Can doctors write themselves refills?

[kangarooo]

Let's say I was diagnosed with anxiety and take low-dose prozac (fluoxetine) and see a therapist once a month. I had already been diagnosed by another provider years before I even got into medicine. I have been taking prozac for years. Would it be appropriate to write a prescription for myself? Would a pharmacist fill it? I've read several threads about this but I seem to be getting mixed messages. Some people have written "yeah I write myself prescriptions all the time" and other people say "I don't know of any pharmacist who would fill a self-written prescription". Obviously I'm not talking about narcotics or anything like that, just regular old prescription drugs like prozac or viagra (not that I need viagra...).

Oh btw I'm an undergraduate... this is a hypothetical.

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[deleted407021]

"Except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members."


I'm assuming that what goes in NH is standard practice across the country.

 

[Psai]

"A physician who treats himself has a fool for a patient"

 

[kangarooo]

"Except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members."


I'm assuming that what goes in NH is standard practice across the country.

Hmm yes, but what do they define as an "emergency".

Is being busy all week and not having enough time to see a doctor considered an "emergency"?

Just curious.

 

[kangarooo]

Also it seems like the way those guidelines are worded it's more about making the diagnosis than writing a prescription.

 

[gyngyn]

Hmm yes, but what do they define as an "emergency".

Is being busy all week and not having enough time to see a doctor considered an "emergency"?

Just curious.

No.

 

[Winged Scapula]

Like others have said: they can and do but it's frowned upon.

My female physician friends and I write each other emergency ABX or birth control scripts when we can't get ahold of our PCPs and I've had one write a script for hypodermics for my diabetic cat after the pharmacist refused to accept a script written by me without a "diabetic card". I guess I look like an IVDA.

At any rate, it's bad practice, even for non controlled substances and you shouldn't do it.

 

[deleted407021]

Hmm yes, but what do they define as an "emergency".

Is being busy all week and not having enough time to see a doctor considered an "emergency"?

Just curious.

Not making time to get your script filled doesn't constitute an emergency, no.

 

[gyngyn]

I'd especially caution against doing it in training as a training license may have even further restrictions.

The regulatory systems aren't precise enough that they are going to screen for this type of stuff, but if something else happens and you have any disciplinary actions, malpractice lawsuit, etc - this would just provide more ammo

The Medical Board uses this as corroboration of "other bad acts."

 

[kangarooo]

Hope I don't cause a flame war but I don't think birth control should be RX only... but what do I know

 

[mik30102]

I can tell you from the pharmacy side we have no problem filling for self written prescriptions, unless its a control of course.

 

[kangarooo]

I can tell you from the pharmacy side we have no problem filling for self written prescription, unless its a control of course.

I see that you're signature says MD/PharmD.... is that a combined program? Now I'm curious.

 

[gyngyn]

Hope I don't cause a flame war but I don't think birth control should be RX only... but what do I know

Compared to cigarettes! I must agree.
The problem really is that the price of Combination OCPS would probably skyrocket. And a BP and History would still be a good idea.

 

[mik30102]

I see that you're signature says MD/PharmD.... is that a combined program? Now I'm curious.

Nop, in my last year of pharmacy now and decided med was the place for me and will be starting that this summer. And I must disagree with the OTC birth control. While its well tolerated in most people, its not the best idea in older women, smokers, and migraine sufferers who really require physician guidance to weigh benefit vs risk. Then again I also think OTC NSAIDs should also cease to be a thing to.

 

[mik30102]

I felt like I got the stink eye...

Sorry were not all friendly . I suppose some pharmacists may have a issue with it but it was fairly common at all of the pharmacies I've been at.

 

[kangarooo]

Nop, in my last year of pharmacy now and decided med was the place for me and will be starting that this summer. And I must disagree with the OTC birth control. While its well tolerated in most people, its not the best idea in older women, smokers, and migraine sufferers who really require physician guidance to weigh benefit vs risk. Then again I also think OTC NSAIDs should also cease to be a thing to.

Not disagreeing with you but does that mean I would have to call up my doc every time I get a headache?

 

[Psai]

I felt like I got the stink eye...

they just hating man, jelly cause they can't write prescriptions

 

[gyngyn]

Nop, in my last year of pharmacy now and decided med was the place for me and will be starting that this summer. And I must disagree with the OTC birth control. While its well tolerated in most people, its not the best idea in older women, smokers, and migraine sufferers who really require physician guidance to weigh benefit vs risk. Then again I also think OTC NSAIDs should also cease to be a thing to.

