Writing your own prescriptions?

[Foxxy Cleopatra]

Somehow I got through intern year without finding out the answer to this...

Can you write a prescription for yourself? I'm not talking about schedule 2 substances, happy pills, or the like; I have been wondering about things like Allegra, OCP's, antibiotics; fairly simple things that you want a refill on but don't have the time to haul yourself to a PCP to get refilled.

I suppose another option would be to ask a fellow resident; I was just curious if it is ok to write one for yourself.

Thanks

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[fourthyear]

Yes, you can.
And try picking it up at your hospital pharmacy. It may be much less expensive than retail pharmacies.

 

[Kalel]

Originally posted by fourthyear
Yes, you can.
And try picking it up at your hospital pharmacy. It may be much less expensive than retail pharmacies.

You guys must have a nice hospital pharmacy. One of my prof's told us that our out-patient hospital pharmacy "gouges" customers with it's pricing. Regarding writing your own prescription, it's perfectly legal as long as it's not a DEA controlled substance (ie any schedule). The only problem is that I've heard that some insurance co's won't pay for a script written by yourself, but this differs from policy to policy, so I'd reccomend asking your insurance co about this.

 

[dthankins]

i am a soon to be intern...can you write a script for a person not under your care at the hosiptal in which you are training?

 

[Kalel]

Originally posted by dthankins
i am a soon to be intern...can you write a script for a person not under your care at the hosiptal in which you are training?

yup. you will just be up the creek if the person has a bad outcome or decides to sue you for whatever reason.

 

[aliraja]

i think this is one situation i'd be really careful about unless it was something with minimal side effects OR something that my friend (or whoever) had been on for a while and had simply run out of... there's just too much on the line if anything goes wrong...

 

[rxfudd]

When I was a pharm tech, we used to have this older doc who would come in and wait patiently in line. When he got to the counter, he would take out his rx pad and very carefully and methodically write out his scripts - even during our busiest periods. He always seemed to get a kick out of seeing the label with his name in both the pt and physician boxes.

So yeah, you can do it - just don't do it like that.

 

[denali]

Originally posted by rxfudd
When I was a pharm tech, we used to have this older doc who would come in and wait patiently in line. When he got to the counter, he would take out his rx pad and very carefully and methodically write out his scripts - even during our busiest periods. He always seemed to get a kick out of seeing the label with his name in both the pt and physician boxes.

So yeah, you can do it - just don't do it like that.

I give him credit at least for waiting in line instead of demanding special front-of-line privileges...

 

[Twiki]

One thing to keep in mind: Some insurance companies will not pay for a script that you write for yourself. In fact, some insurance providers will not cover any script written by a RESIDENT, period. My insurance provider is one of these. When I go to the clinic and have a resident see me and refill my scripts, he has to have an attending cosign it (not just for happy pills, or scheduled meds, BTW). It's a pain. Just so ya know.

 

[beyond all hope]

Even narcotics. However, the DEA will probably take a close look at those, and you may be investigated.

Yes, some insurance plans will not cover scripts you write for yourself. So, you write them for your buddy, who in turn writes scripts for you, and you exchange meds. As long as they're innocuous (Allegra, OCPs, etc) probably nothing will come of it. However, it may be seen as insurance fraud if someone finds out.

However, you need to get your license first, which means interns can't do it. Most residents can write scripts that only cover their own hospital - some can't write them at all - until they get their license.

 

[Apollyon]

I wrote prescriptions for myself (antibiotics) in New York, as a resident, without a license, and had them filled in the hospital pharmacy (for convenience) without a problem; however, I could have had them filled at a community pharmacy, once again, without a problem.

In every state, though, it is dependent on the state laws; there is no blanket "yes" or "no". North Carolina, for example, is now VERY strict on prescription writing (at least on paper - in reality, the state is a sieve for docs writing for themselves, or for Percocet for patients - more Percocet is written for (per capita) in NC than anywhere else in the US); for a doc to write for him/herself, it has to be something "minor or emergent". Moreover, in NC, unless there is a paper chart showing you've examined a patient, you can't just write them a prescription.

