Guest ral Posted June 30, 2017 Share Posted June 30, 2017 Well, not really. Let's say you have a close friend, who is not a patient of yours. Said friend needs a few days off of work. We're not talking short term disability here; just some recharging time. Maybe they come down with an acute viral gastroenteritis...wink, wink. Would you write a sick note for them? I know....ethics, blah, blah, blah, but seriously, is it a big deal in your mind? Link to comment Share on other sites More sharing options...
sas5814 Posted June 30, 2017 Share Posted June 30, 2017 In the big wide world of things it isn't a big deal. Selling your credibility is. I had a stroke patient in the nursing home who had been bed bound for a year and he asked me when he was going to be able to walk again and I had to tell him never. His wife got so mad and asked me why I told him that. My reply was simple... he has to trust I am going to tell him the truth. So doing it raises the slippery slope issue... at what point do you stop once you start this kind of thing? Link to comment Share on other sites More sharing options...
DizzyJ Posted June 30, 2017 Share Posted June 30, 2017 It may be no big deal at first, but then said friend(s) keep coming to you for BS and it may be difficult to say no. So, better not even start the trend. Link to comment Share on other sites More sharing options...
mgriffiths Posted June 30, 2017 Share Posted June 30, 2017 Personally, I believe medical ethics is a big deal and not something to say, "I know....ethics, blah, blah, blah, but seriously, is it a big deal in your mind?" Making up a diagnosis is fraud. Will you get caught, probably not, but that doesn't change the definition. You already know it is an ethics violation, so what's the question here? I had a patient who gave one of her lorazepam pills to her son because he was "really anxious." She thought it was ok because he was related. When I explained that she was now by definition a drug dealer she gasped and I had to explain why giving her pills (of any kind) was not only illegal but dangerous. You can twist it however you want, but if it fits the definition then that is exactly what it is. One of my "mottos:" if I feel like I have to ask whether something is ok ethically (or similar) I probably don't actually need to ask. Link to comment Share on other sites More sharing options...
Joelseff Posted June 30, 2017 Share Posted June 30, 2017 Whenever i get curbsided by friends and family, I always tell them that they should see their provider. They always respect that. Now they dont ask me...much lol Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted June 30, 2017 Share Posted June 30, 2017 2 minutes ago, Joelseff said: Whenever i get curbsided by friends and family, I always tell them that they should see their provider. They always respect that. Now they dont ask me...much lol I respond in this manner as well, and all I get is the GTH look as if I should be at their becon call. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted June 30, 2017 Share Posted June 30, 2017 I think about it like the internet. If my signature is on something - it can last forever. What if someday I become mentally stupified enough to run for public office or had to pass muster for a high level security position - COULD that come back to haunt me? It is more than stealing paper clips or taking home samples for family. Better to stop it in its tracks before it becomes a line crossed. Once you cross a line - hard to step back over. A colleague got cited by our state for rx'ing an inhaler for a family member. A crappy coworker turned her in as a vengeful act but it still remained that she rx'ed for family with no clinic note. She got a ding on her license, a $1000 fine and had to go to a class AND write a paper on ethics. She will have to answer that question on credentialing and licensing forms for the rest of her life. Was it worth it? I say - don't do it - set that boundary. Link to comment Share on other sites More sharing options...
sk732 Posted June 30, 2017 Share Posted June 30, 2017 Just don't do it...if they're a real friend, they'll respect you for it. If not, time to look for new friends... SK Link to comment Share on other sites More sharing options...
BruceBanner Posted June 30, 2017 Share Posted June 30, 2017 I wouldn't. When I was a newer grad I relished it when people would ask me for this stuff, but throughout your career you will be faced with people who want to use you for your medical license, and it quickly gets old. This includes employers, friends, and family. The way I see it is I am sticking my neck out for them and they just want a convenient favor. Usually once you tell them no they wont ask again. Plus this sort of "white lie" dishonesty can be a slippery slope. Link to comment Share on other sites More sharing options...
Guest ral Posted June 30, 2017 Share Posted June 30, 2017 Thanks to all who have responded so far. For the record, it was requested, and I haven't provided such at this point. Link to comment Share on other sites More sharing options...
LKPAC Posted June 30, 2017 Share Posted June 30, 2017 6 hours ago, ral said: Let's say you have a close friend, who is not a patient of yours. Just that statement alone is enough for me not to give them a note! If you're my friend, but don't come to me, get your damn note somewhere else! P.S. This whole scenario was once a Seinfeld episode :-) Link to comment Share on other sites More sharing options...
