A few months later, this patient died due to complications related to her health problem, and I had to inform her parent, who is also my friend. Others might prefer to rely more on their moral compass. It is an important skill as a doctor to learn to be able to assess ones own and ones friends’ ailments in an objective manner, and when to seek help. Having empathy is good as a doctor; having an emotional attachment is not – it’s bound to affect your judgement or focus. Dr. Eniola is an assistant professor in the Department of Family Medicine at the University of North Carolina-Chapel Hill and is an attending physician at Moses Cone Family Medicine Residency Program. Prescribing for self, family, friends and colleagues is widespread among young Irish doctors, suggest the results of a survey, published online in the Journal of Medical Ethics. Should a doctor not be trusted to be able to treat their own fungal nail infection rather than taking a morning or afternoon off – cancelling their own patients – to see their GP? Ethical guidance, Medical professionalism, Achyut Valluri is a senior trainee in Renal medicine in Scotland and in August 2015  finished a year as a Clinical Leadership Fellow with the GMC. Incorporating alcohol screening and brief intervention benefits your patients and family medicine practice. 2014 Sep 25;371(13):1254-8. doi: 10.1056/NEJMsb1402963. Professional standards and guidelines: treating self, family members, and those with whom you have a non-professional relationship. As a house officer I remember hearing my seniors speak openly about prescribing themselves a course of antibiotics to keep that cough at bay. In this case, a new FDA-approved drug is recommended for a patient who subsequently experiences an adverse event that may or may not be related to the prescription. Being husband, dad and son is responsibility enough, without having to be the doctor too! Never be afraid to use your objective medical skills to help your family as you would a stranger. ( Log Out /  Ethical challenges in treating friends and family. 4(July/August, 2017) Please read and accept the privacy policy and cookies notice which governs your use of this site: http://automattic.com/privacy/. Do not join the many parents who are sure their child is sick, but have been reassured and sent home by unrelated doctors, only to have their child die of peritonitis, meningococcal sepsis, ruptured spleen etc. ( Log Out /  J Gen Intern Med. / ACP Ethics Manual. Prescribing medications for friends and family is a major grey area in medicine. We use several social media sites - such as WordPress - to help raise awareness of our work and promote good medical practice. Ethics statements by the American Medical Association, the American College of Physicians, and others warn that the patient-physician relationship can be complicated by pre-existing social and emotional relationships.1,2,3 They recommend that physicians first consider alternative sources of care or referrals to other providers and take care of friends of relatives only if there are no other options. When relatives and friends ask physicians for medical advice: ethical legal, and practical considerations. We encourage you to share your views. The broad legal right for doctors to prescribe for themselves, family, and friends also raises ethical questions about whether they should do so, because that was not the intention when they were granted that right, says Tony Calland, chairman of the BMA’s medical ethics … The opinions expressed here do not necessarily represent those of FPM or our publisher, the American Academy of Family Physicians. Magazine, the quarterly publication of the American Association of Marriage and Family Therapy, is a case in point. I’m getting to the stage of life where I’m starting to talk about the way things used to be. The Last Word: The Ethics of Caring for Friends or Family. If you prescribe a controlled drug for a family member, friend, or colleague, you are at risk of being accused of diverting controlled drugs or, at minimum, inappropriate prescribing. Contact Snyder L. 3. ACP Ethics, Professionalism, and Human Rights Committee. Post was not sent - check your email addresses! Several notable medical societies have issued ethical statements discouraging physicians from treating family members and friends. The proper way to do “friendly prescribing” is to treat your friend like a regular patient with a history, an exam and a chart. A trained health care provider principally offers care to ill-patients, offers advocacy to groups of persons, could be a passionate counsellor when needed, and may offer preventive services to individuals and communities at large. Recently, I faced a situation where I had to care for a friend's daughter who was unable to obtain health care because she was uninsured. Think very carefully before you prescribe for family and friends. The dangers of self-medicating or prescribing controlled drugs to family, friends and colleagues are clear – the risk of addiction and misuse. The MDU website headline today is: “Money is haemorrhaging out of the NHS in compensation claims.” At the very least, a responsible doctor should be assessing whether his management of his/ his relative’s condition is likely to be better than the average unrelated doctor. Ethical Considerations can be specified as one of the most important parts of the research. Please note that this website is not controlled by the GMC and your use of this site will be subject to WordPress’s specified terms and conditions. For example, some doctors treat their own children, no lawyer can. Walkup states that the accurate depiction of trends in prescribing practices for children Dissertations may even be doomed to failure if this part is missing. She had a health condition that warranted immediate attention, so I decided to see her in my clinic. Choose a single article, issue, or full-access subscription. Read the GMC’s guidance on doctors prescribing to themselves or those close to them. Dr Valluri, what you never forgive yourself for, is if you diagnose your father’s skin cancer before he even notices it, then remain professionally disinterested after you advise him to see his GP who arranges treatment. Copyright © 2017 by the American Academy of Family Physicians. The dangers of self-medicating or prescribing controlled drugs to family, friends and colleagues are clear – the risk of addiction and misuse. Snyder L. But where I’ve heard the most debate is around “obvious” minor ailments. As this is out of ours (Sunday) I will have to take her to see a nurse-led out of hours service with a waiting time of several hours or give up. In this circumstance, minor ailments that still require prompt treatment are almost impossible to access without a prolonged delay and further burdening our NHS. This guidance came into effect 25 February 2013. Learn the role telehealth can play in your practice’s efforts, along with billing, coding, and documentation tips. This article will discuss the ethics involved with providing medical care to family, friends, and colleagues and suggest guidelines for caring for these special people/patients. Previous: Making Sense of MACRA: Simplifying Chronic Care Management, Home Send comments to I know someone who was disciplined for prescribing cetraben for their kids when this was already on their repeat prescription. It would indeed be good science to see some figures in this contentious area. Get Permissions, Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights.". My experience is the exact opposite of the ‘Dr Sarah Browne’ anecdote in the GMC newsletter. 