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Hi everyone,

 

This has been an ongoing debate with some people so I thought I'd get some input.  I know of some people that will write for an antibiotic for a spouse or a family member during flu season, or an anti-inflammatory short term.  I don't know of anyone that has ever written for narotics, etc. My question is what are your views on writing a script for an abx, or even a short physical therapy script, for a spouse/family?

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If they have the flu or other viral illness, they dont need antibiotics.

Prescription strength antiinflammatories are achievable through taking 3-4 otc advil 3 times a day.

State medical board will tell you that every script should be tied back to documentation including the indication, consideration of impact on chronic conditions, interaction with current meds and ensuring patient allergies.

Ethically should not take care of family members or close friends. Too much conflict.

Dont fall prey to coworkers requests.

Outright refuse requests for controlled substances from family and friends.

The correct process put in place is there to protect the patient and also protect you. 

Prescribers have been censured, suspended and lost licenses over improper prescribing.

When what was initially a simple favor has some sort of poor outcome, the insight gained into the risk associated with that practice is realized.

Dont do it.

G Brothers PA-C

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I am not answering this on a legal front. I do not have a great answer to that question. I knew one PA who documented in a chart when he helped a friend out w a lower back MSK injury non narcotic mgmt plan.

 

I do not think it is unethical or unprofessional to treat a close friend or family member with a suspected flu provided you have given them an evidence based approach which includes proper exam and testing. However anything beyond a simple straightforward infection of this sort has other implications. However, as I write this I wonder though is anything straight forward ? 

 

Whenever I hear someone say "its just the flut" in this context of this proposed scenario I am reminded of my patients who have recently used IV drugs or unprotected sex and are actually presenting primary HIV infection or endocarditis. My friends and family might not be as open with these issues as a patient would be.  

 

Medication that is controlled is NEVER an option IMO.

 

PT brings up the legal issue. Did you do everything necessary to determine an insurance company should purchase PT for the patient ? What if they ask to see your records / exam?

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I did not mean 'flu' like someone prescribed amoxicillin for a virus. I just meant the season in general. No one has pressured me personally to do anything; this is merely a good discussion point, I think.  Like if I was an ortho PA/physician, why would I want to send my son/ husband to another provider for an ankle sprain when I can send to PT myself.....or if I specialized in ENT and a family member had a problem I dealt with every day.... that was the basis of the question. Social Medicine brought up a great point I think in that what if insurance asked to see an exam dictation if they were deciding whether to cover it?  I also agree that narcotics should NEVER be written in the scenarios.

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For routine stuff and non-recurring prescriptions, yes, it's generally fine.

 

For ANY controlled substance or "weird" drug (something you would see a specialist for), no. 

 

That's the AAFP's position. Most states have their own legal language but there is room for interpretation. I have never heard of a provider getting into trouble for giving their spouse an rx for a non-controlled drug, again as long as it's not on an ongoing basis. Pretty much every physician does it.

 

 

Now, if there is an adverse event and it was found you had no provider-patient relationship with this person, you could get into trouble. So just be cautious. And it bears repeating---NEVER a controlled drug.

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I'm not even sure I could. I don't have a prescription pad, and I am legally prohibited from entering my husband's medical chart to e-prescribe something. I suppose I could call it in. Seems like just as much work as sending him to express care, though, and I wouldn't have to deal with the pharmacist's raised eyebrow. You can hear a raised eyebrow over the phone, you know.

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I run a headache clinic. My wife developed migraines a few years ago.  I listened as a compassionate husband but would not touch or interfere with her treatment with a ten foot pole. I told her to go to her PCP. I would never, ever write her a Rx for anything . . . unless we were living on a deserted island or in the third world and there were no other choices.  

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I run a headache clinic. My wife developed migraines a few years ago.  I listened as a compassionate husband but would not touch or interfere with her treatment with a ten foot pole. I told her to go to her PCP. I would never, ever write her a Rx for anything . . . unless we were living on a deserted island or in the third world and there were no other choices.  

 

 

ditto

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Guest Paula

I run a headache clinic. My wife developed migraines a few years ago.  I listened as a compassionate husband but would not touch or interfere with her treatment with a ten foot pole. I told her to go to her PCP. I would never, ever write her a Rx for anything . . . unless we were living on a deserted island or in the third world and there were no other choices.  

 

There would be no pharmacies on a  deserted island.   LOL! If you lived on a deserted island, it wouldn't be deserted anymore because you are living on it.

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Guest Paula

Another question:  A fellow employee needs a lab test and they don't want to register as a patient to see you because of the $3000 deductible.  Do you order it?  If so, are you committing theft against your employer because there is now a record, but no way to bill for the service, especially if you end up writing a script for a UTI, for example? 

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Another question:  A fellow employee needs a lab test and they don't want to register as a patient to see you because of the $3000 deductible.  Do you order it?  If so, are you committing theft against your employer because there is now a record, but no way to bill for the service, especially if you end up writing a script for a UTI, for example? 

Do you order it? No.

Committing theft? You definitely will be viewed negatively by your employer if discovered. Could be a breach of your contract and cause for termination.

3k deductible? I have a 5k deductible so I dont have much sympathy. But that qualifies for a high deduct plan and should have an HSA they can contribute to. I would encourage them to do so.

My fast and hard rule that I do now is that I tell anyone I am a supervised clinician and according to state law everyone I see has to be registered in the ED, charted on and billed. Otherwise my license is in jeopardy. Plus I am an employee and not owning my practice.

