Is This a Trend for PAs? If So, How Can We Fix It

[jmj11]

I just finished reading the Washington state quality medical assurance report for the quarter. Normally there are about 10 physicians disciplined and maybe one PA now and then. This time they had six cases involving PAs, four for prescribing meds for people they weren't following . . . family and friends without seeing them professionally or documenting the Rx. The other two were not being supervised by the SP per the state agreement. In one case the SP had not been on site in two years. Maybe PA schools should step up their lectures on these topics not to give the profession a black-eye.

[SocialMedicine]

a PA cannot prescribe a medication for a patient that he does not evaluate formally in office ? for example (not that I do this) if a friend had shingles or something and I wanted to get him/her started on an antiviral before they could be evaluated by his/her PCP. I can see controlled substances being an entirely different issue .... or assisting in the management of mental health or chronic issues.

[ventana]

a PA cannot prescribe a medication for a patient that he does not evaluate formally in office ? for example (not that I do this) if a friend had shingles or something and I wanted to get him/her started on an antiviral before they could be evaluated by his/her PCP. I can see controlled substances being an entirely different issue .... or assisting in the management of mental health or chronic issues.

best to decline

 

if you want to write you had been get them to sign a release and consent and make a chart - even some notes just to prove what you thought and did.

 

I have recently been calling their PCP and talking to them about what I see and letting them write the script....

[EMEDPA]

a PA cannot prescribe a medication for a patient that he does not evaluate formally in office ? for example (not that I do this) if a friend had shingles or something and I wanted to get him/her started on an antiviral before they could be evaluated by his/her PCP..

correct. by the letter of the law a pa can not write an rx that their sp is unable to become aware of. delegated practice, remember?

if you were willing to create a chart note and put it on file that would be ok.

(as you noted this is really more of an issue for narcs...chances are they will not bust down your door for writing a z-pak once for your cousin with bronchitis however I just read the report and one of the PAs cited was tagged for writing an mdi and an abx...)

[Teasip]

Illegal to do so in Texas for a non-established pt., or one that can not be reasonably expected to be seen in office. Best approach, don't do it. I've noted the same trend in the TMB newsletters; more PA's listed, usually for lack of documentation.

[Guest Paula]

It behooves all of us to know our state law and practice within those parameters. I decided at the start of my career that I would not write a prescription for any patient or family member or neighbor without seeing them. My law requires my name, my SPs name on the prescription bottle. I purposely do not keep any script pads at my home, in my purse or tote bag. It could be tempting.

 

Now that I've said all this, I did once fill out a form for a handicapped parking sticker for my then soon to be son-in-law, who is in a wheelchair. It was for his driver (my daughter) and they could not get in to see his provider. He cannot drive. So, I broke my own rule, and felt terribly guilty, and then said when this is due for renewal, you have to see your own doc.

 

Whew, got that off my chest. Confession is good for the soul.

[Guest Paula]

It behooves all of us to know our state law and practice within those parameters. I decided at the start of my career that I would not write a prescription for any patient or family member or neighbor without seeing them. My law requires my name, my SPs name on the prescription bottle. I purposely do not keep any script pads at my home, in my purse or tote bag. It could be tempting.

 

Now that I've said all this, I did once fill out a form for a handicapped parking sticker for my then soon to be son-in-law, who is in a wheelchair. It was for his driver (my daughter) and they could not get in to see his provider. He cannot drive. So, I broke my own rule, and felt terribly guilty, and then said when this is due for renewal, you have to see your own doc.

 

Whew, got that off my chest. Confession is good for the soul.

[EMEDPA]

for starters probably best to not write rxs for folks with the same last name as you, that is just asking for trouble.

Rx for Jane Doe, prescriber John Doe, pa-c is likely a read flag....and never write an rx for anything controlled without a chart....

one of the PAs in the report above wrote for narcs and lost their license...the one who wrote abx and mdi got probation, an ethics course and a 1000 dollar fine...

[EMEDPA]

for starters probably best to not write rxs for folks with the same last name as you, that is just asking for trouble.

Rx for Jane Doe, prescriber John Doe, pa-c is likely a read flag....and never write an rx for anything controlled without a chart....

one of the PAs in the report above wrote for narcs and lost their license...the one who wrote abx and mdi got probation, an ethics course and a 1000 dollar fine...

[OpSite]

for starters probably best to not write rxs for folks with the same last name as you, that is just asking for trouble.

 

Super hard if one's sir name is extremely common........................

[OpSite]

for starters probably best to not write rxs for folks with the same last name as you, that is just asking for trouble.

 

Super hard if one's sir name is extremely common........................

[EMEDPA]

Super hard if one's sir name is extremely common........................

I didn't mean legitimate patients, I meant your spouse/kids/extended family.....if jane doe saw john doe in the clinic it's not a problem

[EMEDPA]

Super hard if one's sir name is extremely common........................

I didn't mean legitimate patients, I meant your spouse/kids/extended family.....if jane doe saw john doe in the clinic it's not a problem

[Gordon, PA-C]

Illegal to do so in Texas for a non-established pt., or one that can not be reasonably expected to be seen in office. Best approach, don't do it. I've noted the same trend in the TMB newsletters; more PA's listed, usually for lack of documentation.

 

 

I'm going off on a tangent here, but arcane/stupid rules like this are why telemedicine will never become a major force.