GENERALLY, it isn't a problem in any state, BUT, it's always best to make sure there aren't any secrets.

 

[ny skindoc]

Do not write a prescription for anyone not under your direct care as a resident(this includes hospital staff and nurses,friends).Even routine antibiotics can have serious side effects.You will be responsible.Your malpractice insurance likely will not cover you and you can end up reported to the Office of Professional Medical Conduct,which will not be fun.

 

[k's mom]

One thing to keep in mind: Some insurance companies will not pay for a script that you write for yourself. In fact, some insurance providers will not cover any script written by a RESIDENT, period.

Actually, most insurance providers have it stated in their policy that they will not cover ANYTHING done by a "person undergoing medical training" or some verbage to that effect, which specifically includes interns/residents/fellows.
Absolutely hilarious considering this is the standard line in the policy for our health plan, provided by the MEDICAL COLLEGE, for use AT THE MEDICAL CENTER. Um, how exactly would a teaching hospital function if insurance refused to pay for anything done by a resident? When I had my daughter, 6 of the 8 physicians in the room were residents. The attendings never touched me. I guess it's just medicine's version of don't ask, don't tell

 

[edinOH]

Oxycodone 40 mg

sig: i po q 6 hours prn pain

#200

 

[maxheadroom]

Many residency programs now have strict rules about writing Rx for anyone who is not under your medical care (friends, family, neighbors, etc). My program had someone get in pretty big trouble for writing some simple stuff.

Careful with Abx. We just had a guy DIE from C Diff colitis. He had two doses of Augmentin for bronchitis. Came in with fulminant C Diff Colitis, we did a total colectomy, and he died within 24 hours. NOTHING IS COMPLETELY BENIGN!!

Unless you're willing to take PERSONAL responsibility for non-residency medical care that you give, just don't do it.

 

[Bobblehead]

Originally posted by edinOH
Oxycodone 40 mg

sig: i po q 6 hours prn pain

#200

Just to nitpick but only the extended release version comes in 40mg tabs and if you tried taking those q6 as a narcotic naive individual you'd be on the floor..

 

[edinOH]

Originally posted by Bobblehead
Just to nitpick but only the extended release version comes in 40mg tabs and if you tried taking those q6 as a narcotic naive individual you'd be on the floor..

I meant to write to crush these up before taking, but I figured people would figure it out.

 

[Pilot]

I'm surprised OxyIR hasn't caught on more. Already in a capsule - junkies could just open the capsule, liquidate, and inject.

 

[southerndoc]

Originally posted by maxheadroom
Careful with Abx. We just had a guy DIE from C Diff colitis. He had two doses of Augmentin for bronchitis. Came in with fulminant C Diff Colitis, we did a total colectomy, and he died within 24 hours. NOTHING IS COMPLETELY BENIGN!!

There will always be rare cases of things like this.

One could argue that a person could die from your ordinary advice. For example, a diabetic smoker wants to get in shape. You tell him to join a gym. He dies on the treadmill. Guess what? The wife sues you because you told him to join a gym, and since you're a physician, it's considered medical advice.

Let's not get carried away here. Rare, unfortunate things do happen. Luckily they are not that common.

 

[NYCDOC74]

After graduating from med school, I spent a couple of months working at a retail pharmacy. (I'm also a pharmacist) Had an IM doc come in, totally disheveled, wrote up a script on the store pad for Humibid LA (600mg, long-acting), I responded, "sorry Dr. , they don't make it anymore in this formulation, however, we do have guaifenesin 600mg OTC, on aisle 4....." Dr. X says, "No way, I WANT the Rx, its much stronger...." Then she adds angrily, "Wipe that stupid smirk off your face!"

 

[Winged Scapula]

As others have noted, be careful when doing this for others. It is not uncommon for a nurse to approach you for medical advice, for a script for a UTI, etc. While its tempting to maintain a good relationship, I would advise against it - you can be held responsible for any untoward effects.

OTOH, my BF and I have written each other scripts for mundane things (ie, antibiotics before going overseas). My hospital pharmacy is MUCH cheaper (ie, one script which cost me $20 on the outside only cost $4 here) so I prefer to use it but they will not accept non-Hershey Med scripts so I have to go elsewhere.

