Can I prescribe myself stuff?
Started by suckstobeme
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KidDr said:
Well....I may have missed the detail in Twiki's post. But...I understood him (her?) to mean he was fully licensed as an MD. That just means he's passed all the board exams - it does not give him permission to use a DEA's# unless:
1. he's under the institutional DEA - which covers every resident from day one (the # will start with an "A" or "B" & the first letter of the hospital's name. ex: Stanford Hospital - AS.......)
2. he's applied for & received his own DEA #
Many providers are licensed, but don't have DEA #'s so they don't need to have both. But, the opposite does not hold - if you want a DEA #, you must be licensed as something - MD/DO, DDS/DMD, midlevel, etc...
A resident can have both his own DEA# & use the institution's #. The process of apply, paying your money (it's a lot 😉 ), receiving the information back, then putting the information online takes time - its a beauracracy - the Dept of Justice.
Not every state puts their DEA #'s online - but...as a pharmacist, I have ways of getting them. The onlne database is posted by each state & its up to each state if they want to post them or not, even though they are issued by the Dept of Justice. If you received your DEA for example in MA as a resident, but came to CA to practice or do a fellowship or something, I have to find you in the MA database - not the CA database. It takes me time, but I can usually do it - EXCEPT for brand new residents....they are very hard to reach because of their call schedule. If I call & page a resident who wrote the rx - its usually my bad luck he's gone off call. I just ask for the attending's name & use that - not really legal, but it works.
The issue with new residents & July 1 is they are not in anybody's system yet. It just takes time to put them in the database, but once you're in - I can find you for the whole time you're a resident in that location - or nearby anyway. If you stay in the state....I can find you too.
When you call in an rx - I need your name (spelling is helpful!), address (hospital address is ok with me), phone number (if you're using the hospital - please give me your pager # too), license #, license category (MD/DO) & DEA#. When this NPI gets going.....I'll only need the DEA for controlled substances - as it should be.
I hope I answered the question you asked......let me now if I didn't...
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KentW said:
Excellent post.
I don't see why everyone is so uppity about something that is established in guidelines.
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LADoc00 said:
Preach it, brother! You have just become one of my favorite posters.
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driedcaribou said:
How about those of us who don't belong to the AMA?
Panda Bear said:
C'mon, you guys...get a room! 🙄
awesome. after reading this thread in the time i could've but didn't find a pmd on my handy dandy new insurance plan which i don't even know how to work out yet, i just called cvs and called in a maintenance med prescription for myself. "when would you like to pick it up m'am?" was the only question that threw me 😉
(I get sick alot. 'Nuff said.)
I'm not going to waste my precious, rare SPARE TIME on making an appt, requesting time off (if conflicts occur), sitting in a waiting room, then sitting in the little room, lamenting my decision to leave the STAR magazine in the waiting room, only to have some meathead who isn't my PCP interrogate me about my asthma to determine whether or not I really need to refill my inhaler and/or my pulmicort, and suggest I get worked up for GERD, get a CXR (maybe the coughing is an infection and not the asthma even though this is how it worses EVERY WINTER for my whole freakin' life), etc.
Same goes for my 47th UTI, which I do call about, but get told that "I need to be seen", because as a medical student, I could have made the wrong diagnosis.
Or the "Here's my $15, go buy yourself a steak" appointments so that my PCP can write lab orders to check my TSH for my hypothyroidism (and don't even get me started on how I have to have an appt to get the results!)
Or the third bout with mastitis that started in an airport when about to board a plane with my ten week old son in order to move to another state, where I of course, could not possibly have a PCP yet. (After three days, it finally went away on its own.)
It just seems lame to have to go in or suffer (as in the last example) when one is a physician and knows what to do and is able to do it. I think that I can and should check my own TSH, order my own asthma meds, and treat my own UTIs and mastitis (initially).