2009;24:1333-1335. Thanks / Journals Professional standards and guidelines: treating self, family members, and those with whom you have a non-professional relationship. Thus increasing the risk she would receive Amoxil (Amoxycillin), to which she has a significant allergy. We also recognise that as technology moves on so does the ways that you prescribe. Despite the myriad of legal risks and ethical considerations, the practice is far from infrequent. Clicking links from this story led me to the MDU website. © 2020 Improving medical education and practice across the UK. Achyut Valluri is a senior trainee in Renal medicine in Scotland and in August 2015  finished a year out of programme as a Clinical Leadership Fellow with the General Medical Council. Smoking cessation counseling and pharmacotherapy options are cost-effective ways to help patients quit smoking. For information on how we may use personal information that you submit, please refer to our Privacy and Cookies notice. Claire Zilber, M.D. Claire Zilber, Search for more papers by this author. Treating oneself or a member of one’s own family poses several challenges for physicians, including concerns about professional objectivity, patient autonomy, and informed consent. Some state laws or medical licensing boards prohibit physicians from prescribing controlled substances or psychiatric drugs to themselves or to family members except in emergencies [1]. 24/No. ( Log Out /  We have also published a helpful resource on prescribing to support doctors further on our website. Physicians should also be aware of the pros and cons of caring for friends and family. This issue devotes itself to exploring family therapists and medications, with a special article on pediatric psychopharmacology (Walkup, 2003). College of Physicians and Surgeons of British Columbia website. For clinicians, many ethical challenges from the past decades are still present today. A 1991 study found that 83 percent of over 400 surveyed physicians had prescribed a medication to a family member. Profound insight.. fpmserv@aafp.org for copyright questions and/or permission requests. In fact, when you are in the situation of needing a prescription quickly for you or your family, it really makes it clear to you that the level of access for your patients in the NHS is below par. / fpm \"Depending on the problem and the specialty, it can be appropriate to treat a friend or relative,\" saysDina D. Strachan, M.D., board-certified dermatologist in private practice at Aglow Dermatology in New York City. My father died aged 59 of skin SCC and medical negligence, because doctors who didn’t know him made simple errors. Accessed June 2, 2017. Healthcare attorney Carolyn Buppert, MSN, said while some practitioners prescribe for family and friends, the practice is “generally not a good idea.” In these cases, it is important to set expectations with relatives or friends and make every effort to treat them with the same professional judgment you would use for other patients. Sorry, your blog cannot share posts by email. J Gen Intern Med. Additionally, physicians should treat patients with whom they have a prior nonprofessional relationship only if they have a short-term, minor problem or an emergent medical condition. As seen in the underlined section, there are situations in which prescriptive treatment of family members is appropriate, in acute short term situations. A doctor may treat her own sore throat and soldier on, or attend her GP and be certified unfit for work for a few days. But there are dangers even with less strong analgesics and antibiotics, like the chance of drug interactions through incomplete (or absent) record-keeping and inadequate communication with the regular GP. However, even in states where it’s not expressly prohibited, medical boards may consider the practice unprofessional. As nurse practitioners, the temptation to help out a friend or family member in these situations by calling in a prescription is strong. 2. ACP Ethics Manual. PMID: 24873131 [PubMed - indexed for MEDLINE] MeSH Terms. But where there are no concrete rules, physicians must decide for themselves on appropriate boundaries. To examine the practices of paediatric providers regarding self-prescribing, curbsiding colleagues, and prescribing and refusing to prescribe to friends and family. What is the risk of a doctor self-prescribing the wrong drug, compared with the risk of an unrelated doctor prescribing/administering the wrong drug; and given the higher direct and indirect cost of seeing a colleague, what is the number needed to treat to balance the cost/benefit to the health system? We cannot control when and how they are set on your computer or other device. None of the three doctors recognised the CT change was a simple Caldwell-Luc biopsy incision, because they didn’t know or understand the history. Chapter 1.2.1 of the AMA Code of Medical Ethics. To see the full article, log in or purchase access. Dr. Strahan is a graduate of Harvard College and Yale Medical School. 2012;156:73–104. Learn strategies to thrive in VBP and risk-adjustment models to optimize payment while providing high-quality patient care. The practice of prescribing medications in such situations is not specifically prohibited by … Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to share on Pinterest (Opens in new window), Click to share on Reddit (Opens in new window), Click to share on Tumblr (Opens in new window), Click to share on Pocket (Opens in new window), Click to email this to a friend (Opens in new window), Hooper Review: More support for doctors raising concerns, Medicine and positive leadership: be nice, Peter, Prescribing to friends and family: an ethical minefield, Improving medical education and practice across the UK, GMC’s guidance on doctors prescribing to themselves or those close to them, helpful resource on prescribing to support doctors, Good practice in prescribing medicines | Docbeecee.