Can I prescribe myself stuff?

[suckstobeme]

Hey Guys-
Quick question (I'm sure someone addressed it at some point, but I can't find anything right now). Anyway, I just graduated med school 2 months ago and am now doing a residency. Can I prescribe stuff to myself? Does this look totally shady? Dont worry- I dont want to cover myself in fentanyl patches or anything. My albuterol is running out and I was wondering if I could get myself some more w/o having to talk to my PMD. I haven't been told I have a DEA# or anything, though.

Thanks.

 

[deleted87716]

No.

I guarantee you that your residency program prohibits prescribing for anyone with whom you do not have a legitimate doctor-patient relationship. That includes yourself.

Self-prescribing (or prescribing for family members or any other non-patients) is a slippery slope even after you're in private practice, and I caution against it except under emergent circumstances.* Prescribing outside an established doctor-patient relationship (even for non-scheduled medications) is also illegal in most states.

* Bold type added to assist the reading-impaired. You know who you are. 🙄

 

[southerndoc]

KentW mentions excellent points.

Don't do it. Physician don't treat thyself!

 

[sdn1977]

There actually is a very long thread on this somewhere - I know...I contributed a lot to it.

KentW is correct, for the most part....you shouldn't write an rx for yourself. However, as a pharmacist, particularly on a holiday weekend, I will dispense an albuterol inhaler to you or to anyone who has had a previous legitimate rx for it since the emergency laws within my state allow me to do this.

If a pt has never had it before & they're wheezing - I send them to urgent care or er.

If you aren't out....talk to or call your PMD or have your pharmacy fax a refill request. As long as you're stable, most will refill it for a year. If you have refills on the rx & its just a matter of having moved to a different state - call your new pharmacy & they'll transfer the refills.

The DEA# is needed only to bill insurance, but that is changing. By May 2007, each provider will have a new # - a NPI (National Provider Identifier) which will be a 10 digit numeric identifier that will contain no embedded intelligence about the health care provider it identifies - which a DEA# currently does. The new NPI will be the # that is used by insurers to identify providers which will keep the DEA separate & used only for identifying providers who can prescribe controlled substances.

 

[suckstobeme]

Thanks for the info guys. I guess I'll be giving my PMD a call tomorrow. {insert grumble here}

 

[Solideliquid]

Why not just go to your emplyee health center? Surely someone there can prescribe you albuterol.

 

[southerndoc]

The DEA# is needed only to bill insurance, but that is changing. By May 2007, each provider will have a new # - a NPI (National Provider Identifier) which will be a 10 digit numeric identifier that will contain no embedded intelligence about the health care provider it identifies - which a DEA# currently does. The new NPI will be the # that is used by insurers to identify providers which will keep the DEA separate & used only for identifying providers who can prescribe controlled substances.

What do you mean no embedded intelligence about the healthcare provider it identifies? Please explain.

 

[irrka]

ok i've two put my two cents in here. what a pain in the ass. i've been on the same med for years with no adjustments, nothing, all i need to go in for is refills. it's a waste of my time, it's a waste of their time, and for any chronic thing, i'm pretty sure any village idiot can figure out if he's getting worse he needs to go in. that said, it's also quite hard to find anyone who's going to work on the hours that you're off AND awake (ie not passed out post call)

 

[sdn1977]

What do you mean no embedded intelligence about the healthcare provider it identifies? Please explain.

Your DEA # tells me what kind of a provider you are - MD/DO/DDS or midlevel. It also tells me about when you received your DEA (#s that start with A's or older than those with B's). It also tells me if there have been any controlled drug violations against you. It also gives folks who shouldn't have access to your # the ability to use your # to prescribe without your authority, which in pharmacy we'e like to limit the availabilty of this #.

The NPI has been designed to give an identity to each provider to allow for billing - this is for prescribers as well as hospitals, clinics, pharmacies, etc. For some cirucumstances - billing from your office for example, you might use your tax id# which has all sorts of information linked to it - your SSI or if its a corporation, the SSI#s of the corporate officers.

The idea is to be able to bill for services without linking anything other than the service, the date, the provider & the pt to the insurance company. None of the other stuff should be available to insurance since it has nothing to do with the claim. Until now, tax id #s for medical office visits & DEA#s for medication claims have been used.