I'm not going to waste my precious, rare SPARE TIME on making an appt, requesting time off (if conflicts occur), sitting in a waiting room, then sitting in the little room, lamenting my decision to leave the STAR magazine in the waiting room, only to have some meathead who isn't my PCP interrogate me about my asthma to determine whether or not I really need to refill my inhaler and/or my pulmicort, and suggest I get worked up for GERD, get a CXR (maybe the coughing is an infection and not the asthma even though this is how it worses EVERY WINTER for my whole freakin' life), etc.
Same goes for my 47th UTI, which I do call about, but get told that "I need to be seen", because as a medical student, I could have made the wrong diagnosis.
Or the "Here's my $15, go buy yourself a steak" appointments so that my PCP can write lab orders to check my TSH for my hypothyroidism (and don't even get me started on how I have to have an appt to get the results!)
Or the third bout with mastitis that started in an airport when about to board a plane with my ten week old son in order to move to another state, where I of course, could not possibly have a PCP yet. (After three days, it finally went away on its own.)
It just seems lame to have to go in or suffer (as in the last example) when one is a physician and knows what to do and is able to do it. I think that I can and should check my own TSH, order my own asthma meds, and treat my own UTIs and mastitis (initially).
Where is your MD?
In your emotional state of disgust for those of us that have practiced this thing one assumes is so easy, you stated UTI. Now if you have that many UTIs as a man, you should have those congenital posterior urethral valves taken care of by a practicing urologist. If you are a women, then maybe you should take some time and visit your OB/GYN.
But more than likely, we recognized that you mean URI, and not UTI.
THen again, at your age, why are you getting so many URIs? And of course being in Medical school, you must know what percent can be treated with a prescription.
I dont know why we even bother with residencies, what with this 80hr work week and all. Why not let us just prescribe and treat ourselves. And why wait 4 yrs for the MD - we know what is best for us now, right?
I digress. It's been a while since I have let my sarcasm go and abused my pen on this here 'ol site. Must be my Concerta has worn off for the evening.
Or my Super-Ego has just gone to bed, leaving my Ego un-controlled.
Heck - maybe my age is showing?
Go ahead and take that Z-pack; it will cure your UTI, help increase our chances of Community Acquired MRSA, flesh eating bacteria, etc. and......
OK OK - sorry I'll quit before I get demoted and bumped to the Drs Lounge.
Sorry - couldn't help it.
In your emotional state of disgust for those of us that have practiced this thing one assumes is so easy, you stated UTI. Now if you have that many UTIs as a man, you should have those congenital posterior urethral valves taken care of by a practicing urologist. If you are a women, then maybe you should take some time and visit your OB/GYN.
But more than likely, we recognized that you mean URI, and not UTI.
THen again, at your age, why are you getting so many URIs? And of course being in Medical school, you must know what percent can be treated with a prescription.
I dont know why we even bother with residencies, what with this 80hr work week and all. Why not let us just prescribe and treat ourselves. And why wait 4 yrs for the MD - we know what is best for us now, right?
I digress. It's been a while since I have let my sarcasm go and abused my pen on this here 'ol site. Must be my Concerta has worn off for the evening.
Or my Super-Ego has just gone to bed, leaving my Ego un-controlled.
Heck - maybe my age is showing?
Go ahead and take that Z-pack; it will cure your UTI, help increase our chances of Community Acquired MRSA, flesh eating bacteria, etc. and......
OK OK - sorry I'll quit before I get demoted and bumped to the Drs Lounge.
Sorry - couldn't help it.
Doc Oc said:
Residents in my program self-prescribe all the time. Sleepers, abx, antihistamines. One even ended up hospitalized with pyelo. Antibiotic resistance anyone?
I think it's stupid to self-prescribe meds without lab work. What if Dr. Chick has an itch down there, thinks it's yeast and it turns out to be BV. That's going to be a raging mess
Maybe albuterol is ok, but if you are using that much albuterol you probably are on the wrong meds.
I think it's stupid to self-prescribe meds without lab work. What if Dr. Chick has an itch down there, thinks it's yeast and it turns out to be BV. That's going to be a raging mess
Maybe albuterol is ok, but if you are using that much albuterol you probably are on the wrong meds.