[Gordon, PA-C]

Illegal to do so in Texas for a non-established pt., or one that can not be reasonably expected to be seen in office. Best approach, don't do it. I've noted the same trend in the TMB newsletters; more PA's listed, usually for lack of documentation.

 

 

I'm going off on a tangent here, but arcane/stupid rules like this are why telemedicine will never become a major force.

[A1CAMERON]

I think it's as simple as ethics and professionalism: why would any healthcare provider write an Rx for someone they didn't evaluate? Especially not documenting. It would be, among other things, unethical to not fully evaluate a patient when an Rx is given- it simply puts the patient at risk. Even with something as "benign" as abx.

 

And really, a lot of us cannot truly impartially evaluate and prescribe for family members. We have too much invested in the "relationship" to neutrally care for them.

 

With so much experience of seeing the same things day in and day out we can become complacent; that moment of complacency is when we get our a**es handed to us.

 

Let me finish by saying that is not always the case.

[A1CAMERON]

I think it's as simple as ethics and professionalism: why would any healthcare provider write an Rx for someone they didn't evaluate? Especially not documenting. It would be, among other things, unethical to not fully evaluate a patient when an Rx is given- it simply puts the patient at risk. Even with something as "benign" as abx.

 

And really, a lot of us cannot truly impartially evaluate and prescribe for family members. We have too much invested in the "relationship" to neutrally care for them.

 

With so much experience of seeing the same things day in and day out we can become complacent; that moment of complacency is when we get our a**es handed to us.

 

Let me finish by saying that is not always the case.

[jwells78]

I think it's as simple as ethics and professionalism: why would any healthcare provider write an Rx for someone they didn't evaluate? Especially not documenting. It would be, among other things, unethical to not fully evaluate a patient when an Rx is given- it simply puts the patient at risk. Even with something as "benign" as abx.

 

And really, a lot of us cannot truly impartially evaluate and prescribe for family members. We have too much invested in the "relationship" to neutrally care for them.

 

With so much experience of seeing the same things day in and day out we can become complacent; that moment of complacency is when we get our a**es handed to us.

 

Let me finish by saying that is not always the case.

 

 

Ahhh, the curbside eval. If you are a student and don't know what that is- you will soon. Unless you work in IR or something. My question is for the vets on here: who hasn't been asked by a peer to write a script for their family member? Or by a coworker to evaluate their wrist pain/neck pain/cough (albeit not a documented pt encounter)? I know for all the ED guys out there- it happens ALL THE TIME. Where do you draw the line so you don't find yourself sliding down the slippery slope on a plastic tobaggan?

 

It's not "mean" to say no, if you explain why you don't feel comfortable doing it. Who wants to get fined a grand for an albuterol script???!? Seriously???

 

-J

[jwells78]

I think it's as simple as ethics and professionalism: why would any healthcare provider write an Rx for someone they didn't evaluate? Especially not documenting. It would be, among other things, unethical to not fully evaluate a patient when an Rx is given- it simply puts the patient at risk. Even with something as "benign" as abx.

 

And really, a lot of us cannot truly impartially evaluate and prescribe for family members. We have too much invested in the "relationship" to neutrally care for them.

 

With so much experience of seeing the same things day in and day out we can become complacent; that moment of complacency is when we get our a**es handed to us.

 

Let me finish by saying that is not always the case.

 

 

Ahhh, the curbside eval. If you are a student and don't know what that is- you will soon. Unless you work in IR or something. My question is for the vets on here: who hasn't been asked by a peer to write a script for their family member? Or by a coworker to evaluate their wrist pain/neck pain/cough (albeit not a documented pt encounter)? I know for all the ED guys out there- it happens ALL THE TIME. Where do you draw the line so you don't find yourself sliding down the slippery slope on a plastic tobaggan?

 

It's not "mean" to say no, if you explain why you don't feel comfortable doing it. Who wants to get fined a grand for an albuterol script???!? Seriously???

 

-J

[Guest Paula]

I get requests from coworkers for curbside consults. I always say, " I don't have a problem renewing your blood pressure medication as long as we pull a patient encounter form, your blood pressure is documented, and I do an exam. I will dictate the note." If they are agreeable, we do the quick consult and exam and I write the script. In our clinic (paper charts) we can get away with this and not bill for it. Once we are up and running with EHR the free stuff from me will end. It is not often, tho that this happens. They can get it from the doc with no questions asked.

[Guest Paula]

I get requests from coworkers for curbside consults. I always say, " I don't have a problem renewing your blood pressure medication as long as we pull a patient encounter form, your blood pressure is documented, and I do an exam. I will dictate the note." If they are agreeable, we do the quick consult and exam and I write the script. In our clinic (paper charts) we can get away with this and not bill for it. Once we are up and running with EHR the free stuff from me will end. It is not often, tho that this happens. They can get it from the doc with no questions asked.

[Guest Paula]

^^^^^^^

And may I add: No documentation or exam done either.

[Guest Paula]

^^^^^^^

And may I add: No documentation or exam done either.

[ToppDog]

So, in your opinions, would the increase in this be more from the schools not spending as much time on this topic, or from schools increasingly accepting students with less or lower quality HCE? Or do you have other thoughts?

[ToppDog]

So, in your opinions, would the increase in this be more from the schools not spending as much time on this topic, or from schools increasingly accepting students with less or lower quality HCE? Or do you have other thoughts?