 

[njbmd]

Hey Guys-
Quick question (I'm sure someone addressed it at some point, but I can't find anything right now). Anyway, I just graduated med school 2 months ago and am now doing a residency. Can I prescribe stuff to myself? Does this look totally shady? Dont worry- I dont want to cover myself in fentanyl patches or anything. My albuterol is running out and I was wondering if I could get myself some more w/o having to talk to my PMD. I haven't been told I have a DEA# or anything, though.

Thanks.

Hey there,
One of the first things that I did when I started residency was get a good primary care doc and supply this person with a list of my meds. This kept me from running out of maintenance stuff (OCPs & inhalers). I just beep my PMD and the scripts ready for pick up or the med is phoned in. My PMD also makes sure that I keep up with my maintenance checks too. It's just good business and I love to have the medical students practice their interview skills on me anyway.

I would not prescribe any medication for self, relative or friend unless they are directly under your care (kinda hard to take care of yourself). Your training license allows you to write scripts for folks that you take care of within the context of your training program and you do have an institutional DEA number. To go outside this policy is to invite trouble that you do not need at this stage in your career. (One fellow in another program at my institution wrote a script for morphine for his girlfriend and got booted out of the program and cannot get licensed in this state).

My program gave us printed prescription pads complete with name and DEA number (for insitutional use only). We actually do not use them very often because our scripts print up complete with DEA number when we write the discharge instructions.

Good luck
njbmd 🙂

 

[12R34Y]

I got my NPI number when I started residency a few weeks ago.

just fyi.

i thought everybody had an NPI?

 

[needinformation]

I am surprised that all the writers here have the same opinion. Where are those who do prescribe for themselves, and I KNOW for a fact it is not that uncommon, I mean, certainly no controlled substances, but antibiotics, steriod creams, allergy meds...etc. Anyone?

The law acually simply says that meds can only be filled if there is a note. The doctor-patient relationship exists if there is a note. So, one could theoretically write on ANY piece of paper a simple SOAP note and then call the pharmacy in case you get audited. I don't know how the insurance then process the information for billing, but I would think if you just want some good old PCN, and since it is nearly free, if you paid for it youself, then no biggie. I would think. Not sure though.

Anyone with a differing opinion?

 

[LADoc00]

No.

I guarantee you that your residency program prohibits prescribing for anyone with whom you do not have a legitimate doctor-patient relationship. That includes yourself.

Self-prescribing (or prescribing for family members or any other non-patients) is a slippery slope even after you're in private practice, and I caution against it except under emergent circumstances. Prescribing outside an established doctor-patient relationship (even for non-scheduled medications) is also illegal in most states.

Wrong Kent, wrong. I self prescribed myself regularly in residency and the best part was the program paid for it if I got it at the hospital in house pharm. Same thing at my fellowship location but they would actually deliver it to me. You can absolutely have a minimalist doctor-patient relationship with yourself and would definitely challenge that anywhere in the US it is illegal to self-prescribe. The only exception is restricted narcotics, steroids and other class 2 or higher. (I think that is terminology, but Im a pathologist so what the hell do I know) Contrary to popular belief, DEA numbers are not needed for non-controlled substances, even if it a pharmacy demands it, it is ILLEGAL for them to require you have one for routine drugs. Tell them this or speak to a supervisor. DEA numbers are also not needed for insurance billing. That is myth.

 

[fuzzyerin]

I think what many of us do is have our Rx written by a colleague. Though I have called in Rx for myself for albuterol when I was wheezing and the pharmacist was extremely good about it. But when my medical file shows I've been taking the drug since I was 6, it's not like I'm prescribing myself some novel med. I probably wouldn't go much farther than that.

 

[Jocomama]

Yes, doctors may call in a inhaler or BCP or something simple like that. However, it is NOT the right thing to do. There are Federal and State laws. An audit? Hmmm, can you tell me about an audit? Do you think a SOAP note written on paper in your drawer will suffice?

Why in God's name would any doctor who knows their medicine be prescribing penicillin for themselves?

Listen - you are not supposed to write prescriptions for yourself or family members. Sure it happens, but why make a habit of crossing that boundary? Just do the right thing.

I am surprised that all the writers here have the same opinion. Where are those who do prescribe for themselves, and I KNOW for a fact it is not that uncommon, I mean, certainly no controlled substances, but antibiotics, steriod creams, allergy meds...etc. Anyone?