LADoc00 said:
Ethically prescribed by another doctor, of course.
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I agree.Doc Oc said:
- Does a plumber hire another plumber to fix his pipes?
- Does an accountant refuse to do his own taxes?
- Does a lawyer have to hire another attorney to analyse his contracts?
- Does a dentist hire another dentist to fix the teeth of his own family?
I think its funny how Puritan we still are in medicine..you would think we walk around with shoe buckles and turkey rifles for all the events of the last two centuries. The idea of denying care to your own family members seems unnatural, cold, and defies common sense.
By pulling up your name in their prescriber database (which you get into if you have a DEA and a medical license). That is why, depending on the state, you might have a hard time to just call something in as an intern without being in the pharmacies computer system from prior paper based prescriptions.
Watch your state laws. Think about the political climate. By calling and writing your own scripts, you leave a paper trail. If it's an emergency - but otherwise, get your intern/resident to call it in - that's so easy.
It's just not worth the risk to call in your own stuff.
It's just one of those things that is not a good idea to get started with.
You never know who is watching - and if the state law says, then follow.
It's just not worth the risk to call in your own stuff.
It's just one of those things that is not a good idea to get started with.
You never know who is watching - and if the state law says, then follow.
Hurricane said:
Hurricane said:
We know.....& no...I won't give away how I get the ways to know - just know that I can & I do when its important enough (albuterol is not important enough!)
As the initial poster asked - if I remember correctly....it was about an albuterol inhaler. I wouldn't deny an albuterol inhaler to anyone who had a previous rx for one (or NTG or isosorbide, etc...) - MD or otherwise. If you are from another state, its easy for me to determine that you have received the rx there.
But...if you try to scam me...yes - I can find out if you are real - the data base is pretty extensive, unless you are brand new - then you don't exist until you get put in the data base.
I'm in CA & I actually had to call today to verify the validity of someone in FL - we share info all the time - not just numbers, but we can see if you have an active license, what state your license came from....& in this case...the Fl pharmacist thought the MD I was asking about was dead (he wasn't - just an inactive license, which still meant he couldn't prescribe in my state).
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sdn1977 said:
If a doc in State A writes a rx for a patient in his office (in State A), but the patient then travels to State B and goes to the pharmacy in State B, is that prescription valid and will the pharmacy fill it?
This is assuming that the doc has a valid license in State A, but does not have a license in State B.
group_theory said:
Yes...the rx is valid. Will the pharmacy fill it - hmmm...depends. If its for albuterol - yes - I'd jump out there & say unless the pharmacist is pissed off at something you have absolutely nothing to do with at all, yes..he'd fill your albuterol (or lisinopril, ortho novum, zithromax, etc) no matter what state we work in.
But...if you come to me with an rx that your friend wrote on a blank with an Iowa address for Dilaudid. Well.....I probably won't fill that rx in CA. For controlled drugs, some states have actual laws which prevent them from filling out of state rxs. Texas is one that I know of for sure. Texas pharmacists can't fill a controlled drug from any other state - even if it is a valid rx in CA that I have filled & it has valid refills & I transfer from pharmacist to pharmacist over the phone. They can't do it & vice versa - they can't transfer one out to me either. The lesson here is - if you go into or out of Texas - take enough medication! 😀 (Also - controlled drugs can only be transferred once by any pharmacy - federal law).
Controlled drug rx filling is much more under the influence of the pharmacists judgement. GENERALLY, I don't fill CII's from physicians outside of the 3 counties which surround me, which rarely happens. However, I live in an area with a lot of contract software workers who are here for 6-9 months at a time. So...there are times I do need to verify the validity of their own physician. But its easy enough to do. So, I can't say it never happens, but not that often & these folks are used to having to set up a relationship with someone like me early when they arrive. We can just tell when someone is trying to pass off a fake rx.
suckstobeme said:
I think it's really less of a legality issue and more of an ethical issue.
Shortly after graduating med school, I "wrote" a script for myself here and there but only for things I had taken before that had been prescribed (e.g. clindamycin topical solution, one time I got a Z-pack).