At any rate, I haven't found any clause which states I can't write my own scripts but just prefer not to...even for non-narcs.

 

[Yogi Bear]

what's the rule when it comes to treating immediate/extended family members? i.e. can u write a prescription for ur children, parents, grandparents, cousins, etc? i.e. allegra for soemone w/ allergies or benzamycin for teenager w/ acne.

 

[Winged Scapula]

Yogi...

You can write them but IMHO its better not to (my grandmother was a bit disappointed when I told her I couldn't authorize her going off her beta blocker and wouldn't give her something else that wouldn't make her as tired).

Even if the script is for something seemingly within your field of specialization, for most things its better to have another physician examine and prescribe things for your family members. Exceptions might be for antibiotic for known UTI, NSAID for severe musculoskeletal pain after a trauma, etc.

 

[ny skindoc]

No doubt most doctors write prescriptions for immediate family members for relatively innocuous medications.Its a bad idea to get in the habit of prescribing for extended family members.You have not properly examined them,and you dont know their full medical history-there are many things they are not telling you! .If something goes wrong or is improperly diagnosed/treated you will never hear the end of it.Your family members are entitiled to the same level of care anyone else.I am a dermatologist but sent my mother to her own dermatologist for her skin problems and it works out great.

 

[WaitingForJuly]

I'm an intern, I don't have a license. I have written scripts for routine meds for myself, my mother, nurses, etc. I can't think of a colleague who hasn't done the same. No problems getting it filled in hospital or out, no problems with insurance on self Rx. Might someone have an adverse reaction to a Zpak? Sure. Am I going to lose any sleep over it? Hells no.

 

[maxheadroom]

I agree that C Diff from routine Abx is exceedingly rare, it's just an example of how things that we consider "safe" are never 100% benign.

One of the chiefs at my program gave us great advice at intern orientation last year. He said to just tell everyone who asked for an Rx (who wasn't a patient) the truth: "At this program I can get fired for writing a prescription for someone who is not under my direct medical care." The nurses here have learned to not even ask.

 

[beriberi]

Uh.... you have to have a license to practice medicine and write prescriptions, WaitingForJuly.

You likely have a provisional license (which is what most residents have until they have completed one year of residency, taken step III AND applied for a full license.)

 

[Apollyon]

Originally posted by beriberi
Uh.... you have to have a license to practice medicine and write prescriptions, WaitingForJuly.

I didn't have a license, and wrote prescriptions in NY, as a resident.

It depends on the state. For another angle, consider South Carolina - all you need is a degree and a contract, and you can do residency. However, I don't know about prescribing.

 

[tsj]

What about Radiology residents writing presciptions. Are they allowed to or would the Hospital Pharmacy not fulfill it. I suppose if they have a license and DEA# that they can write whatever they want and have it filled outside.

But theoretically radiology or pathology shouldn't be allowed tu write scrpts at all as they have to patients.

 

[Winged Scapula]

All that's needed to write a prescription is a license - temporary, limited or permanent. To write for scheduled drugs you need a DEA number - different states have different requirements about what you need to do to get one.

It doesn't matter what your specialty is - you are allowed to write scripts (even if it seems you have no business doing so. However, remember that vascular/interventional radiologists may have reason to do so.)

 

[edinOH]

Originally posted by tsj
What about Radiology residents writing presciptions. Are they allowed to or would the Hospital Pharmacy not fulfill it. I suppose if they have a license and DEA# that they can write whatever they want and have it filled outside.

But theoretically radiology or pathology shouldn't be allowed tu write scrpts at all as they have to patients.

Why even go there?

 

[Whisker Barrel Cortex]

Originally posted by tsj
What about Radiology residents writing presciptions. Are they allowed to or would the Hospital Pharmacy not fulfill it. I suppose if they have a license and DEA# that they can write whatever they want and have it filled outside.

But theoretically radiology or pathology shouldn't be allowed tu write scrpts at all as they have to patients.

Tell that to the TIPS patient I had to write a dilaudid PCA for or the post hepatic embolization patient I had to write dolasetron, morphine, and zolpiem for.