The law acually simply says that meds can only be filled if there is a note. The doctor-patient relationship exists if there is a note. So, one could theoretically write on ANY piece of paper a simple SOAP note and then call the pharmacy in case you get audited. I don't know how the insurance then process the information for billing, but I would think if you just want some good old PCN, and since it is nearly free, if you paid for it youself, then no biggie. I would think. Not sure though.

Anyone with a differing opinion?

 

[Jocomama]

Sorry - but just because you did it as a resident, doesn't mean it is right.
I would caution anyone suggesting to young student doctors or residents that it is OK to carry on this behavior.
You never know when and why you may get audited, or investigated.
A paper trail of self-prescribing is not something to be proud of. While you are a pathologist, that does not exclude you from following the code of ethics that all of us should adhere to regarding prescription writing.

Especially as electronic systems are becoming the standard.

If you have a problem, ask one of your colleagues on the appropriate service to check it out.

KentW had some great points that all of you reading this thread should try to follow. It is part of being a good doctor, and doing the right thing for your patients, your families and yourselves.
Short cuts can lead you down the wrong road.

Wrong Kent, wrong. I self prescribed myself regularly in residency and the best part was the program paid for it if I got it at the hospital in house pharm. Same thing at my fellowship location but they would actually deliver it to me. You can absolutely have a minimalist doctor-patient relationship with yourself and would definitely challenge that anywhere in the US it is illegal to self-prescribe. The only exception is restricted narcotics, steroids and other class 2 or higher. (I think that is terminology, but Im a pathologist so what the hell do I know) Contrary to popular belief, DEA numbers are not needed for non-controlled substances, even if it a pharmacy demands it, it is ILLEGAL for them to require you have one for routine drugs. Tell them this or speak to a supervisor. DEA numbers are also not needed for insurance billing. That is myth.

 

[LADoc00]

Sorry - but just because you did it as a resident, doesn't mean it is right.
I would caution anyone suggesting to young student doctors or residents that it is OK to carry on this behavior.
You never know when and why you may get audited, or investigated.
A paper trail of self-prescribing is not something to be proud of. While you are a pathologist, that does not exclude you from following the code of ethics that all of us should adhere to regarding prescription writing.

Especially as electronic systems are becoming the standard.

If you have a problem, ask one of your colleagues on the appropriate service to check it out.

KentW had some great points that all of you reading this thread should try to follow. It is part of being a good doctor, and doing the right thing for your patients, your families and yourselves.
Short cuts can lead you down the wrong road.

OMG, code of ethics?? Show me the code of ethics which says you are disallowed from treating yourself?! OMFG, you are in outer space! Im banging my head against the computer screen, Im in a profession filled with idiots. If you think other MDs should sit around in a waiting room to get Rx's for albuterol and flonase refills (I have had asthma/allergies since childhood) to do nothing more than line the pockets of self serving PMDs, you are quite frankly high or greedy.

Seriously, SHOW ME THE CODE OF ETHICS YOU SPEAK OF! Link it. Or STFU.

Im not claiming you should be treating complex diseases or serious issues, but the original poster Im sure would do just a good of a job managing his/her own asthma condition as any of us.

Let me make this as crystal clear as possible: IT IS RIGHT to give yourself an albuterol refill.........for the love of all living things, it is right and ethical.

 

[Heeed!]

OMG, code of ethics?? Show me the code of ethics which says you are disallowed from treating yourself?! OMFG, you are in outer space! Im banging my head against the computer screen, Im in a profession filled with idiots. If you think other MDs should sit around in a waiting room to get Rx's for albuterol and flonase refills (I have had asthma/allergies since childhood) to do nothing more than line the pockets of self serving PMDs, you are quite frankly high or greedy.

Seriously, SHOW ME THE CODE OF ETHICS YOU SPEAK OF! Link it. Or STFU.

Im not claiming you should be treating complex diseases or serious issues, but the original poster Im sure would do just a good of a job managing his/her own asthma condition as any of us.

Let me make this as crystal clear as possible: IT IS RIGHT to give yourself an albuterol refill.........for the love of all living things, it is right and ethical.

Crackin' me up!!

 

[Gut Shot]

OMG, code of ethics?? Show me the code of ethics which says you are disallowed from treating yourself?! OMFG, you are in outer space! Im banging my head against the computer screen, Im in a profession filled with idiots. If you think other MDs should sit around in a waiting room to get Rx's for albuterol and flonase refills (I have had asthma/allergies since childhood) to do nothing more than line the pockets of self serving PMDs, you are quite frankly high or greedy.

