Can I prescribe my girlfriend zofran?

[Syndicate]

I am a PGY3 internal medicine resident who's about to graduate in 2 months. My girlfriend and I are planning a vacation to Tulum, Mexico, where tap water is not drinkable. I want to prescribe zofran to my girlfriend so that in case we run into food poisoning/etc, we have zofran to take at the very least. Is there any way I can get in trouble for this? I am still under a hospital issued NPI number.

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[Chemist0157]

I am a PGY3 internal medicine resident who's about to graduate in 2 months. My girlfriend and I are planning a vacation to Tulum, Mexico, where tap water is not drinkable. I want to prescribe zofran to my girlfriend so that in case we run into food poisoning/etc, we have zofran to take at the very least. Is there any way I can get in trouble for this? I am still under a hospital issued NPI number.

It varies from state to state. I don't think you would get in trouble per se, but generally, the guidelines often read in such a way that prescribing to family or other loved ones should really be only in special circumstances. She could probably get Zofran else from another doctor before your trip.

I prescribed Tamiflu to my wife's aunt over Christmas time one year. She was able to get tested at a pharmacy I think, but there was no one to prescribe the medication, and she was within the window of potentially benefiting from it. That is the only time I have needed to do something like that.

 

[Redpancreas]

It varies from state to state. I don't think you would get in trouble per se, but generally, the guidelines often read in such a way that prescribing to family or other loved ones should really be only in special circumstances. She could probably get Zofran else from another doctor before your trip.

I prescribed Tamiflu to my wife's aunt over Christmas time one year. She was able to get tested at a pharmacy I think, but there was no one to prescribe the medication, and she was within the window of potentially benefiting from it. That is the only time I have needed to do something like that.

While in residency?

 

[Redpancreas]

I am a PGY3 internal medicine resident who's about to graduate in 2 months. My girlfriend and I are planning a vacation to Tulum, Mexico, where tap water is not drinkable. I want to prescribe zofran to my girlfriend so that in case we run into food poisoning/etc, we have zofran to take at the very least. Is there any way I can get in trouble for this? I am still under a hospital issued NPI number.

Your NPI doesn’t change. I wouldn’t RX anything, she can see a her PCP. Zofran’s also a helluva anti-emetic to use a first line for your girlfriend. I’m not saying she’s going to get QTC prolongation with the maybe 1-2 doses she may take assuming she’s not on a lot of other medications but I wouldn’t do it. I don’t know the exact specifics policy-wise. I had a Derm resident at my hospital Rx me something for an eczema flare once. I was grateful but I’d never do that sort of thing for others so I guess that makes me a hypocrit in a way.

 

[chessknt]

It isn’t illegal and nobody will care, same goes for self-prescribing. This only matters when controlled substances become involved or if you are using insurance to pay for drugs. People have particular ethical hang ups and there is theoretical liability risk but it isn’t like the state medical board is going to audit you.

 

[Chemist0157]

While in residency?

I think I was in fellowship. I don't think that matters very much.

 

[VA Hopeful Dr]

Your NPI doesn’t change. I wouldn’t RX anything, she can see a her PCP. Zofran’s also a helluva anti-emetic to use a first line for your girlfriend. I’m not saying she’s going to get QTC prolongation with the maybe 1-2 doses she may take assuming she’s not on a lot of other medications but I wouldn’t do it. I don’t know the exact specifics policy-wise. I had a Derm resident at my hospital Rx me something for an eczema flare once. I was grateful but I’d never do that sort of thing for others so I guess that makes me a hypocrit in a way.

Zofran is used first line by probably most of us. I keep a stash at my house and travel with it all the time.

 

[ortnakas]

It isn’t illegal and nobody will care, same goes for self-prescribing. This only matters when controlled substances become involved or if you are using insurance to pay for drugs. People have particular ethical hang ups and there is theoretical liability risk but it isn’t like the state medical board is going to audit you.

This is somewhat location dependent. Some states have pretty strict rules on prescribing only to people with an established physician-patient relationship with a documented medical record.

Now, I don’t know that those states have the motivation or means to track you down for something benign like doxycycline or zofran, but they could.

 

[VA Hopeful Dr]

This is somewhat location dependent. Some states have pretty strict rules on prescribing only to people with an established physician-patient relationship with a documented medical record.

Now, I don’t know that those states have the motivation or means to track you down for something benign like doxycycline or zofran, but they could.

That's why you jot down a quick note. I'll do that for family members for minor stuff after hours: poison ivy, allergies, GI bugs. Sheet of paper, 3-4 line soap note. Put it in a locked drawer.

State satisfied.

 

[chessknt]

This is somewhat location dependent. Some states have pretty strict rules on prescribing only to people with an established physician-patient relationship with a documented medical record.

Now, I don’t know that those states have the motivation or means to track you down for something benign like doxycycline or zofran, but they could.

Can you name a state for me where that is the case?

 

[Gastrapathy]

Someone has learned the GI secret about Zofran as a pretreatment for hangovers...

 

[Candidate2017]

If I got Mexican food poisoning, getting Zofran would be the least of my concerns. BTW, I believe no script is needed for most meds in Mexico.

 

[VA Hopeful Dr]

Can you name a state for me where that is the case?

Easily.

https://llr.sc.gov/med/PDF/Establishment%20of%20Physician-Patient%20Relationship%20as%20Prerequisite%20to%20Prescribing%20Drugs.pdf

 

[Redpancreas]

Zofran is used first line by probably most of us. I keep a stash at my house and travel with it all the time.