 

[GopherBrain]

What specialty is least qualified to write prescriptions?

Many people would say path or rads, but it think it is medical genetics. I was working with one who told me she hadn't written one for over three years.

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"There is a great difference between a good physician and a bad one; yet very little between a good one and none at all.
-Arthur Young
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[aphistis]

Originally posted by GopherBrain
What specialty is least qualified to write prescriptions?

Many people would say path or rads, but it think it is medical genetics. I was working with one who told me she hadn't written one for over three years.

I think the question is moot. Writing for meds is just one more treatment modality on the list, and not something inherently worth getting excited over.

 

[southerndoc]

Originally posted by GopherBrain
What specialty is least qualified to write prescriptions?

Many people would say path or rads, but it think it is medical genetics. I was working with one who told me she hadn't written one for over three years.

One would think that the less qualified you are to write scripts, the more likely you are to look up dosing, adverse reaction, and drug interaction information before you write it. Therefore, the least qualified prescriber might be the safest.

 

[ny skindoc]

No..the least qualified to write a prescription is not the safest. Anyone can look up the rare and unusually severe side effects of a drug.The PDR lists many potential side effects of drugs some of which have only a remote association with the medication. Someone who writes a prescription regularly should know the proper circumstances use the drug,how to monitor response and how to look for serious and less serious complications/interactions.Its essential to look things up in a book if you are not familiar with a particular drug but its not a substitute for clinical experience with it.

 

[southerndoc]

Originally posted by ny skindoc
Its essential to look things up in a book if you are not familiar with a particular drug but its not a substitute for clinical experience with it.

My point was based on the fact that many physicians think they know a drug more than they really do. Many blow off looking up a drug because they think they know it.

Let's not kid ourselves either. Radiologists, dermatologists, etc. do have clinical experience. Unless their medical school allowed them to graduate without clinical experience, then they should have become familiar with the drugs during medical school and during their PGY-1 year.

 

[ny skindoc]

I'd agree there are those who should know more about the drugs they presecribe and not be cavalier about it.If they dont know the drug well enough to discuss the risks,benefits etc to their patients they will run into trouble.Dermatologists,radiologists,FP's & anyone else should stick to prescribing things they are familiar with and trained to prescribe.If they need to give a drug they dont know much about they need to learn its ins and out before subjecting a patient to it.

 

[tsj]

Tell that to the TIPS patient I had to write a dilaudid PCA for or the post hepatic embolization patient I had to write dolasetron, morphine, and zolpiem for.

OK, I guess in some special instances a radiology resident would write scripts, but as we all know, radiologists tend not to follow patients after their TIPS, the hepatology, MICU or SICU residents do.

But a radiology resident or one in private practice has no business writing morphine or zolpiem scripts for people to take and have filled as an out-patient which is what this thread was about. Nor do they have any reason to right any script at all as they do not care for patients. Same goes for path, and I am sure it would bring a lot of scrutiny from regulatory agencies if they new a radiologist was writing scripts for sleeping or pain pills or even "benign" drugs like antibiotics or PPIs or SSRIs and people were getting them filled at Walgreens. I think they would risk losing their medical license as this would be sooo unethical.

 

[Jim Picotte]

Hey, I have a script pad and write for antibiotics occassionally for myself and an occasional script for my wife and family member. All you need to write prescriptions is a medical license. Doesn't matter what your specialty is and the state board of medicine will not do a thing about it if the local pathologist decides to treat their own high blood pressure, chronic pain. There is no risk at all to your medical license doing this. You should also document it, just like any other patient with a physical exam. Is it smart? Not at all. I personally wouldn't write for any hypertension drugs, SSRI's, etc. Hell, I can get some botox, open up a clinic and start doing a fee for service cosmetic practice if I want. Laser hair removal, the works...probably would do well. So could any physician.

As long as you pass the three steps (that's what Step III is about, the ability to practice GENERAL medicine alone and without supervision) and satisfy that particular state's requirements for licensure you can do anything really. The license doesn't restrict you from practicing ANY form of medicine. If I was good enough and a hospital was crazy enough to give me priveledges, I could do appendectomies even though I've had hardly any surgery training. I doubt I would be able to get any malpractice insurance and insurance carriers wouldn't pay for it, but if the patient would pay out of pocket and they don't sue me then there's nothing illegal about doing so.