Seriously, SHOW ME THE CODE OF ETHICS YOU SPEAK OF! Link it. Or STFU.

Im not claiming you should be treating complex diseases or serious issues, but the original poster Im sure would do just a good of a job managing his/her own asthma condition as any of us.

Let me make this as crystal clear as possible: IT IS RIGHT to give yourself an albuterol refill.........for the love of all living things, it is right and ethical.

Say it, brother! I get wicked fever blisters (all oral, thank you), so I keep some self-prescribed Valtrex handy. Knocks those little suckers right out. Honestly, would you like your doctor greeting you with a huge crusty vesicular lesion weeping on his lip?

 

[12R34Y]

Residents and docs do this very frequently.

My EM attending recently prescribed himself a z-pack. whoop dee dooo.

Of course you never prescribe narcs, for friends/yourself. DUH!


but residents write stuff for each other all of the time as well. especially antibiotics.

who cares.

what happens if you get audited?! Nothing......you tell them your wife needed a steroid cream for poison ivy......so what.

this is very common practice where I'm at and definately no biggie.

later

 

[LADoc00]

Say it, brother! I get wicked fever blisters (all oral, thank you), so I keep some self-prescribed Valtrex handy. Knocks those little suckers right out. Honestly, would you like your doctor greeting you with a huge crusty vesicular lesion weeping on his lip?

You obviously going to burn in Hell for it according to some of the self-righteous posters on this site. I'll pray for your soul...

Seriously, this is total crazy talk. Everyone stop and think about it rationally.

There is NO audit, the government isnt going to pound down your door because of a damn albuterol refill!!!!!
I know most of you got through premed/med school and interships by being mindless sycophants but come on, give me a break here.

For all our viewers at home today:

are not coming to your house, calm down. I think some of the people here are screwed on so tight they may need medicinal MJ, in large amounts.

 

[pgg]

I am surprised that all the writers here have the same opinion. Where are those who do prescribe for themselves, and I KNOW for a fact it is not that uncommon, I mean, certainly no controlled substances, but antibiotics, steriod creams, allergy meds...etc. Anyone?

Yeah ... it's as if these people believe there's some absolute contraindication for self-prescribing or family-prescribing. I've done it a number of times. Just a few months ago I was picking up a prescription for my wife, and the pharmacist was kind enough to twist her computer around so I could use it to put in a prescription for myself at the same time.

Obviously no controlled substances, ever, and nothing that should have formal periodic followup or lab monitoring (eg BCP, hypertension or cholesterol meds, antidepressants, etc).

One of the benefits of self-prescribing many of us enjoy is that (depending on the institution) you can get OTC meds free from the hospital pharmacy. I'm not going to pay $20 for a three week supply of Claritin at Target when I can prescribe it to myself and pick it up at the place I work. (That garish red decor hurts my eyes, and then I'd have to self-prescribe some Visine.)

I've also *gasp* ordered labs, xrays, and consults for my wife because I thought the nurse practitioner assigned to her was a '****, and changing PCMs meant a month+ delay for another provider to get a routine appointment. (Her PCM apparently blew her off as a whiner but the orthopod I sent her to actually arranged treatment.)

There are limits, and it's important to never think of yourself as your own doctor or a family member's doctor. But this never ever never ever EVER ever never self/family-prescribe or self/family-treat SDN mantra is silly.

If my son cuts his arm on the playground and needs a few stitches, we're not going to the ER to sit and wait for 4 hours. I'm doing it in the kitchen.

Stick with the trivial stuff, maintain a healthy fear of your own bias/incompetence/not-my-area-of-expertise, and you'll be OK. Sheesh. 🙄

 

[deleted87716]

Wrong Kent, wrong.

Just because you can do something, doesn't mean you should.

Emergency prescribing is one thing. Doing it routinely is another.

There's an old saying, "When you treat yourself, you have an idiot for a doctor." Just remember that. 😉

 

[LADoc00]

Just because you can do something, doesn't mean you should.