What I did, though, was always just call in the prescription and talk to the pharmacist on the phone (that's how I "wrote" the scripts). I let them know of the situation and they were cool with it. If you're worried about getting into trouble for whatever reason, call it in and don't leave a paper trail by providing a written Rx.
Hurricane said:
Docs know how scripts are written and in what order, know the latin words used commonly (e.g. sig, prn, q4h, etc), and they know what info they usually have to provide beforehand so a real doc would say something like this:
"hi, this is dr. hurricane calling in a script for one of my patients...the patient's name is john hurricane, spelled h-u-r-r-i-c-a-n-e, date of birth is ___, and the script is for albuterol x% inhaler. my directions are as follows: sig 1-2 puffs po q4 hours prn. Dispense 1 inhaler, and you can put two refills on that."
then they'll usually ask your phone number and if necessary your DEA.
and as for some of the posts on this thread, i'm surprised....i was writing 10-15 scripts a day for CII meds using my hospital DEA # and medical trainee license on my first week of internship. i guess it varies depending on where you are.
oh, and FYI interns out there---you ARE allowed to CALL IN schedule III-IV drugs without any paperwork. this is very convenient at times for surgical interns if you forgot to give the patient a script for vicodin or tylenol #3, etc. or if you want to make any changes to the Rx after the patient has left the hospital (e.g. authorize a refill, change the quantity, etc). just have your dea number handy.
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mcindoe said:
There's still a "paper trail," it's just an electronic one. The pharmacist has to record who he dispensed the medication to, who the prescriber was, etc. in his computer system. If somebody wants that information, it's there.
KentW said:
Yep! Any the trail goes to the Dept of Justice & DEA in real time online for CII-III & I've got your signature when you picked it up & I've got your face on the camera which points right at you when you stand at the pharmacy (like the little one at the ATM).
After everything you've put in to get to this point why would you risk losing any part of it over something as stupid as this? Get a friend to write it if there is any question!
Some of you seem to be trying to subvert or trying to get around the system. Drug diversion is a huge, huge problem - no not flonase - who gets a fix from flonase!!! But...thats not the issue here. It is not an ethical issue for me - it is absolutely a legal issue. If I dispense a Z-pk to you - I AM DOING YOU A FAVOR! I am breaking the law. I know it & will do it, but only on my terms. If you arrogantly come up to me and say I've been an intern for 1 week & I've already written 20 percocet rxs so now I want you to fill my Z-pk, I'll just smile & say no, I really can't (or more likely, sorry - we've just run out of that).
Now...as I've posted before....if you are nice, explain you are new to the area, don't have a dr, can't find that albuterol inhaler you use (or any of the many other possible scenarios) and use the word please......yes - I'll probably not only dispense you one, I'll dispense it for free because you've been nice & you're poor (which I do for lots of pts anyway). But...never, ever think I haven't broken the law - I have! I just know how far I am willing to go & nobody - even a prescriber - will ever push me farther than what I'm willing to lose myself.
What the hell?traintosave2000 said:
I've self prescribed myself several drugs in my limited career as well as to my wife (I have a full license as well as DEA number). Of course, I would never prescribe any controlled substance to myself or family member unless it was an emergency. Never had a problem and at least in Michigan this practice isn't illegal. May not be smart, and I'd certainly not self prescribe any controlled substances, you're not going to get your license pulled for prescribing yourself a Z-pak or albuterol.
Of course, I'd recommend that you should be under the care of a more objective physician (someone thats not you) for you and your family members.
Of course, I'd recommend that you should be under the care of a more objective physician (someone thats not you) for you and your family members.
KidDr said:
Actually, there was a thread awhile ago where I listed all the applicable CA business & professions codes which apply. That was CA only - there are 49 other versions! My internet connection is transient because my power is on a rolling blackout, so I can't cite them exactly.