If that supervision thing ever changes, I would still use the same line.

This is a slippery slope and not maintaining proper medical records is a real issue with the state medical board.

Just dont go there.

GB PA-C

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Writing a prescription for ANYONE - spouse, neighbor, friend, whatever WITHOUT documentation that they are a patient of your clinic puts your license and DEA on the line.

 

Don't know why anyone would risk this.

 

Your DEA is only on the line if you improperly or illegally prescribe controlled drugs. The DEA does not monitor other Rx drugs.

 

No state medical board has the time or the resources to monitor every provider's prescribing. There isn't someone out there sitting in a cubicle reviewing your entire prescribing history. There has to be a reason, like a complaint or a licensing issue that could provoke an audit into your practice habits. Just look at the DEA's "cases against doctors" or your state board's legal news. People that get into trouble are flagrantly breaking the law or doing unethical things, usually repeatedly.

 

In the grand scheme of risk prescribing an acute, common, non-controlled drug for friend or family is very very low on the scale. It shouldn't be done routinely or abused, but in most cases it's benign.

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I've mentioned this before. I get the Washington State Quality Medical Assurance newsletter (quarterly) and in it they list all disciplinary actions.  Each time 2-6 PAs are punished.  Almost every single one is for writing prescriptions for family, co-workers or colleagues (or friends) with no documentation.  While the physicians are usually disciplined for sexual misbehavior. 

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Guest Paula

@GB: I got caught off guard and had a request similar to above.  The nurses can order the test if ok'd.   I documented the encounter when I wrote the script and it all went into the medical record.  The exam was just getting the history,etc.   

 

I asked later if other practitioners get curbsided by co-workers and it seems that some do including the physicians.  Afterwards I regretted doing it and do not want to be an easy target. I've already decided I won't again since I definitely do not want to ever find my name in the medical board discipline list.   

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Out of curiosity I spent some time combing through my state's medical board disciplinary records. There were, of course, PA's who were admonished or disciplined. However, out of the 30-40 cases I looked at, almost all were for the following reasons:

 

Criminal charges (DUI, DV, drug charges, etc)

Personal health or psych conditions making one unfit to practice

Improper prescribing of CONTROLLED drugs (i.e. to friends and family, poor documentation, or liberal prescribing like early refills, etc.)

Inadequate documentation of exam findings or plan (a complaint or adverse outcome usually flagged this)

Practicing without a supervising physician on record, knowingly or unknowingly.

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I've mentioned this before. I get the Washington State Quality Medical Assurance newsletter (quarterly) and in it they list all disciplinary actions.  Each time 2-6 PAs are punished.  Almost every single one is for writing prescriptions for family, co-workers or colleagues (or friends) with no documentation.  While the physicians are usually disciplined for sexual misbehavior. 

 

But now we're getting into two separate issues: writing scripts for family members, and lack of documentation.  The OP asked if it was okay to write scripts for family members, not if it was okay to not document it.  I would not hesitate to write a script for my wife or kids, for an acute condition, not counting controlled meds or anything that could be used recreationally or with high abuse potential.  But I would also make sure I wrote a note on them.  I don't see what the big deal is.

 

In practice, though, it's probably  just as easy for them to see their PCM, unless there were no appointments available for some reason.

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I will not write for my wife or kids.  I understand why people would,and don't think that it's always inappropriate, but that is just toooooo close to home for me.  I will write simple things (tessalon, topical creams, epi pens, some abx) for other family and close friends.  The next time I'm in the ED I write a note and send it to medical records...which totally confuses them. 

For my wife and kids I call a colleague which allows someone else to get a "gut check" on the situation.  I've never had a colleague say "no, I would want to see them first"...but it allows for that extra opportunity to break an error chain in a situation fraught with potential problems. 

 

Obviously never narcotics, and I don't do chronic meds for anyone. 

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Guest Paula

While I have not written a prescription for husband or kids, I have used drug samples in the past for simple things like fluconazole, albuterol inhaler, or a starter pack of a medication that was prescribed by another clinician and the sample was soon to outdate.   That was in the past when I worked at an FQHC but my new practice does not have a drug closet. 

 

I do provide text pictures and messaging medical advice to direct family members when they send me pics of their rashes, red eyes, blisters in the throat or send  pictures of the medication bottles and antibiotics they have left over from previous prescriptions.  I tell them, yup ok to use, or nope, don't use.  

 

So far my kids, sisters , nieces and nephews  haven't sued me.  

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While I have not written a prescription for husband or kids, I have used drug samples in the past for simple things like fluconazole, albuterol inhaler, or a starter pack of a medication that was prescribed by another clinician and the sample was soon to outdate.   That was in the past when I worked at an FQHC but my new practice does not have a drug closet. 

 

I do provide text pictures and messaging medical advice to direct family members when they send me pics of their rashes, red eyes, blisters in the throat or send  pictures of the medication bottles and antibiotics they have left over from previous prescriptions.  I tell them, yup ok to use, or nope, don't use.  

 

So far my kids, sisters , nieces and nephews  haven't sued me.  

 

I haven't myself, but I have no problems writing for simple things and I am sure I will at some point.  FWIW, I would almost never provide advice based on phone pictures, esp. a red eye unless maybe there was a slam dunk history to go with it, but even then...  Maybe it's just because I' m a newb.

 

I love the left over antibiotics thing.  First thing I always ask is, why do you have left over antibiotics???? :)

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