When you treat yourself, you have an idiot for a doctor. Just remember that. 😉

Christ! Kent, you are speaking for yourself not me. Yes if I was an idiot, I wouldnt entrust my own health to my better judgment, luckily tho I ended up okay, with powers of reason and common sense. Common sense is all Im talking about, can we agree a general proclamation against all self-prescribing is ridiculous? Meet me halfway here Kent, you are killing me on this. Im going to self-Rx up some blood pressure meds soon, and since Im a pathologist they will likely be out of date and kill me...do you want my death on your hands Kent??? I think not.

 

[deleted87716]

If you bother to read the two posts I've already made on the subject, I think you'll find that further clarification is unnecessary.

 

[Gut Shot]

If my son cuts his arm on the playground and needs a few stitches, we're not going to the ER to sit and wait for 4 hours. I'm doing it in the kitchen.

Or how about when your better half starts to notice a bladder infection coming on one Friday evening. "Gee honey, I'd love to call you in some Bactrim-DS, but why don't we go sit in an ER all night long, or perhaps wait until Monday. Wouldn't that beat a 15 minute trip to the pharmacy?"

Yeah, there went the nookie train. Won't be back for some time.

 

[deleted87716]

Or how about when your better half starts to notice a bladder infection coming on one Friday evening. "Gee honey, I'd love to call you in some Bactrim-DS, but why don't we go sit in an ER all night long, or perhaps wait until Monday. Wouldn't that beat a 15 minute trip to the pharmacy?"

Has anyone in this thread stated that emergency prescribing was wrong? 😕

 

[deleted87716]

More info., for anyone interested.

http://www.cnn.com/HEALTH/bioethics/9811/self.prescription/template.html

http://www.aafp.org/fpm/20050300/41shou.html

http://www.nh.gov/medicine/bnews_guidelines_self.html

http://ask.metafilter.com/mefi/27780

http://www.webmm.ahrq.gov/case.aspx?caseID=71

Self-prescribing by Physicians. Vatcher et al. JAMA.1999; 281: 1488-1490.

The AMA position on self-prescribing, as shown in one of the above links:

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.

 

[LADoc00]

Kent, you are taking yourself too seriously on this point.

Seriously, we are gonna die anyway, I at least learned that much for my 150 grand in med school tuition.

I think this thread makes a very good point for legalizing recreational drugs...

 

[deleted87716]

Kent, you are taking yourself too seriously on this point.

You've written far more words in this thread than I have, my friend. 😉

 

[drbon]

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

i dunno, but i kinda think this statement supports some steroid cream, antibiotics, or an albuterol inhaler....

 

[deleted87716]

i dunno, but i kinda think this statement supports some steroid cream, antibiotics, or an albuterol inhaler....

The statement that I put in bold type supports it even better. 😉

 

[LADoc00]

Where's the love here? Back to the OP, some poor dude is getting home late at night from his/her internship and just wants a bit of albuterol to breath FFS. Where is the love?

 

[organicmatter]

I'm really enjoying this debate, though I feel some boundaries of civil discourse have been crossed as is unfortunately so common. I suppose the smart thing for me to do would be to contact my state medical board for a definitive answer to the question.

That said, I have to agree with those who consider it appropriate to prescribe for self/family/colleagues for noncontrolled substances even without an emergency indication. My time is much too valuable to me to be setting up an appointment with a primary care doctor. I would actually prefer a colleague to write the script for me just to avoid any potential anal retentive pharmacist who wants to question why the patient and the doctor have the same last name. Caveat: I would never prescribe a narcotic, benzo, etc. for myself or a family member.

 

[Twiki]

OP:
Just so you know, some insurance companies won't cover prescriptions written by a resident at all (unless it's cosigned by an attending). The insurance I had until recently was like that. I tried to get one of my fellow residents (who had a full medical license, not just a training one) to write me a script for some allergy medicine, and it was denied, because it was written by a resident. My husband was unable to fill a prescription written by a nephrology fellow (with whom he has a legitimate doctor-patient relationship) because it wasn't cosigned by an attending.

 

[Hardbody]

OP:
Just so you know, some insurance companies won't cover prescriptions written by a resident at all (unless it's cosigned by an attending). The insurance I had until recently was like that. I tried to get one of my fellow residents (who had a full medical license, not just a training one) to write me a script for some allergy medicine, and it was denied, because it was written by a resident. My husband was unable to fill a prescription written by a nephrology fellow (with whom he has a legitimate doctor-patient relationship) because it wasn't cosigned by an attending.

