Maverick87 Posted August 6, 2016 Share Posted August 6, 2016 Most places I've worked in, you're only allowed access to your file under someone else's scrutiny...same with family members. When I was military, when we had paper charts, they were kept in the Base Senior Medical Officer's office or that of their AA. If we wanted to see it, we made an appointment and went over it with them. When we went electronic, same same - if I accessed my own or (like happened once to me by accident) my wife's chart, it was flagged and I'd get dragged up on the carpet to explain myself.,,and did once due to the accidental look see when I was covering the charts of a deployed buddy of mine. I've dragged a few people up on the carpet for it as well - it's considered a breach of trust, and can actually affect your security clearance, and since it's a direct order that's in fact legal (even under our wishy washy Constitution) and in black and white on the form you sign to get the EMR account, persons could be charged under the National Defence Act (read Article 15 or worse under the UCMJ). The College here has it written out in black and white about prescribing for self and for family/close friends. Family and close friends only if an emergency. SK Seriously? Wow. I just got out and, honestly, I didn't even know that looking at my own chart was wrong literally until I read this thread minutes ago. I did it constantly and never had any issues. Maybe it's base or service dependent? Link to comment Share on other sites More sharing options...
Reality Check 2 Posted August 6, 2016 Share Posted August 6, 2016 SK is Canadian Military.... The reason to get into one's own chart via a portal is that you cannot change data in the portal. Changes can be made thru regular EHR access and there is no lock for that. Every access leaves a digital footprint and trail and some things can be deleted. I still think we should stay above board and keep a standard of being good patients and providers. Link to comment Share on other sites More sharing options...
Maverick87 Posted August 6, 2016 Share Posted August 6, 2016 SK is Canadian Military.... The reason to get into one's own chart via a portal is that you cannot change data in the portal. Changes can be made thru regular EHR access and there is no lock for that. Every access leaves a digital footprint and trail and some things can be deleted. I still think we should stay above board and keep a standard of being good patients and providers. True, but I didn't realize that it was a "bad" thing to do. So it wasn't like I was trying to do a work-around. Besides, with AHLTA, you can't make changes in your notes without it being logged. Link to comment Share on other sites More sharing options...
Moderator ventana Posted August 6, 2016 Moderator Share Posted August 6, 2016 so mechanics should not be allowed to fix their own cars, janitors should not be allowed to clean their own houses, and police should not be able to protect their own families?, give me a break, more liberal socialism at work If you think that we're just like a mechanic you have something misaligned in your perception of what a PA does. No one is saying that you can not prescribe/treat in a life threatening emergency so you police example is invalid - as well the police example you provided is very accurate if you provide a real example - should a police officer investigate a family members legal violations - as I work in law enforcement (corrections) I can tell you that family members or even close friends are not allowed to partake at this level ever (at least in my facility) I am unable to see how this has anything to do with anything about liberal or socialism.... In fact this is called regulating our own profession and the product that we provide to society as point of personal pride. No politics here... Link to comment Share on other sites More sharing options...
sk732 Posted August 6, 2016 Share Posted August 6, 2016 so mechanics should not be allowed to fix their own cars, janitors should not be allowed to clean their own houses, and police should not be able to protect their own families?, give me a break, more liberal socialism at work I've never seen a mechanic who's worked on their own car...mind you if they did, I'm willing to bet that they certainly wouldn't be allowed to certify it as road worthy if it's their own vehicle. Food for thought. Maverick, Canadian Forces Security Orders are pretty strict when it comes to personal/personnel records. Any one can have access to the information, as it is in fact their own, however, the files themselves actually belong to the CF (just as medical charts in your office are the property of the practice) and so they have access controls in place. Not sure what the US military is like, since I've only worked with them on a causal basis - mainly trading medical supplies with each other or dropping off/picking up sickies and sickos. SK Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted August 7, 2016 Moderator Share Posted August 7, 2016 I guess it varies in different practice settings. When I was in the military, we free prescribed each other medications without documentation, I frequently accessed my own chart, and I even (accidentally) prescribed myself eye drops before. It's interesting to see that all of this would be a no-go in the civilian world. Good to know early since a situation like this hasn't come up yet. Right? We do this stuff all the time. My hospital pharmacy has a memo for new arrivals that specifically says that we can prescribe to family members uncontrolled Rx meds. Link to comment Share on other sites More sharing options...
Moderator ventana Posted August 7, 2016 Moderator Share Posted August 7, 2016 https://www.theguardian.com/news/2016/aug/04/perils-being-your-own-doctor-als?CMP=share_btn_link Sums it up Link to comment Share on other sites More sharing options...