We all agree that older smokers are at increased risk.
In order to make good public policy, the number of bad outcomes for unintended pregnancies that would have been prevented by the intervention compared to the number of bad outcomes for women over 35 who smoke (and are warned not use them) would need to be compared.
Most normotensive women with vascular headaches are good candidates for the pill. So called menstrual migraines (without aura) are actually treated with extended use OCP's.

 

[TooMuchResearch]

"Except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members."


I'm assuming that what goes in NH is standard practice across the country.

Controlled substances does not equal most medications.

 

[kangarooo]

Controlled substances does not equal most medications.

Controlled substances are the ones of the DEA "list" right?
Like the schedule I - V?

 

[Vain Brother]

yes, and prozac is not a control. i think you would be hard-pressed to find someone who would seriously object to a physician calling in a refill for him/herself for a maintenance medication. routinely prescribing for self/family is another matter

there was an NEJM article about this kind of stuff recently http://www.nejm.org/doi/full/10.1056/NEJMsb1402963

 

[kangarooo]

yes, and prozac is not a control. i think you would be hard-pressed to find someone who would seriously object to a physician calling in a refill for him/herself for a maintenance medication. routinely prescribing for self/family is another matter

there was an NEJM article about this kind of stuff recently http://www.nejm.org/doi/full/10.1056/NEJMsb1402963

Thanks for the article!

 

[Winged Scapula]

Sorry were not all friendly . I suppose some pharmacists may have a issue with it but it was fairly common at all of the pharmacies I've been at.

Yeah you're definitely not all friendly.

When I tried to buy hypodermics for the diabetic cat without a script, I was told that it required a prescription and diabetic card. It does not (at least in our state). When I said I'd write my own script then and that my vet does not provide "diabetic cards", I got the stink eye and the script grudgingly filled. A few months later when I went in to get a refill and inquired about a smaller syringe rather than the 100 unit ones Id been given, a different pharmacist was very kind, charming and even remarked how much he liked my cats name.

Some of youse guys needs social skills.

 

[Psai]

wtf diabetic treatment for cats? just pick up a new one. u gonna start feeding it invokana or something? lol

 

[Winged Scapula]

wtf diabetic treatment for cats? just pick up a new one. u gonna start feeding it invokana or something? lol

LOL--well he's been with me since I was an intern and I'm quite fond of him. He gets 3 units Lantus BID Plus a pricey renal diet.

Besides he's very dog like in that he plays fetch, greets me at the door and hangs out with me and my friends.

 

[Instatewaiter]

That's pretty rare in a cat...

I have written myself antibiotics in the past... most of the time though I get one of my friends to call something in.

 

[DrShephardWannabe]

Although doctors do write themselves prescriptions, several physicians will just be walking down the hallway and said conversation will follow;
"Hey Dr. X, mind writing me a week of amoxicillin? Trying to get over this nasal crap with the hours we've been working."
"Sure Dr. Y, here ya go."

 

[bc65]

No problem writing Rx for yourself, including birth control, blood pressure, insulin etc.
You should not write sleeping pills, narcotics, or psychotropics for yourself or family members.
In my state, all prescriptions need to have an associated chart, so if you write for a friend or staff member, you need to have a chart for them and a record of the encounter. If you have electronic records, you will have to enter an encounter there.

"A doctor who treats himself has a fool for a patient".

This is true, but I have always prefered treating myself anyway, as I would rather have a fool for a patient than a fool for a doctor.

 

[Captain Toad]

"A physician who treats himself has a fool for a patient"

even if I just need a loradatine refill?

 

[aalamruad]

even if I just need a loradatine refill?

Loratadine*? you don't need an Rx for that, wouldn't really consider it "treating yourself" haha

 

[Captain Toad]

Loratadine*? you don't need an Rx for that, wouldn't really consider it "treating yourself" haha

ok, what about propecia? Would you really go to a FP or derm doc to get that script?

 

[NickNaylor]

We all agree that older smokers are at increased risk.
In order to make good public policy, the number of bad outcomes for unintended pregnancies that would have been prevented by the intervention compared to the number of bad outcomes for women over 35 who smoke (and are warned not use them) would need to be compared.
Most normotensive women with vascular headaches are good candidates for the pill. So called menstrual migraines (without aura) are actually treated with extended use OCP's.

I'd be worried about people taking other meds that may inadvertently make OCPs less effective due to medication interactions. As a public policy measure I agree that it's a good idea, but there should be some kind of safeguard in place. Otherwise you may end up with people taking OCPs thinking they're effective when they otherwise may not be. But perhaps this is such a small number of people that a move like that would still be an overall net positive.