I am only pre med right now (so I have no first hand info on this), but this sounds like some jack a$$ pharmacist getting his/her **** off by busting the chops of a resident. A FULLY LICENSED physician is just that.

 

[Hardbody]

OP:
Just so you know, some insurance companies won't cover prescriptions written by a resident at all (unless it's cosigned by an attending). The insurance I had until recently was like that. I tried to get one of my fellow residents (who had a full medical license, not just a training one) to write me a script for some allergy medicine, and it was denied, because it was written by a resident. My husband was unable to fill a prescription written by a nephrology fellow (with whom he has a legitimate doctor-patient relationship) because it wasn't cosigned by an attending.

Seriously, if this is true, it is ridicolous. That means that a freshly minted NP or PA with NO residency training could write a script for the same thing, but the FULLY LICENSED physician couldn't? 👎

 

[Twiki]

I am only pre med right now (so I have no first hand info on this), but this sounds like some jack a$$ pharmacist getting his/her **** off by busting the chops of a resident. A FULLY LICENSED physician is just that.

Nope, it wasn't the pharmacist at all. They were fully prepared to fill the scripts, but when they called the insurance company, the coverage for the scripts was denied. We could have gotten them filled, but would have had to pay out of pocket for them. Our insurance at the time was through my husband's residency program, and I suspect this was their way of cracking down on people writing scripts for their buddies. In any case, it was the doing of the insurance company, not the pharmacy.

 

[sdn1977]

As a pharmacist....I bend lots of "rules" - really, there are more exceptions to the rules than rules themselves...so....yeah, I fill lots of stuff, but no controlled drugs.

As for insurance - the issue is the DEA#, which I spoke of before. No...you don't need a DEA# to prescribe noncontrolled substances, but the only way (right now anyway) for insurance companies to identify a prescriber...which they must do to process the rx, is the DEA#. The DEA#'s that won't fly are those that are issued to "institutions" - ie each teaching hospital has a DEA# which residents who don't have their own personal # can use to prescribe controlled substances. But...the insurance companies know these are institutional #'s (the embedded info...)& won't allow them, on occasion. I can argue myself deaf, dumb & blind - but...if the processor won't allow it....they just won't do it. For myself, in these situations, I ask who the attending is & I can find that DEA# in my files & I use that. There is usually a way around it.

This new NPI # should alleviate all this insurance nonsense!

And about the audits.....I just spent 30 minutes tonight looking thru our hardcopy rx files to make copies of rxs to send to an insurance company along with our dispensing record & signature record. I do this about 6-8 times per year.

As pharmacists, we're usually pretty good about stuff like this. Sometimes, we'll ask you to give us a name of one of your buddies we can use so we can fill an rx. So....please.....try not to call us names 🙁

 

[njbmd]

Or how about when your better half starts to notice a bladder infection coming on one Friday evening. "Gee honey, I'd love to call you in some Bactrim-DS, but why don't we go sit in an ER all night long, or perhaps wait until Monday. Wouldn't that beat a 15 minute trip to the pharmacy?"

Yeah, there went the nookie train. Won't be back for some time.

Hi there,
Why are you going to an ER? If you have a good primary care doc with whom you have a good relationship, you would be able to head on over to the pharmacy and pick up that Bactrim (not prescribed by you but by your primary care doc) for your wife. She could be at home drinking plenty of water to start the flush out process while you are picking up the medication for her.

I have never had to wait for a medication or wait an ED for anything for me or my family and I do not prescribe for myself or them. I beep or call my primary care doc for the things that I need on those Friday evenings. When his son needed a few sutures, I graciously met them in the ED on a Saturday night, examined the child and placed the sutures in one of the minor procedure rooms.

You really do not have to use the ED as an after-hour clinic wasting your time and theirs. You also, do not need to take on the liability of treating yourself. Just because you CAN do something does not mean that you SHOULD be doing it.

njbmd 🙂

 

[Gut Shot]

Why are you going to an ER? If you have a good primary care doc with whom you have a good relationship, you would be able to head on over to the pharmacy and pick up that Bactrim (not prescribed by you but by your primary care doc) for your wife.

