Medicolegal Issues

Should you prescribe medications for family and friends?

Current Psychiatry. 2011 June;10(6):41-51

References

1. Balon R. Psychiatrist attitudes toward self-treatment of their own depression. Psychother Psychosom. 2007;76:306-310.

2. Walter JK, Lang CW, Ross LF. When physicians forego the doctor-patient relationship should they elect to self-prescribe or curbside? An empirical and ethical analysis. J Med Ethics. 2010;36:19-23.

3. Reynolds H. Medical ear in the early morning tennis group—when to advise and what to say. Pharos Alpha Omega Alpha Honor Med Soc. 2010;73:14-15 discussion 16.

4. Sataline S, Wang SS. Medical schools can’t keep up: as ranks of insured expand nation faces shortage of 150,000 doctors in 15 years. Available at: http://online.wsj.com/article/SB10001424052702304506904575180331528424238.html. Accessed March 21, 2011.

5. Steinberg S. Of medical specialties demand for psychiatrists growing fastest. USA Today. July 1, 2010:6D.

6. Leonhardt D. A labor market punishing to mothers. New York Times. August 4 2010:B1.

7. Madden K. Reluctant to go on vacation? Available at: http://www.cnn.com/2010/LIVING/08/04/cb.reluctant.to.take.vacation/index.html. Accessed March 20 2011.

8. Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001;286:3007-3014.

9. Clark A, Kau J. Patterns of psychoactive drug prescriptions by house officers for nonpatients. J Med Educ. 1988;63:44-50.

10. State Medical Board of South Carolina. Prescribing for family members. Available at: http://www.llr.state.sc.us/pol/medical/index.asp?file=Policies/MEPRESCRIBEFAM.HTM. Accessed March 20 2011.

11. Dietz LH, Jacobs A, Leming TL, et al. Physicians, surgeons, and other healers, §§130, 216-218. In: American jurisprudence. vol 61. 2nd ed. New York, NY: Thomson Reuters; 2010.

12. Medical Board of California. General office practices/protocols-frequently asked questions. Available at: http://www.medbd.ca.gov/consumer/complaint_info_questions_practice.html#13. Accessed March 20 2011.

13. Montana Board of Medical Examiners. Statement of physician prescribing for self or members of the physician’s immediate family. Available at: http://bsd.dli.mt.gov/license/bsd_boards/med_board/pdf/prescribing_self.pdf. Accessed March 20 2011.

14. New Hampshire Medical Board. Guidelines for self-prescribing and prescribing for family members. Available at: http://www.nh.gov/medicine/aboutus/self_presc.htm. Accessed March 21 2011.

15. State Medical Board of Ohio. Frequently asked questions. Available at: http://www.med.ohio.gov/professional_guidelines.htm. Accessed March 20 2011.

16. Virginia Board of Medicine. Can I prescribe for my family and myself? Available at: http://www.dhp.virginia.gov/Medicine/medicine_faq.htm#Prescribe. Accessed March 20 2011.

17. Aboff B, Collier V, Farber N. Residents’ prescription writing for nonpatients. JAMA. 2002;288:381-385.

18. Johnson LJ. Malpractice consult. Should you give informal medical advice? Med Econ. 2007;84:36.-

19. Nisselle P. Danger zone: when boundaries are crossed in the doctor-patient relationship. Aust Family Physician. 2000;29:541-544.

20. Eastwood GL. When relatives and friends ask physicians for medical advice: ethical legal, and practical considerations. J Gen Intern Med. 2009;24:1333-1335.

Restrictions and rules for prescribing controlled substances are stricter, despite many doctors’ sometime-lax attitudes. State medical boards tell doctors not to prescribe controlled substances for friends, family, or themselves except in emergencies. Yet studies have found that house officers often write prescriptions for psychoactive drugs (including narcotics) for family members, friends, and colleagues⁹ and that residents are willing to prescribe codeine for a hypothetical colleague with pain from a fractured finger.¹⁷

Table 1

Selected state medical board rules and comments on casual prescribing

State	Rules
California¹²	‘[E]valuating, diagnosing, treating, or prescribing to family members, co-workers, or friends…is discouraged’ and requires ‘the same practice/protocol for any patient in which medications are prescribed,’ including a ‘good faith exam’ and documentation that justifies the prescription
Montana¹³	Although prescribing for one’s family or oneself is not prohibited, doing so ‘arguably…does not meet the general accepted standards of practice, and is therefore unprofessional conduct [that] may subject the physician to license discipline’
New Hampshire¹⁴	‘Physicians generally should not treat themselves or members of their immediate families.…Except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members’
Ohio¹⁵	‘[I]t is almost always a bad idea to treat a family member’s chronic condition, serious illness, or psychiatric/emotional problems’
South Carolina¹⁰	Treating immediate family members may produce less than optimal care. ‘[P]rescribing controlled substances for family members is outside the scope of good medical practice except for a bona fide emergency situation’
Virginia¹⁶	Prescriptions ‘must be based on a bona fide practitioner-patient relationship. Practitioners should obtain a medical or drug history, provide information about risks, benefits, and side effects, perform an exam, and initiate follow-up care. Practitioners should not prescribe controlled substances for themselves or family members except in emergencies, isolated settings, or for a single episode of an acute illness’

Table 2

Cautions and recommendations for casual prescribing

Avoid doing it in non-emergencies
Obtain a medical and drug history
Perform an appropriate, good-faith exam
Create a medical record that documents the need for a prescription
Prescribe controlled substances only in emergencies or isolated settings
Inform your patient about risks, benefits, and side effects
Initiate needed additional interventions and follow-up care
Maintain confidentiality and respect HIPAA rules
Ask yourself, ‘Can I avoid this—is there another option?’ If the answer is ‘yes,’ don’t do it
HIPAA: Health Insurance Portability and Accountability Act

Liability risk

Clinical Point

Casual prescribing can be hard to defend in court because it usually looks suspicious and is not well documented

Most residents are unaware of federal or state regulations addressing the appropriateness of prescription writing for non-patients.¹⁸ A survey of U.S. internal medicine and family practice residents at a teaching hospital found that less than a quarter believed that ethical guidelines on prescription writing existed.¹⁷ Such deficits can make malpractice liability more likely if something “goes wrong” with your casually prescribed treatment. Friends and relatives do sue doctors whom they have consulted informally,¹⁸ and casual prescribing can be hard to defend in court because it usually looks suspicious and is not well documented.

Revisiting Mike’s case

Understandably, Dr. C wants to help Mike and may even think he has a condition (eg, adult attention-deficit/hyperactivity disorder) for which a stimulant would be appropriate. But respect for Mike’s humanity—the paramount value in medical practice¹⁹—suggests that his treatment should occur after and because of a careful medical assessment rather than a golf game. Moreover, prescribing a controlled substance in a non-emergency likely would violate standards of practice promulgated by Dr. C’s medical board. Dr. C should tell Mike that his problem deserves thoughtful evaluation and suggest that Mike see his primary physician. Dr. C also could recommend psychiatrists whom Mike might consult.

Related Resource

Aboff B, Collier V, Farber N. Residents’ prescription writing for nonpatients. JAMA. 2002;288:381-385.

Drug Brand Names

Codeine • Tylenol with Codeine, others
Methylphenidate • Ritalin

Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Bottom Line

Be prepared to be asked for advice and prescriptions in casual settings. When this happens, it’s fine to provide general medical information, but it’s best not to give specific advice or engage in “casual prescribing.” You can maintain social connections, be caring, and avoid boundary violations by responding with tact, referral information, and good judgment.^19,20