can/do psychiatrists prescribe meds for there children

[ronaldo23]

are psychiatrists allowed to prescribe say depression meds to there children without a formally documented evaluation and is this commonly done? or unethical

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[OldPsychDoc]

are psychiatrists allowed to prescribe say depression meds to THEIR children without a formally documented evaluation and is this commonly done? or unethical

It is unethical, to say nothing of unwise, for any physician to treat a family member.
It is also unethical to prescribe in the absence of a medical record--e.g. the "formally documented evaluation".
Psychiatrists are no different from any other physicians in this regard.

 

[billypilgrim37]

I believe the buzzword I've always heard here is that before treatment can be provided, an "objective physical exam" (or in our case, mental status exam) must be performed. Since, by definition, you cannot perform an "objective" exam on someone with whom you have a personal or family relationship, you cannot ethically write them a prescription, in most instances.

In reality, enforcement is up to pharmacists, and although states each have different laws, writing scripts for family members is rampant (and occasionally, very occasionally, appropriate). My wife and I have different last names, and I could probably write her a script for a pound of morphine (come july), and the pharmacist probably wouldn't bat an eye.

 

[whopper]

First answer is correct, though is more of the "by the book" example.

2nd explains more of what happens in real life.

If a doctor prescribes to a family member, the reality of the situation is they possibly can get away with it at that time. Remember rules only are followed if they are enforced by self or others. The pharmacist is the next step that can block the prescription. If the last names differ-they'll most likely succeed since the pharmacist will have no way of knowing that the prescriber & the patient are family.

However its not supposed to be done, and there will be a written record of what happened. It can creep back on the prescriber & haunt them.

I remember as a child seeing doctors prescribe to family (my parents are doctors & several of their friends are doctors). Its not supposed to be done but I guess they got away with it because of the above situation.

Psyche meds IMHO are a level of higher severity since there's even more room for confusion & lack of objectivity with family.

I wouldn't reccomend violating any regulation or law.

 

[Anasazi23]

I agree that in general, one should not prescribe to family or friends. In reality, it happens all the time. As a physician, you have the privilage to do this, and it's not illegal. I know that my mother has periodic bouts of severe back spasms. If she comes to visit me from Florida, and goes into a spasm where she's incapacitated, I'm writing a script for valium or another muscle relaxer which I know has worked for her in the past. I'm not taking her to the ER, or waiting a week to see a PCP. That's just reality. A pharmacist cannot tell me that I can't do this.

 

[Faebinder]

There is a thread about this in general residency.

You can prescribe for a family member, even yourself, the lower drugs. But if you want to prescribe the higher controlled substances like antipsychotics, opiods and benzos, you will be in trouble with an audit.

I am not sure what will happen if you are simply continuing a higher controlled medication another physician is giving them.

 

[billypilgrim37]

Here's the AMA's take, which is essentially the same we've said here, Sazi's reasonable exceptions included.

E-8.19 Self-Treatment or Treatment of Immediate Family Members

Physicians generally should not treat themselves or members of their immediate families. Professional objectivity may be compromised when an immediate family member or the physician is the patient; the physician’s personal feelings may unduly influence his or her professional medical judgment, thereby interfering with the care being delivered. Physicians may fail to probe sensitive areas when taking the medical history or may fail to perform intimate parts of the physical examination. Similarly, patients may feel uncomfortable disclosing sensitive information or undergoing an intimate examination when the physician is an immediate family member. This discomfort is particularly the case when the patient is a minor child, and sensitive or intimate care should especially be avoided for such patients. When treating themselves or immediate family members, physicians may be inclined to treat problems that are beyond their expertise or training. If tensions develop in a physician’s professional relationship with a family member, perhaps as a result of a negative medical outcome, such difficulties may be carried over into the family member’s personal relationship with the physician.
Concerns regarding patient autonomy and informed consent are also relevant when physicians attempt to treat members of their immediate family. Family members may be reluctant to state their preference for another physician or decline a recommendation for fear of offending the physician. In particular, minor children will generally not feel free to refuse care from their parents. Likewise, physicians may feel obligated to provide care to immediate family members even if they feel uncomfortable providing care.
It would not always be inappropriate to undertake self-treatment or treatment of immediate family members. In emergency settings or isolated settings where there is no other qualified physician available, physicians should not hesitate to treat themselves or family members until another physician becomes available. In addition, while physicians should not serve as a primary or regular care provider for immediate family members, there are situations in which routine care is acceptable for short-term, minor problems.
Except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members. (I, II, IV)

Issued June 1993.

 

[Anasazi23]

The highlighed part, which I assumed you did, was just what I was talking about. I think most physicians would agree that continuing an ongoing treatment situation with either themselves or a family member is suboptimal at best.

There appears to be no law per se stating that a physician cannot write such scheduled prescriptions for themselves...only that they should not do it from an ethical standpoint. My understanding is that the majority of abuse claims come to fruition through so called "dr. shopping," and that you open yourself up to liability should a patient have an adverse reaction or die from a prescribed medicine for which there is no formally established treatment relationship. Conceivably, if one is prescribing to themselves, there is unlikely to be such a complaint. At that point, the issue becomes one of the impaired physician.

 

[billypilgrim37]

The highlighed part, which I assumed you did, was just what I was talking about.

Yup, that's why I highlighted it.