But...here it is in a nutshell - in CA...you have you to have a "good faith relatioship" with the pt in addition to other stipulations. This is a particularly ambigious statement to be sure. But...the original intent (decades ago) was to prevent just anyone from prescribing - what one poster said - just calling me up impersonating a prescriber. Currently...what this is doing is limiting the "internet" prescribers. That thread went back & forth on all the different possibilities of interpretation, but it comes down to what the pharmacist feels comfortable doing. If they've been harrassed by their state board inspector, they will do nothing outside the boundaries.
The other major limitation is prescribers are limited to their "scope of practice". So...a dentist should not be prescribing lisinopril, for example.
However, I do use this example because I was just presented with this very situation on Sunday. A local dentist - I know him from other rxs I've filled had his Canadian mother visiting. She lost her lisinopril which she packed (DON'T PACK YOUR MEDICATION). She had a bottle in her purse with 1 tablet remaining so I could see the label, see the pharmacy (Montreal Canada) see the drug & strength, verify the one tablet was indeed what it was supposed to be - BUT we cannot fill rxs from prescribers from out of the country nor can we transfer them. She was 79, in my area for 3 days & with a son who was a dentist. So...I could send her to the local ER (which is waaaaay backed up because we've had hotter than normal temps for more than 10 days - very unusual) - or - I could let him prescribe 5 days worth of medication until she got home or to her next stop when the luggage might catch up. Did I break the law - yep. Lisinopril is definitely out of the scope of practice of a dentist & he did not have a proper medical relationship with her - dental maybe, but not medical.
But...I used my judgement to give the lady what she needed so she didn't end up being a pt here, she could finish her visit & go on the the next set of grandchildren or home, whatever....I didn't charge her - professional courtesey.
A few points to remember:
Each state is governed by separate pharmacy laws - what is allowable in NY may not be allowable in CA. So - if you did your first PGY-1 year in NY then you move to CA & we are different, its because we have different laws.
As a licensed MD/DO/DDS - you can prescribe - you don't need your institutional #. However, your degree alone does not allow prescribing - you must be in good standing with your license - whichever state licenses you. A license to practice medicine or dentistry is good enough (you have to pay your money & get the license#!) Not all states allow prescribers from other states to prescribe in their state - we do in CA. So...MD's who do academic research only & do not have a license do not get to prescribe.
Insurance reimbursement requires an indentifying prescriber. Currently - it is a DEA - it will change by May of next near to an NPI which is far better. So...if the pharmacist calls & says the insurance denies your prescription (which they might because they do sometimes deny institutional DEA's) - its not because you are not allowed to prescribe - its because the insurance cannot recognize you. In this situation, use your attending's name & #, if its ok with him/her.
To prescribe controlled substances, you need a DEA # - your DEA can be 2, 2N, 3, 4 or 5. If you don't have the appropriate classification on your DEA #, I won't dispense what you write. So...if you don't have a 2N - I won't dispense Percocet, but I will dispense Vicodin if you have a 3. These are federal laws, however, if state law is more restrictive, state law prevails (TX for example).
Pharmacy is one of the most regulated professions around with more exceptions to the rules sometimes than rules themselves. There are 50 versions of each set of rules too - so its hard to give you a flat answer on a forum such as this. I only know CA laws since that is the only place I'm licensed.
Go talk to your pharmacist....be nice....explain what you'd like to have. Really - most of us want to work with you. We have no vested interest in pissing you off & sometimes its external forces (like a state board inspector) who might cause us to be extra tight.
I hope that answered your question - gotta send this before my power goes out again!
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It is not the pharmacist who is "demanding" that a DEA# accompany all Rxs. If a cash customer has a non-controlled substance RX, we can process it without a DEA#. Very few insurance companies will process an online claim these days without a valid DEA#. Some of them actually have databases that cross reference the DEA# with the type of prescriptive authority and will reject certain claims based on this. For example, the processor for the Group Health Options Plan identifies and excludes Rx's written by dentists, since their formulary excludes dental Rx's. The DEA#s were not intended to be used this way, which is why there was the push to go to another identification code system. If you are upset about being asked for a DEA# for insurance purposes, you belong on the backs of the insurance processors. It's their system. Like the patient and prescriber, we just operate within it.LADoc00 said:
There is no federal law. It's a state-by-state thing. In OR it's legal to self prescribe any drug. In WA a prescriber may not self-prescribe controlled substances. Some states may have laws outlawing any self-prescribing. It is each prescriber's responsibility to know and follow their own state law.KidDr said:
As residents with training licenses, are we permitted to prescribe Rx out-of-state?