 

[Mad Jack]

Hope I don't cause a flame war but I don't think birth control should be RX only... but what do I know

There's a lot of different formulations of birth control out there, some which work better or worse for a given patient. Then there's interactions- so, so many interactions that would be difficult for the average patient to sort out. Finally, there's the fact that a lot of people tie their birth control workup with their pelvic exams, which literally thousands of lives by effectively getting people in the door for a screening they might otherwise have neglected.

 

[gyngyn]

I'd be worried about people taking other meds that may inadvertently make OCPs less effective due to medication interactions. As a public policy measure I agree that it's a good idea, but there should be some kind of safeguard in place. Otherwise you may end up with people taking OCPs thinking they're effective when they otherwise may not be. But perhaps this is such a small number of people that a move like that would still be an overall net positive.

Medications that may reduce OCP efficacy are largely confined to prescription systemic antifungals and anti-tuberculosis medications.
The drugs that increase the metabolism of estrogen are many but have little effect on efficacy since progestins are largely resposible for ovulation suppression.

 

[gyngyn]

There's a lot of different formulations of birth control out there, some which work better or worse for a given patient. Then there's interactions- so, so many interactions that would be difficult for the average patient to sort out. Finally, there's the fact that a lot of people tie their birth control workup with their pelvic exams, which literally thousands of lives by effectively getting people in the door for a screening they might otherwise have neglected.

Sadly, pelvic exams as a screening tool have not been associated with a reduction in disease.
Limited access to effective contraception, on the other hand has been strongly associated with bad outcomes.
For this reason we no longer require pelvic exams or pap smears to prescribe OCP's.

 

[Mad Jack]

Sadly, pelvic exams as a screening tool have not been associated with a reduction in disease.
Limited access to effective contraception, on the other hand has been strongly associated with bad outcomes.
For this reason we no longer require pelvic exams or pap smears to prescribe OCP's.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27862/

Pelvic screening has had a substantial impact on cervical cancer mortality rates from the research I've seen. I'm not saying women should have to have a pelvic exam to get birth control, just that maybe encouraging regular visits to the OB/Gyn might be a good idea. Interestingly, I was recently engaged in a discussion about the great number of unnecessary deaths from cervical cancer in the lesbian community because no one thinks to perform annual pelvic exams on women who aren't having sex with men, and they largely do not take birth control, so rarely have encounters with an OB/Gyn to encourage screening. Just my two cents, I'm obviously no expert on the matter.

 

[Raryn]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27862/

Pelvic screening has had a substantial impact on cervical cancer mortality rates from the research I've seen. I'm not saying women should have to have a pelvic exam to get birth control, just that maybe encouraging regular visits to the OB/Gyn might be a good idea. Interestingly, I was recently engaged in a discussion about the great number of unnecessary deaths from cervical cancer in the lesbian community because no one thinks to perform annual pelvic exams on women who aren't having sex with men, and they largely do not take birth control, so rarely have encounters with an OB/Gyn to encourage screening. Just my two cents, I'm obviously no expert on the matter.

Pap smears have a substantial impact on cervical cancer mortality. Current evidence is that if a woman has never had an abnormal one that they don't need to be done more often than every 3-5 years (3 for younger women, 5 for older women if you do a concurrent HPV test)

Pelvic exams, which include a lot more than just a pap smear, have never been shown to have an impact on anything. They include things like the bimanual exam (where the doctor attempts to feel the ovaries) and frequently a rectal exam.

Many Ob/Gyns persist in A) Performing yearly pap/pelvic exams and B) requiring them before a prescription of birth control can be given. It's pretty inappropriate, but they either trained a long time ago and haven't kept up with modern standards... or ignore modern standards either for their own profits or because they disagree with them. Guidelines state that there's absolutely no reason to tie birth control prescriptions to pelvic exams.

--------

Back on to the actual topic of discussion:

Can doctors write themselves scrips? Yes.
Should they write themselves scrips for scheduled substances (pain medication, sleeping meds, benzos, ADHD meds)? Absolutely, positively not. Good way to lose your license.
Should they write themselves scrips for non-scheduled substances? Technically no. But it's done all the time.