I'll stop writing my own prescriptions when all the other specialties stop reading their own radiology studies. Feel free to report me to my state medical board as well...it is the eithical thing to do as you say.

 

[Bandit]

sorry guys. writing yourself scripts is NOT legal. Of course, it is done frequently -- I myself have writen for my synthroid when I was out----but it IS illegal and unethical.

EVERY script should be "endorsed" by a medical record/chart. This is not just for medical reasons--but trust me--it looks terrible to ANY type of governing body that you wrote yourself a script. If you find yourself in trouble--it wont matter if it is ocp, abx or allegra!

Need something? just get it from the sample closet.

 

[Jim Picotte]

It's not illegal (at least not in Michigan, I can't speak for other states) to write scripts for yourself. Ethical? Well that's another ballgame. You're right in that you should document it in a chart and it certainly isn't very smart to do as you would have trouble explaining to your state board how your treating your chronic back pain with all that vicodin.

 

[DoctorDoom]

Self-prescribing is not illegal in any state I know of, although the ethics have been debated. Basically it is not a practice to be engaged in recklessly. Knowingly feeding an addiction, whether for self or others, is a separate issue that is criminal under applicable state laws.

 

[Whisker Barrel Cortex]

OK, I guess in some special instances a radiology resident would write scripts, but as we all know, radiologists tend not to follow patients after their TIPS, the hepatology, MICU or SICU residents do.

But a radiology resident or one in private practice has no business writing morphine or zolpiem scripts for people to take and have filled as an out-patient which is what this thread was about. Nor do they have any reason to right any script at all as they do not care for patients. Same goes for path, and I am sure it would bring a lot of scrutiny from regulatory agencies if they new a radiologist was writing scripts for sleeping or pain pills or even "benign" drugs like antibiotics or PPIs or SSRIs and people were getting them filled at Walgreens. I think they would risk losing their medical license as this would be sooo unethical.

I see no ethical issues with prescribing antibiotics, SSRIs, PPIs, etc. I agree that giving outpatient narcotics, sleeping pills, etc is more of a problem.

So what do you think of clinicians referring their patients to their own imaging facility, billing them for the procedure, and then interpreting them? A little unethical? Out of their realm of practice? It is increasingly being done with a resulting increase in utilization of imaging and decrease in quality control since they have no real training in imaging. They have no training in radiation safety, formal imaging training, the physics behind the imaging and the artifacts it may cause, or what findings outside of their specialty may have an impact on the patient yet they seem to have no ethical problem with it.

 

[DoctorDoom]

So what do you think of clinicians referring their patients to their own imaging facility, billing them for the procedure, and then interpreting them? A little unethical? Out of their realm of practice? It is increasingly being done with a resulting increase in utilization of imaging and decrease in quality control since they have no real training in imaging. They have no training in radiation safety, formal imaging training, the physics behind the imaging and the artifacts it may cause, or what findings outside of their specialty may have an impact on the patient yet they seem to have no ethical problem with it.

Isn't this specifically prohibited by federal regulations against self-referral? Not only is it unethical it seems clearly illegal based on my understanding of the law.

 

[maxheadroom]

WBC, I disagree about PPIs and SSRIs. Both are drugs that are given for a long-term problem with significant possible complications related to the disease pathology. Deaths from esophageal cancer are up in the US when compared to the 1970s. Why? Because of the use of H2 blockers and PPIs -- symptoms are relieved, but there is a higher rate of Barrett's today than 30 years ago.

And do you feel qualified to diagnose and treat depression? Can you select an anti-depressant that is appropriate for a patient?

I know that I can't do that and be confident in my decison.

Yes, we all have a license to practice "medicine and surgery", but we have a responsibility to practice appropriately. As a Plastic Surgeon, I will write for appropriate pain meds and antibiotics on my own patients. It is foolish to work outside of your scope of practice.

 

[tsj]

I see no ethical issues with prescribing antibiotics, SSRIs, PPIs, etc. I agree that giving outpatient narcotics, sleeping pills, etc is more of a problem.

