you know even once, it can be harder to refuse later down the line, even if the situation is totally different.

[Meenah]

My DH is actually my primary with the insurance company!!! He routinely prescribes for me but it is usually asthma related and he is a pulmonologist. He won't give anyone an antibiotic unless they are half dead so I don't get that. GYN stuff is left to my Ob GYN.
Luanne