 

[gyngyn]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27862/

Pelvic screening has had a substantial impact on cervical cancer mortality rates from the research I've seen. I'm not saying women should have to have a pelvic exam to get birth control, just that maybe encouraging regular visits to the OB/Gyn might be a good idea. Interestingly, I was recently engaged in a discussion about the great number of unnecessary deaths from cervical cancer in the lesbian community because no one thinks to perform annual pelvic exams on women who aren't having sex with men, and they largely do not take birth control, so rarely have encounters with an OB/Gyn to encourage screening. Just my two cents, I'm obviously no expert on the matter.

Yes, cervical cancer should be an almost entirely preventable disease. Vaccination, screening and barrier contraception have reduced cervix to the smallest proportion of pelvic cancer deaths. Women who have ever had penetrative male intercourse should be screened even though they currently have sex with women.

When we evaluated the effects of tying contraception to other (unrelated) health behaviors we discovered that the risks far outweighed the potential benefits. At present, the only absolute requirements for pill Rx are a history (essentially: age, smoking and clots) and a BP.

 

[mehc012]

I did find it slightly disturbing when not the doctor, not the nurse, but the receptionist at a small practice I was scribing with called herself in a prescription. Not because of the content - I don't remember it being anything heavy (though honestly that would probably have raised fewer flags at the pharmacy than BCP since it was an ortho clinic masquerading as a pain clinic) - but I found it profoundly disturbing because they were basically putting things under the doc's name that he wasn't even told about, never mind asked.

 

[mehc012]

Pap smears have a substantial impact on cervical cancer mortality. Current evidence is that if a woman has never had an abnormal one that they don't need to be done more often than every 3-5 years (3 for younger women, 5 for older women if you do a concurrent HPV test)

Pelvic exams, which include a lot more than just a pap smear, have never been shown to have an impact on anything. They include things like the bimanual exam (where the doctor attempts to feel the ovaries) and frequently a rectal exam.

Many Ob/Gyns persist in A) Performing yearly pap/pelvic exams and B) requiring them before a prescription of birth control can be given. It's pretty inappropriate, but they either trained a long time ago and haven't kept up with modern standards... or ignore modern standards either for their own profits or because they disagree with them. Guidelines state that there's absolutely no reason to tie birth control prescriptions to pelvic exams.

Oh god, their offices are persistent, too. They call, and call, annnnnd call. You can't just be like "I have no risk factors whatsoever for any of the things you are looking for please go away" because they don't listen and they keep trying to get you in for an exam you're essentially declining, even if you give them valid reasons.

 

[fancymylotus]

brb writing myself a bunch of valium and xanax prescriptions

(joking)

 

[dpmd]

I did find it slightly disturbing when not the doctor, not the nurse, but the receptionist at a small practice I was scribing with called herself in a prescription. Not because of the content - I don't remember it being anything heavy (though honestly that would probably have raised fewer flags at the pharmacy than BCP since it was an ortho clinic masquerading as a pain clinic) - but I found it profoundly disturbing because they were basically putting things under the doc's name that he wasn't even told about, never mind asked.

How do you know that the doc didn't know about it from previous requests and was cool with it?

As for the original question, I have prescribed for myself plenty of times, both by phone and in person at the pharmacy. They have even given me a blank rx to write on when I have gone in in-person but didn't have my rx pad with me. I did residency in california where you don't get a training license, you just get a regular license once you have done enough year of residency, so I never prescribed for myself before I had my own license (for residency related stuff we did have rx pads where we could just mark the appropriate attending and sign our own name even before we got our licenses as long as it wasn't schedule II stuff, but would have been crossing a huge line to use that for myself). I go see a doctor when needed, but if I just need a refill on a maintence med why wait however long it takes for the refill request to go through the docs office and get processed by the pharmacy. Also, not going to go see some random urgent care if I get a UTI or otitis externa while on vacation.

 

[mehc012]

How do you know that the doc didn't know about it from previous requests and was cool with it?

As for the original question, I have prescribed for myself plenty of times, both by phone and in person at the pharmacy. They have even given me a blank rx to write on when I have gone in in-person but didn't have my rx pad with me. I did residency in california where you don't get a training license, you just get a regular license once you have done enough year of residency, so I never prescribed for myself before I had my own license (for residency related stuff we did have rx pads where we could just mark the appropriate attending and sign our own name even before we got our licenses as long as it wasn't schedule II stuff, but would have been crossing a huge line to use that for myself). I go see a doctor when needed, but if I just need a refill on a maintence med why wait however long it takes for the refill request to go through the docs office and get processed by the pharmacy. Also, not going to go see some random urgent care if I get a UTI or otitis externa while on vacation.