I ran into the problem where the out-of-state pharmacy needed a DEA number to look me up on their list of physicians. But since I have only a hospital DEA number, she couldn't do it. It was (obviously) not an uncontrolled substance, but they wouldn't just take my training license number. It appears that most states will allow patients to fill scripts written by physicians licensed in another state, but does this not hold true for training licenses?
I ran into the problem where the out-of-state pharmacy needed a DEA number to look me up on their list of physicians. But since I have only a hospital DEA number, she couldn't do it. It was (obviously) not an uncontrolled substance, but they wouldn't just take my training license number. It appears that most states will allow patients to fill scripts written by physicians licensed in another state, but does this not hold true for training licenses?
sdn1977 said:
bananaface said:
If I understand it correctly, that is what the NPI is for. I didn't really look into it, the credentialing office just sent of a bunch of stuff recently to obtain one. My understanding is that it replaces the UPIN to some extent (while including non-physician prescribers).
There is nothing wrong, per Se , with a licensed physician prescribing for himself or his family, and there are no State Laws which categorically forbid that. There are laws that address the self-prescription of controlled substances, like narcotics and sedative-hypnotics. I have prescribed non-controlled medications to myself and family members (MDIs, ABx, etc.), based on my examination (and yes, I keep notes on file). I see nothing wrong with this. I'm sure that many will disagree, and I suspect that most of them are not licensed physicians. Many of them may well change their opinions after they graduate from med school and get licensed and have been practicing for some time.
In many cultures (Greek, for example, where most of what we learned originated), it would be the height of offensiveness if you DIDN'T prescribe and treat your family.
Just learned that recently. Thought it was interesting. All the frowning on self- and fam-prescribing is largely cultural. To my surprise, I'm finding that MUCH of medicine is nothing more than taboo, superstition and cultural norms given unnatural staying power by highly controlling personalities.
Just learned that recently. Thought it was interesting. All the frowning on self- and fam-prescribing is largely cultural. To my surprise, I'm finding that MUCH of medicine is nothing more than taboo, superstition and cultural norms given unnatural staying power by highly controlling personalities.
neurodoc said:There is nothing wrong, per Se , with a licensed physician prescribing for himself or his family, and there are no State Laws which categorically forbid that. There are laws that address the self-prescription of controlled substances, like narcotics and sedative-hypnotics. I have prescribed non-controlled medications to myself and family members (MDIs, ABx, etc.), based on my examination (and yes, I keep notes on file). I see nothing wrong with this. I'm sure that many will disagree, and I suspect that most of them are not licensed physicians. Many of them may well change their opinions after they graduate from med school and get licensed and have been practicing for some time.
You and I are coming from different perspectives, you as a prescriber & me as the dispenser, but we practice in the same state, so we are on the same page here. I take exception to your statement there are no laws which address this - there are - they are just not in your field.
Your medical laws may not expressly state that you cannot prescribe for yourself - I don't presume to know those laws. However...there are pharmacy state laws in CA, which I must follow, which expressly state that I cannot filll an rx from someone:
1. outside of the scope of their practice
2. for someone the prescriber does not have a professional relationship with
3. for the prescriber him/herself
and - I know those laws very, very well since I've been a pharmacist in CA for nearly 30 years. I've had lots of experience & uniformly those physicians who have been in practice a long time have others write their rxs. Again....that is not to say I won't do it - especially if you are prescribing Imitrex for your wife (are you a neurologist?) However...if you want to prescribe Lamisil for your dad or amoxicillin for yourself - we are now out of your scope of practice & that becomes a favor & my decision on how much risk I take. I'm sure you've done it & it was filled, but perhaps you didn't realize the pharmacist was breaking one of his/her laws that you weren't even aware of.