Yes, if if if, could be could be could be. Perhaps she doesn’t have a primary care doctor because she’s in that hinterland between finishing college and starting a new job with benefits. Perhaps she just moved to the area and hasn’t had time to establish care with anyone. Perhaps she does have a primary care doctor who happens to be in Guam. Perhaps she noticed symptoms in the morning, and she absolutely has to get the script on her way to a very long, very demanding day at work, and trying to get the doctor on the horn at 6:30 AM isn’t too terribly possible. Perhaps life just isn't going as planned, ya know?

I have never had to wait for a medication or wait an ED for anything for me or my family and I do not prescribe for myself or them. I beep or call my primary care doc for the things that I need on those Friday evenings. When his son needed a few sutures, I graciously met them in the ED on a Saturday night, examined the child and placed the sutures in one of the minor procedure rooms.

Good for you, Dr. Gracious.

You really do not have to use the ED as an after-hour clinic wasting your time and theirs.

Since you’re so interested, I’ve actually been fortunate enough never to have to do this. I was merely positing a humor-tinged scenario.

Just because you CAN do something does not mean that you SHOULD be doing it.

The same goes for writing trite clichés.

 

[CNphair]

Ok, I don't want to get in the middle of the cat fight, but I do have a question about the emergency circumstances.

Say my mom needs an antibiotic rx over a weekend, and I feel ok with giving her one. Does it matter if she lives in a different city or state? Are residents restricted by their medical license to prescribe only within their state?

Thanks!

 

[outofhere]

Ok, I don't want to get in the middle of the cat fight, but I do have a question about the emergency circumstances.

Say my mom needs an antibiotic rx over a weekend, and I feel ok with giving her one. Does it matter if she lives in a different city or state? Are residents restricted by their medical license to prescribe only within their state?

Thanks!

I recently had a patient who went home to MA for a funeral, and I thought I wouldn't be able to use my CA license to refill his meds. But I could! So I have no idea what the 'rules' are. I have my own license and my DEA #.

I am very much enjoying the different views.

 

[deleted87716]

Are residents restricted by their medical license to prescribe only within their state?

Residents should ask their program director.

All other physicians will need to be familiar with the prescribing laws in their own state, and any other states in which they're attempting to prescribe. This information is usually available on the Internet. Virginia laws may be reviewed here: http://www.dhp.state.va.us/dhp_laws/default.htm

You could also ask the pharmacist in the state you're prescribing in.

In the state of Virginia:

54.1-3303.C. A pharmacist may dispense a controlled substance pursuant to a prescription of an out-of-state practitioner of medicine, osteopathy, podiatry, dentistry or veterinary medicine authorized to issue such prescription if the prescription complies with the requirements of this chapter and Chapter 34 (§ 54.1-3400 et seq.) of this title, known as the "Drug Control Act."

 

[KidDr]

As a pharmacist....I bend lots of "rules" - really, there are more exceptions to the rules than rules themselves...so....yeah, I fill lots of stuff, but no controlled drugs.

As for insurance - the issue is the DEA#, which I spoke of before. No...you don't need a DEA# to prescribe noncontrolled substances, but the only way (right now anyway) for insurance companies to identify a prescriber...which they must do to process the rx, is the DEA#. The DEA#'s that won't fly are those that are issued to "institutions" - ie each teaching hospital has a DEA# which residents who don't have their own personal # can use to prescribe controlled substances. But...the insurance companies know these are institutional #'s (the embedded info...)& won't allow them, on occasion. I can argue myself deaf, dumb & blind - but...if the processor won't allow it....they just won't do it. For myself, in these situations, I ask who the attending is & I can find that DEA# in my files & I use that. There is usually a way around it.

This new NPI # should alleviate all this insurance nonsense!

hey sdn1977,
Thanks for your input on this topic, it's interesting and helpful.
A couple questions for you--in the example you're referring to (originally posted by Twiki), the resident who was prescribing did have a full license, but the insurance company still did not pay for it. But you seem to be saying here that as long as a resident has a personal DEA# (and not an institutional DEA), the insurance companies should cover it. What am I missing here? Did the pharmacist just maybe not have access to the resident's personal DEA? (or maybe the resident had a license, but not a DEA# yet??). Along these lines, I'm also curious about this--when we call in prescriptions, and you look our names up in your system, does it say whether we have a personal DEA# (and can you access the number?). Thanks so much for your help!

 

[shorrin]

Hi there,
Why are you going to an ER? If you have a good primary care doc with whom you have a good relationship, you would be able to head on over to the pharmacy and pick up that Bactrim (not prescribed by you but by your primary care doc) for your wife. She could be at home drinking plenty of water to start the flush out process while you are picking up the medication for her.

