Can You Prescribe for Yourself – Overview
As a doctor, if you have a cough and you feel a fever coming on with shortness of breath, what do you do? Do you self-prescribe antibiotics, order a chest X-ray, consult a colleague, or simply visit a regular physician?
It sounds tough to decide if treating yourself, your family, and your friends is right. As with medical regulations, you should also have guidelines to help you make this decision.
According to reports, a significant number of physicians admit to treating family, friends, and themselves with antibiotics, contraceptives and antihistamines. However, this practice makes it harder to deny care to that person in the future.
Although several ethical and legal guidelines regulate self-prescription, physicians have much grey area to interpret.
Besides this, factors such as the need for a diagnostic test, the severity of the medical condition, the requested treatment and convenience also matter.
This article is meant to help you consider this issue and increase your awareness of how other physicians work.
This article is meant to enhance your knowledge of legal and ethical guidelines regulating self-prescription and prescribing for family, friends, and colleagues.
Prescribing Outside of the Office
Can you prescribe for yourself – Prescribing Outside of the Office
Treating oneself and non-patients, such as relatives, friends, colleagues, etc., without proper documentation is common in the US.
Reports show that the percentage of physicians self-prescribing can range between 52% and 84%. Treating non-patients is even more prevalent, with some reports showing that nearly 100% of physicians engage in it.
Contraceptives, antibiotics, and antihistamines are the most commonly self-prescribed medications in the United States.
Several ethical guidelines dictate the terms for prescribing to non-patients, but not many physicians know them.
Section E-8.19 of the AMA Code of Medical Ethics advises against physicians treating themselves or immediate family members to avoid compromising professional objectivity, but it acknowledges exceptions under certain circumstances.
Exceptions are provided for ‘minor, short-term problems’ or ‘in isolated or emergency settings.
The ACP Ethics Manual advises physicians to avoid treating themselves or close relations to maintain professional boundaries and objectivity.
Further, it states that “physicians should be very cautious about assuming the care of closely associated employees.”
Some state medical boards go further. North Carolina’s medical board guidelines recommend maintaining proper records for treatments, reflecting best practices rather than specific medical ethics laws.
Virginia Board of Medicine regulations emphasize the importance of maintaining records for all prescriptions and drug administrations, which is intended to ensure patient safety and continuity of care.
Besides this, some insurance companies, including Blue Cross Blue Shield and Medicare, prohibit payments for care that physicians provide to immediate family members, even if the care is provided in a clinical setting.
Legal and Ethical Aspects of Self-Prescription
Several legal considerations and laws need to be considered when determining whether to treat yourself or non-patients.
A physician-patient relationship is established once the physician treats a patient. Henceforth, the physician is responsible for every interaction and its consequences.
Federal regulations on prescribing primarily focus on controlled substances, requiring a documented physician-patient relationship, but best practices and state laws also guide the prescription of other medications.
The law states that a prescriber should have a genuine patient-physician relationship, which includes written records. State laws complement federal regulations on controlled substances, with some states imposing additional requirements for prescribing, including thorough documentation like medical history and physical exams. Here is the list of self-prescribing laws by state.
In short, the legal aspects dictate that physicians should not treat non-patients except for minor problems or medical emergencies.
Record every diagnosis, suggestion, treatment, prescription, etc. Make sure to avoid prescribing controlled substances to non-patients, especially.
6 Factors that dictate self-prescription
Still, there are a lot of grey areas open for physician interpretation in specific situations. Apart from the ethical and legal issues mentioned earlier, other factors influence your decision to self-prescribe or treat non-patients, such as:
#1. Your area of training and expertise
#2. Type of relationship and emotional closeness you have with the person being treated
#3. The severity of the diagnosis or medical condition
#4. Need for an intimate exam or medical history
#5. Medication or treatment requested
#6. Convenience
Conclusion
It’s often hard to think clearly when someone close to you is suffering, and you have the ability to alleviate their pain.
Still, imagining your reaction in such situations can make it easier to set your personal guidelines.
Make sure to consider the ethical questions and opinions regarding state and federal self-prescription laws. This will help you to make a well-thought and comfortable decision.
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