Zach Posted July 1, 2017 Share Posted July 1, 2017 I have a question related to this. What are the rules about prescribing to family members? One poster seemed to imply that is not allowed, but I definitely know of a doctor who prescribes his wife gout medication when in reality he's the one taking it. Seems like there are two violations there... Do rules about that vary by state? Link to comment Share on other sites More sharing options...
AliB Posted July 1, 2017 Share Posted July 1, 2017 It is not illegal to prescribe for a family member ... if you properly chart the encounter. It is illegal to prescribe for anyone knowing that it is being redirected, including back to the prescriber. It MAY be a violation of your contract depending on where you work. It IS usually considered ill-advised to prescribe for a family member OR a close friend as there is a significant risk that the patient in question will be even less forthcoming with information than even your typical patient about factors that related to their health, and that lack of knowledge impairs the prescriber. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted July 2, 2017 Share Posted July 2, 2017 Many corporate and larger practices have a POLICY that one may NOT treat family members NOR access their charts for any reason. I watched a clerk get fired on the spot for accessing her daughter's chart in an EMR - big brother had instant notification. Our malpractice carrier expressively advised us all to NOT treat family - NOT write Rx's even if charts noted. This was immediate family - spouse, children, parents, inlaws, siblings. I have treated a second cousin in an ER. Not the same name or anything - hardly knew each other. The person I knew called in an inhaler and something else was happening at work and a vengeful coworker of a different professional level called it in to the state. It wasn't a smart thing and no patient chart was made. It WAS not right. It happens more than we know. The practice I am leaving - the doc treats his own mom and puts labs in MY NAME. Let's go figure that one out - that actually plays a part in why I am leaving. Lots of hinky things that don't jive with me and would make our malpractice carrier run screaming. I firmly believe it is a good policy to NOT treat one's family or close friends if at all possible - don't poop where you eat and set some boundaries. One of my kid's pediatricians scoffed me for not writing a PE note for school about an injury and not ordering the X-ray. He is much older and that is how it worked in his day. I told him I had to stay 100% clean with my kids and would not order things. Still - my bottom line - my signature, my ethics, my integrity, my choices - they matter. If it sounds remotely like a bad idea - it probably is - kind of like skateboarding off the roof into the swimming pool - sounds awesome - ends poorly. Link to comment Share on other sites More sharing options...
BruceBanner Posted July 2, 2017 Share Posted July 2, 2017 On 6/30/2017 at 7:50 PM, Zach said: I have a question related to this. What are the rules about prescribing to family members? One poster seemed to imply that is not allowed, but I definitely know of a doctor who prescribes his wife gout medication when in reality he's the one taking it. Seems like there are two violations there... Do rules about that vary by state? The rules vary by state and contract. The unofficial truth is family prescribing is a common practice, but for routine, limited things like abx. Most docs I've known do it. Obviously prescribing controlled drugs to family or friends will get your license taken away. And in most institutions, accessing your own chart or your family's chart is INSTANT termination. I recommend you dont do it. Whenever I read my state's disciplinary bulletin, almost all infractions are prescribing-related. Usually inappropriate narcotics rx. Narcotics obviously are tracked and monitored, but there isnt some Big Brother Agency out there tracking every prescription every provider writes. Usually there is a whistle blower such as a pharmacist. Link to comment Share on other sites More sharing options...
sas5814 Posted July 2, 2017 Share Posted July 2, 2017 It has always been an "iffy" thing but generally (per my last reading of the AMA opinion) is barely tolerated for short term problems as long as there is documentation and medical decision making consistent with what anyone else would receive. Never OK for anything scheduled. Something changed here in Texas in the last couple of years as the pharmacists have basically refused to fill a prescription for a first degree relative one going so far as to tell a spouse it is "unethical". It has happened to several PAs and MDs I know including prescriptions for allergy meds which seems pretty simple. Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 2, 2017 Moderator Share Posted July 2, 2017 I would say if they are your patient - sure but since they are not your patient.... nope... Link to comment Share on other sites More sharing options...
sk732 Posted July 3, 2017 Share Posted July 3, 2017 My regulatory body allows prescribing for family members, but for emergencies only...and since my scripts always have an SP's name on it, I have to have some sort of documentation to cover their/my posterior. Funny thing about RC mentioning other folks ordering things under their name - I had a nurse hauled up on the carpet once for sending a lab test in for themselves under my name without my knowledge or consent...it almost resulted in an all out investigation by the College of RN's. It turns out that the person that had the practice before me tolerated stuff like that - this wasn't the first time they'd done it...but it was the last. I find it interesting that many people don't think that the ethics side of medical practice apply to them - it's very rare that I see disciplinary sanctions for incompetence, they're almost always ethical breaches (and sometimes outright Criminal Code violations). Makes you stop and think sometimes... SK Link to comment Share on other sites More sharing options...