WOW, have you ever had a UTI? If so then you would know that drinking plenty of water does NOT alleviate those terrible sx. What if the PCP was out of town or the office was closed and their "resident" or whoever was covering (if in fact you could get a hold of someone), didn't feel comfortable prescribing it even if you said you are an MD and described the sx perfectly.

This happened to me as a med student. I suffered for seven days till they could get me in to pee in a cup and tell me what I had already know for 9 days.

sorry, but you aren't being reasonable.

 

[outofhere]

WOW, have you ever had a UTI? If so then you would know that drinking plenty of water does NOT alleviate those terrible sx. What if the PCP was out of town or the office was closed and their "resident" or whoever was covering (if in fact you could get a hold of someone), didn't feel comfortable prescribing it even if you said you are an MD and described the sx perfectly.

This happened to me as a med student. I suffered for seven days till they could get me in to pee in a cup and tell me what I had already know for 9 days.

sorry, but you aren't being reasonable.

NINE DAYS! Wow, how did you not die from the PAIN!?!?!?

I was about to start my MSIII year when I had a UTI. I marched to my university hospital ER, waited an hour, peed in a cup, which was full of BLOOD! They rx the antibiotic ASAP. It was miserable.

I take Trader Joe's cranberry supplement, and it has helped, or at least, I have not had another AWFUL infection. Perhaps it is a placebo... but hey, can I give myself an herbal supplement or do I need my PCP's okay?

 

[All4MyDaughter]

hey sdn1977,
Thanks for your input on this topic, it's interesting and helpful.
A couple questions for you--in the example you're referring to (originally posted by Twiki), the resident who was prescribing did have a full license, but the insurance company still did not pay for it. But you seem to be saying here that as long as a resident has a personal DEA# (and not an institutional DEA), the insurance companies should cover it. What am I missing here? Did the pharmacist just maybe not have access to the resident's personal DEA? (or maybe the resident had a license, but not a DEA# yet??). Along these lines, I'm also curious about this--when we call in prescriptions, and you look our names up in your system, does it say whether we have a personal DEA# (and can you access the number?). Thanks so much for your help!

I'm not as knowledgable as sdn1977 but I can address a few of your questions. In my area (and I'd assume everywhere) medical residents generally have full license but many (maybe all?) do not yet have a personal DEA number assigned to them. They prescribe under their institutional DEA.

Contray to what others have said on the subject, a DEA# is required for some but not all insurance billing. Some insurance plans require a valid DEA# before they will adjudicate the claim. Some insurance computer systems kick out institutional DEA's as invalid. So the pharmacist can fill the (legend) prescription without the DEA but the third party (insurance) won't pay for it.

Yes, when we have a prescriber in our computer we can look at their profile and see their DEA number. We can also tell whether the DEA number is personal or institutional because the personal number is generally related to the prescriber's name. Most of the pharmacists around here are familiar with the institutional DEA numbers anyway.

There is a way to look up information about any prescriber anywhere in the country and get his or her DEA number, office address, etc. I've only seen it done once; it was online and accessed by the pharmacist using a username and password. Residents are probably not in the database if they don't yet have their own DEA#.

On the subject of self-prescribing, I'd agree that it isn't generally a good idea and I would not want to see a physician making a habit of it. However, I have filled prescriptions that doctors wrote for themselves and family members and would do so again, depending on the circumstances. I really think that most doctors self-Rx very sparingly if at all because it really is an ethical grey area.

I have seen and heard of several prescribers reported to Metro Narcotics or disciplined by the state board for problematic self and family Rxing. Our pharmacy reported a nurse practitioner who was trying to approve an early prescription for Adderall for her daughter. Nurse practitioners may neither prescribe nor approve early fills for controlled substances in my state. In this case, we suspected that the NP had actually written the script (signing the MD's name). It was too early for it to be filled (needs to be 28/30 days) and when we said we needed to call the doctor she demanded the script back and told us not to call.

 

[Vox Animo]

What if i prescribe myself narcotics, saying its the last time and promising myself to clean up after its gone?

 

[Hardbody]

So....please.....try not to call us names 🙁

Agreed, I was the jack a$$. I became a little too emotional when I was responding on this thread. Sorry for the "jack a$$" crack, it was uncalled for.