Because of the conversation she was having with her deskmate at the time. It was basically
"uggh, I need a prescription for xyz"
"Just call it in like we do for the patients"
"Can I do that?"
"Sure, I do all the time"

 

[dpmd]

Because of the conversation she was having with her deskmate at the time. It was basically
"uggh, I need a prescription for xyz"
"Just call it in like we do for the patients"
"Can I do that?"
"Sure, I do all the time"

Gotcha. Yeah that would piss me off. I am happy to help someone out with some stuff, but I want to know about and actually discuss it so that if something happens later I have some sort of defense.

 

[fancymylotus]

I do get a fair amount of "my next door neighbors son thinks he has an infection, can you write an antibiotic rx for me to give to him??" which I never do, bc thats just ridiculous

 

[dpmd]

I do get a fair amount of "my next door neighbors son thinks he has an infection, can you write an antibiotic rx for me to give to him??" which I never do, bc thats just ridiculous

Yeah, that would be a big NO from me too. BCP and allergy meds (for people with a certain common insurance in the area if you get an RX for certain OTC allergy meds you get it with no copay) are the usual ones I write for other people who aren't actually patients. Heck I don't even generally like writing stuff outside my area of concern for people who ARE my patients (like sometimes they ask me for BP med refills or worse, refills for their chronic narcotics-which I absolutely won't do past the immediate post op period and even then they only get a quantity that would be typical for the operation I did)

 

[Vain Brother]

I'd be worried about people taking other meds that may inadvertently make OCPs less effective due to medication interactions. As a public policy measure I agree that it's a good idea, but there should be some kind of safeguard in place. Otherwise you may end up with people taking OCPs thinking they're effective when they otherwise may not be. But perhaps this is such a small number of people that a move like that would still be an overall net positive.

well for one thing the number of medications that meaningfully interact with OCs is very small (essentially some antiepileptic drugs and rifampin), so writing a friend a refill for her birth control in the event she can't get ahold of her PCP is unlikely to do much harm. and it's not hard to ask if they're taking one of these

the larger point is that doctors should establish doctor-patient relationships with their own PCPs like anyone else, because it's just not possible to be objective treating yourself/family. as far as examples that have been raised itt, why is it so difficult to go to your PCP to get a prescription for propecia or any of the other non-urgent prescriptions?

 

[mehc012]

well for one thing the number of medications that meaningfully interact with OCs is very small (essentially some antiepileptic drugs and rifampin), so writing a friend a refill for her birth control in the event she can't get ahold of her PCP is unlikely to do much harm. and it's not hard to ask if they're taking one of these

the larger point is that doctors should establish doctor-patient relationships with their own PCPs like anyone else, because it's just not possible to be objective treating yourself/family. as far as examples that have been raised itt, why is it so difficult to go to your PCP to get a prescription for propecia or any of the other non-urgent prescriptions?

Why would you go to a PCP if you didn't have to? What's the benefit? Just means you add a PCP copay to the price of your med.
I mean, if you have a lot of chronic health problems that they are helping you balance/manage, that's one thing. But if you're an otherwise healthy person who just wants BCP, or has a fairly straightforward UTI, or has been feeling cruddy but has to go into work anyway and just wants some Zofran so as not to vom on your computer, why make things complicated when it could not be? It's not like they'll know who the heck you are anyway if you only see them once every few years when you need something minor.

 

[blackroses]

well for one thing the number of medications that meaningfully interact with OCs is very small (essentially some antiepileptic drugs and rifampin), so writing a friend a refill for her birth control in the event she can't get ahold of her PCP is unlikely to do much harm. and it's not hard to ask if they're taking one of these

the larger point is that doctors should establish doctor-patient relationships with their own PCPs like anyone else, because it's just not possible to be objective treating yourself/family. as far as examples that have been raised itt, why is it so difficult to go to your PCP to get a prescription for propecia or any of the other non-urgent prescriptions?

Because I'm lucky if my combined appointment and waiting time take only an hour. Because where I live, PCPs are booked out 3 weeks. Because the last time I went in for a tweaked muscle in my back hoping for a shot of toradol, I walked out with orders for X-rays and an MRI, 6 months of physical therapy, a referral to a pain management specialist, and notes on my chart that ended up giving my insurance a reason to refuse to pay for a surgery that 3 other doctors had agreed that I needed. (I eventually got the toradol, and was right as rain in 3 days).

I'll stick with the KISS rule.

 

[Psai]

Because of the conversation she was having with her deskmate at the time. It was basically
"uggh, I need a prescription for xyz"
"Just call it in like we do for the patients"
"Can I do that?"
"Sure, I do all the time"

Sounds illegal