I mean in practice it is, but we are told it’s supposed to be really reserved as a first line for cancer patients getting chemo who’s gut lining cells are releasing serotonin, etc. but I suppose what else are we supposed to use? Compazine/Tigan have potentially dangerous side effects too and Zofran is probably what we’ve all prescribed the most. There’s supposed to be a small effect from antihistaminergics like atarax which would be a cleaner solution pharmacologically but I doubt that’s going to do that much for nausea from food poisoning. Would also wonder if it may be better to just watch and rehydrate in the case of toxin-induced gastroenteritis, unless the person’s retching dramatically.

 

[Syndicate]

If I got Mexican food poisoning, getting Zofran would be the least of my concerns. BTW, I believe no script is needed for most meds in Mexico.

I don’t trust the medical system there. I’ve heard horror stories about how tourists go to the ED and the hospitals demand upfront payment of thousands of dollars before they are even seen.

whether or not it’s true, idk. But I don’t want to take any chances

 

[VA Hopeful Dr]

I mean in practice it is, but we are told it’s supposed to be really reserved as a first line for cancer patients getting chemo who’s gut lining cells are releasing serotonin, etc. but I suppose what else are we supposed to use? Compazine/Tigan have potentially dangerous side effects too and Zofran is probably what we’ve all prescribed the most. There’s supposed to be a small effect from antihistaminergics like atarax which would be a cleaner solution pharmacologically but I doubt that’s going to do that much for nausea from food poisoning. Would also wonder if it may be better to just watch and rehydrate in the case of upper gastroenteritis, unless the person’s retching dramatically.

You know what's an absolute wonder drug for bad nausea? Haldol. I'm sure that's safer than zofran. Ativan isn't half bad either, plus you can get kinda high.

I'm not directing the snark at you personally, and I get why we're taught stuff like that. You want to make sure that you consider all the risks before prescribing something to a patient. But zofran, at the doses us non oncologists use, is very very safe.

 

[Redpancreas]

You know what's an absolute wonder drug for bad nausea? Haldol. I'm sure that's safer than zofran. Ativan isn't half bad either, plus you can get kinda high.

I'm not directing the snark at you personally, and I get why we're taught stuff like that. You want to make sure that you consider all the risks before prescribing something to a patient. But zofran, at the doses us non oncologists use, is very very safe.

Point taken. Thinking about this every time freezes you and if you're thinking about this you lose the ability to even function efficiently.

 

[VA Hopeful Dr]

Point taken. Thinking about this every time freezes you and if you're thinking about this you lose the ability to even function efficiently.

Its one of those things that over time you just kind of internalize it.

 

[chessknt]

Easily.

https://llr.sc.gov/med/PDF/Establishment%20of%20Physician-Patient%20Relationship%20as%20Prerequisite%20to%20Prescribing%20Drugs.pdf

Wow that is very clear. I guess ymmv depending on the state. I wonder if this has ever been used against a sc doc. Seems like massive overkill to me but no one ever accused the medical field of being under regulated.

Thanks for the link!

 

[VA Hopeful Dr]

Wow that is very clear. I guess ymmv depending on the state. I wonder if this has ever been used against a sc doc. Seems like massive overkill to me but no one ever accused the medical field of being under regulated.

Thanks for the link!

Its not usually the inciting thing for non-controlled meds, but if found during an investigation into something else it can get tacked on. Same sorta thing with seat belt laws.

SC is actually the least punitive in the country. Our board sanctions/1000 physicians/year is the lowest out of everywhere.

 

[NotAProgDirector]

My take is a bit more nuanced. If you have a full license, then all you you need to do is follow the law in the state you are in. Best practice is to have some sort of documentation. If your partner is enrolled in your EMR, you can simply add a note to their file. Or you can keep your own record as mentioned above -- and an electionic version in an electronic "drawer" is fine also. Ativan is a no-no to family members.

If you're on a training license, it's much more complicated. Everything you do should be supervised by someone. Just writing a script, even for something benign, is technically a problem. Will anyone notice / care? Probably not. But if someone does look, could be a huge problem for you from your training program. In that case, I'd recommend running it by someone and including that in your documentation.

The chance of badness is very small.

 

[DrMetal]

I want to prescribe zofran to my girlfriend

Don't drug up your girlfriend! Today it's zofran, tomorrow it's GHB . . . this ain't the 90s anymore.

 

[Siggy]

As others had said...

Theory: You should have a full license (not a training license) and establish a patient/provider relationship with documentation. Nothing scheduled/controlled.

Reality: Assuming nothing scheduled/controlled, the chance that someone notices you slipping your girl friend a course of Macrobid or someone in your family a few day supply of Tessalon perles is extremely small, and the likelyhood of someone actually caring is even less.

As a side note, why is Tessalon a prescription med in the first place?

 

[Animalcules]

Because we and everyone else underestimate the danger: Benzonatate Toxicity: Nothing to Cough At

Tessalon perles should not exist.

 

[shaggybill]

My take is a bit more nuanced. If you have a full license, then all you you need to do is follow the law in the state you are in. Best practice is to have some sort of documentation. If your partner is enrolled in your EMR, you can simply add a note to their file. Or you can keep your own record as mentioned above -- and an electionic version in an electronic "drawer" is fine also. Ativan is a no-no to family members.

If you're on a training license, it's much more complicated. Everything you do should be supervised by someone. Just writing a script, even for something benign, is technically a problem. Will anyone notice / care? Probably not. But if someone does look, could be a huge problem for you from your training program. In that case, I'd recommend running it by someone and including that in your documentation.

The chance of badness is very small.

But if the absolute worst happens, does malpractice cover you?