So what do you think of clinicians referring their patients to their own imaging facility, billing them for the procedure, and then interpreting them? A little unethical? Out of their realm of practice? It is increasingly being done with a resulting increase in utilization of imaging and decrease in quality control since they have no real training in imaging. They have no training in radiation safety, formal imaging training, the physics behind the imaging and the artifacts it may cause, or what findings outside of their specialty may have an impact on the patient yet they seem to have no ethical problem with it.

I don't know what this has to do with people owning their own MRIs or X-Rays. But if an orthopedist did own his own MRI, was up-front with the patient that it was his MRI machine, and told him that there were alternate locations to get an MRI if he so desired, I see no ethical problem with that. I am sure orthopedic surgeons are more than capable of diagnosising routine orthopedic issues, and could send any "trickier" cases to one who was more specialized. In fact I would bet an orthopedic surgeon with 20 years of experience would be superior over a radiologist just out of residnecy at reading "orthopedic" MRIs. Hell, dentist have read their own teeth X-rays for decades, why can't an orthopedist read an x-ray or MRI? It is basically the same thing.

 

[aphistis]

I don't know what this has to do with people owning their own MRIs or X-Rays. But if an orthopedist did own his own MRI, was up-front with the patient that it was his MRI machine, and told him that there were alternate locations to get an MRI if he so desired, I see no ethical problem with that. I am sure orthopedic surgeons are more than capable of diagnosising routine orthopedic issues, and could send any "trickier" cases to one who was more specialized. In fact I would bet an orthopedic surgeon with 20 years of experience would be superior over a radiologist just out of residnecy at reading "orthopedic" MRIs. Hell, dentist have read their own teeth X-rays for decades, why can't an orthopedist read an x-ray or MRI? It is basically the same thing.

You're right, it *is* exactly the same thing. That "thing" is training to interpret the images. We get extensive training at reading the radiographs we use in our field- primarily panos, bitewings, and periapicals. Would you want Joe Orthopod treatment-planning you based on his readings of your oral x-rays? (the correct answer here is a resounding "no" ) Likewise, you don't want a dentist interpreting your rotator cuff MRI. It's all about being educated enough to operate within your expertise, and equally importantly, being educated enough to recognize your own boundaries for the sake of your patients' welfare.

 

[Whisker Barrel Cortex]

WBC, I disagree about PPIs and SSRIs. Both are drugs that are given for a long-term problem with significant possible complications related to the disease pathology. Deaths from esophageal cancer are up in the US when compared to the 1970s. Why? Because of the use of H2 blockers and PPIs -- symptoms are relieved, but there is a higher rate of Barrett's today than 30 years ago.

And do you feel qualified to diagnose and treat depression? Can you select an anti-depressant that is appropriate for a patient?

I know that I can't do that and be confident in my decison.

Yes, we all have a license to practice "medicine and surgery", but we have a responsibility to practice appropriately. As a Plastic Surgeon, I will write for appropriate pain meds and antibiotics on my own patients. It is foolish to work outside of your scope of practice.

You're right, I'll change my statement a little bit. No I would not feel comfortable giving someone SSRIs. I would be OK with giving them a script for a refill if it wasn't available. Same with PPIs. At this point in time in my career, I would feel comfortable giving a lot of these meds since I just finished an internal medicine internship where I had a clinic at the VA. At this point I could manage hypertension, diabetes, depression (not as good as a psychiatrist) etc very well. As I progress in my career, I am sure this will change as I mover further away from clinical medicine.

As for self-referral being illegal, that does not apply to labs and radiology performed in a clinicians own clinic. I have had to over-read these images before, and as I stated, they are many times significantly sub-optimal in their quality and result in less diagnostic/less accurate results. This is because there is no radiologist who actually has knowledge of MRI sequences on site. Also, clinicians with no formal imaging training often get tunnel vision on their area of interest and miss signficant findings elsewhere. It is bad for patients and also drives up the cost of healthcare (the fastest increase in imaging is by cardiologists who often order multiple redundent tests on a patient now that they collect the interpreting fees in many locations).