Guest JMPA Posted August 7, 2016 Share Posted August 7, 2016 If you think that we're just like a mechanic you have something misaligned in your perception of what a PA does. No one is saying that you can not prescribe/treat in a life threatening emergency so you police example is invalid - as well the police example you provided is very accurate if you provide a real example - should a police officer investigate a family members legal violations - as I work in law enforcement (corrections) I can tell you that family members or even close friends are not allowed to partake at this level ever (at least in my facility) I am unable to see how this has anything to do with anything about liberal or socialism.... In fact this is called regulating our own profession and the product that we provide to society as point of personal pride. No politics here... i don't mind providing "special" examples for you. How about a Veterinarian treating his pet dog? A soldier defending his own family? an electrition wiring his own home? a lawyer representing a family member in court? a chef cooking his own dinner? an accountant doing his own taxes? a fireman extinguishing a fire at his inlaws? do you need more? Link to comment Share on other sites More sharing options...
quietmedic Posted August 8, 2016 Share Posted August 8, 2016 Thanks for all the thoughts. Some more of my two cents... It's strange to me that something that should be so straight forward -- i.e., either yes or no -- is so murky. I find the concept of "legal but ethically problematic" a bit strange. I can't think of too many definitive things that a medical provider can do, in typical practice, that are unethical but legal, present discussion aside; medical ethics is strongly present in the gray areas that really crossover into philosophical/spiritual questions ("when does life start" when does life end"; life support issues; and the like), but questions of objectivity...honestly, I see these as fairly clear cut, legally. If your own parent is begging you for oxycodone, or your boss demands you prescribe to him or he fires you....that sure is a lot of pressure...but if it's medically justified, then so what? It's legal. And if it's not, if it is inappropriate treatment, it's malpractice, and illegal. I don't see a gray ethical area here. Just a legal question. Furthermore, about the idea of treating self and family in general...we are trusted to make decisions about strangers, or perhaps people somewhat familiar to us, but suddenly when a family member walks in, it is assumed we lose all common sense and lose our backbone? If we are trusted as professionals, then we should be trusted. Controlled substances aside, If I think my kid has an ear infection, I don't see where the ethical problem lies. Just as with any patient, if I think ABX are appropriate, then that's my clinical gestalt. If I think they are not appropriate, then I certainly wouldn't want my child to develop antibiotic resistance, and I wouldn't prescribe it. If my signif other may leave me unless I prescribe them Bactroban, then...I think there are bigger issues that have to be dealt with, likely urgent psych assessment. (And then again it would be quite impressive if they figured out a way to abuse Bactroban...) Certainly concerning myself, the same would hold true. Specifically, putting controlled meds aside, it's highly unlikely I'd suddenly have the urge to start abusing amoxicillin and Zofran, and to my knowledge, the black market for albuterol and 2.5% hydrocortisone cream is not sizable. I'm a bit lost to imagine how this would really be a legal or ethical concern. Yeah, maybe I will prescribe myself a hundred tablets of synthroid and sell it to my bodybuilder friend to abuse, but then again I could just as well write him (or her, I suppose) the script. It would be the same legal exposure. Sure, I could be mailing lots of self-prescribed amlodipine to a cousin in Russia, but...again, it would be an odd thing to risk my license for, and something they could get for themselves fairly easily. Granted, in this paragraph, depending on the state, I'm fighting city hall; not any previous commenters. Yet it does boggle me why it should be an issue. I understand for police, to investigate family, there would be a real dilemma...but that sort of matter is a course of action which may determine someone's freedom or life, not determine if they will have some diarrhea relief for a few days. Even the concept of "an established/genuine patient-doctor relationship" seems vague, as I mentioned. If I go to Urgent Care once, the provider may never see me again, but they can prescribe me a medication. I don't call that an established relationship. Family should be no different; If I do a history, do a physical, and write a full chart, then I have done my part and established a medical relationship. If they withhold information out of embarrassment, or what have you, it's their problem. It was their free choice to come to me as a provider, and they could just as well have left out pertinent facts (or outright lied) to another provider. The onus is on them, not me. No different than any other patient. Perhaps I'm playing a bit of devil's advocate, but I definitely want to raise the issues that others here have also echoed, many of which I too am unclear about. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted August 8, 2016 Share Posted August 8, 2016 I appreciate the discussion and evidence of sorts. I still won't do it. One of absolute favorite adages: Just because you CAN do something doesn't mean you SHOULD. Applies to many facets of life and society. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted August 8, 2016 Administrator Share Posted August 8, 2016 One of the challenges in treating friends and family is that if you're just somebody's medical provider, you have no other relationship with your patient, and nothing to jeopardize by them either lying to you or telling you the truth. That is, your spouse may be reluctant to admit to you as a provider that they have been engaging in extracurricular sexual recreation not involving you. An extreme example, of course, but one that illustrates something people would be reluctant to tell their spouse, but not particularly reluctant to tell their provider. Oh sure, in a small town, they may have to look you in the eye when you run across each other in the local grocery store, but that's not the same as an existing, important interpersonal relationship that could be damaged depending on how truthful the patient is with his or her provider. Link to comment Share on other sites More sharing options...
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