Boatswain2PA Posted July 3, 2017 Share Posted July 3, 2017 On 6/30/2017 at 7:37 AM, ral said: Well, not really. Let's say you have a close friend, who is not a patient of yours. Said friend needs a few days off of work. We're not talking short term disability here; just some recharging time. Maybe they come down with an acute viral gastroenteritis...wink, wink. Would you write a sick note for them? I know....ethics, blah, blah, blah, but seriously, is it a big deal in your mind? It is disturbing that you would even consider this. You would be lieing, even as you wink. That used to be a clear-cut wrong thing to do. Truth, ethics, the American way.....yeah, it's a big deal. Link to comment Share on other sites More sharing options...
TWR Posted July 4, 2017 Share Posted July 4, 2017 Better not to start a bad habit that (always) escalates. I have told my family and friends that I won't do it. In an emergency? Hasn't happened. Any thing that involves my ethics in medicine I take seriously. What would they do if you were not in medicine? Link to comment Share on other sites More sharing options...
welkins Posted July 4, 2017 Share Posted July 4, 2017 I am not going to lie and damage my credibility for a friend or a patient or an employer. Anyone who feels its ok to ask is telling much more than they realize about their character and I would question if they are truly a friend or an opportunist. The answer is simply no and if they don't understand, oh well. Link to comment Share on other sites More sharing options...
Guest Paula Posted July 4, 2017 Share Posted July 4, 2017 Prescribing to family and friends can be outside of the PA scope depending on state laws. I never do it and do not write any notes or prescriptions for family or friends. I do give medical guidance to family who call (usually my kids or nieces/nephews/ and my siblings) and they know is is not a diagnosis of what I tell them. My final words are: Go see your medical provider, and please pick a PA if you have no provider. With electronic records it is nearly impossible to prescribe or write a work note as the EHR requires one to log in and put the patient in context. In my system, if they are not registered as a patient or registered as actually being at the clinic, I can't write a script or work note. Plus, we no longer keep any paper script pads around for anyone to snag and take home with them.... if any are tempted. Link to comment Share on other sites More sharing options...
Zach Posted July 4, 2017 Share Posted July 4, 2017 Thank you very much for the input! I appreciate everyone taking the time to type out their responses. 1 hour ago, Paula said: Prescribing to family and friends can be outside of the PA scope depending on state laws. I never do it and do not write any notes or prescriptions for family or friends. I do give medical guidance to family who call (usually my kids or nieces/nephews/ and my siblings) and they know is is not a diagnosis of what I tell them. My final words are: Go see your medical provider, and please pick a PA if you have no provider. With electronic records it is nearly impossible to prescribe or write a work note as the EHR requires one to log in and put the patient in context. In my system, if they are not registered as a patient or registered as actually being at the clinic, I can't write a script or work note. Plus, we no longer keep any paper script pads around for anyone to snag and take home with them.... if any are tempted. Paula - I believe I saw that you're in Wisconsin? That's where I'm at. Ethics and good medicine aside, is prescribing to family and friends outside of the PA scope of practice here? Link to comment Share on other sites More sharing options...
Guest Paula Posted July 19, 2017 Share Posted July 19, 2017 On 7/4/2017 at 11:04 AM, Zach said: Thank you very much for the input! I appreciate everyone taking the time to type out their responses. Paula - I believe I saw that you're in Wisconsin? That's where I'm at. Ethics and good medicine aside, is prescribing to family and friends outside of the PA scope of practice here? I would say yes if you have not seen them as a patient, documented in their chart and they get billed for your services. You can check out the WI DSPS site. You can search for discipline orders (against any type of provider) and see what the MEB has disciplined PAs for. Some is for prescribing for family w/o any documentation of a note. I regularly check it and then it reminds me to stay focused and think about patient safety and to not ever get disciplined. Not a fun time for anyone. Link to comment Share on other sites More sharing options...
DizzyJ Posted July 19, 2017 Share Posted July 19, 2017 4 hours ago, Paula said: I would say yes if you have not seen them as a patient, documented in their chart and they get billed for your services. You can check out the WI DSPS site. You can search for discipline orders (against any type of provider) and see what the MEB has disciplined PAs for. Some is for prescribing for family w/o any documentation of a note. I regularly check it and then it reminds me to stay focused and think about patient safety and to not ever get disciplined. Not a fun time for anyone. Being out of your scope of practice is working in ortho and treating your family member for diabetes. Treating family members/friends is an ethical issue and in some states a legal issue. You can be disciplined by your licensing authority for ethical violations. You can be disciplined by your employer as well. if you are FP, IM, ER and treat a family member for cellulitis then you are not outside your scope of practice, but have an ethical issue. Link to comment Share on other sites More sharing options...
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