All we ask is you are respective of the laws we must function under even though you don't know them & they don't make rational sense to you.
sdn1977 said:
I'm a neurologist and have been licensed in CA since 1990. I don't claim to know all of the laws that regulate pharmacist dispensing, but I think I know the laws that regulate my own prescribing as a physician. These laws require a good faith examination of the patient to whom you prescribe (and there is no outright prohibition against prescribing for oneself or family/friends). There are laws that prohibit "self-prescription" of narcotics. I understand and agree with the reasons for these laws, and I have no problem obeying them.
I suspect that some people, who are not physicians (and some who are) may object to a licensed physician's ability to self-prescribe ANY medications. To repeat: this is not prohibited (except for narcotics) by California or any other State. If I'm wrong, please let me know, and please cite the law, so that I can look it up.
Who would be watching the Antibiotic Police?
I am just a path resident and I have perscribed z-packs and stuff like that for me and my friends. Big god damn deal.
Get stoned on what? Amoxacillin for bronchitis? Atenolol for essential hypertension or migraine prophylaxis? Let's get real here. Or maybe you are just "projecting" (that's a term from psychiatry). 🙂
Nick
You shouldn't be treating bronchitis with anything other than comfort care as it is almost always viral. Nor would amoxicillin be your druf of choice for a pulm infection. You did say you were a neurodoc however. So, I'll cut you some slack
You shouldn't be treating bronchitis with anything other than comfort care as it is almost always viral. Nor would amoxicillin be your druf of choice for a pulm infection. You did say you were a neurodoc however. So, I'll cut you some slack
I was referring to bacterial bronchitis, which can appropriately be treated with amoxacillin, doxycycline, TMP-SMX, or a po cephalosporin, or in more severe cases with Augmentin, Biaxin, Zithromax, or even fluoroquinolones....but thanks for cutting me some slack...😉
Nick
Not quite sure how you are diagnosing "bacterial bronchitis". There is UAB "uncomplicated acute bronchitis" which is almost always viral. Many pathogens have been identified, but these patients can grow out anything. Lots of normal oral flora in the sputum cultures.
Studies have been done that amoxicillin, erythromycin, fluoroquinolones for UAB do NOT affect outcome and increase risk for side effects.
Now if you are treating exacerbation of COPD then yes........antibiotics. If it is pneumonia you treat with antibiotics.
You generally need a cough with an uncomplicated course for 2-3 weeks to diagnose and sputum cultures and gram stain are not indicated.
You also don't treat it with antibiotics.
no problem with the slack.......again......you are a neurologist. I wouldn't be good at localizing a stroke of Physical exam nor treating MS either.
To go back to the original question:
1. Yes, you can prescribe meds for yourself. As evidenced here by the testimony of many physicians. There are no laws against it, only guidelines.
2. Does it look shady? Perhaps. But this is an ethical call for you and your conscience to battle out.
3. No DEA number? May be problematic for the filling pharmacy.
1. Yes, you can prescribe meds for yourself. As evidenced here by the testimony of many physicians. There are no laws against it, only guidelines.
2. Does it look shady? Perhaps. But this is an ethical call for you and your conscience to battle out.
3. No DEA number? May be problematic for the filling pharmacy.
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I have run into the no DEA number for some of my non-controlled substances. I still and adamantly refuse to provide a DEA number for unscheduled Rx. Why?
Because our state monitors the use of Schedule II-IV medications by patient/prescriber and in the "pay-for-performance" scheme of things, I get dinged if I am one of multiple prescribers. There are certain pharmacies that want a DEA number for any meds. In the past, I have relented since my patients were the ones caught in the crossfire.
This has caused me a bunch of trouble as certain pharmacies will pick the closest sounding physician's name or match out of the computer and I find myself receiving reports from the state for prescribing amphetamines to children all the time from a particular pharmacy.
The problem with this is that I don't do behavioral medicine, and certainly not in pediatric cases. I'm an oncologist. This is so far outside my scope of practice as to be just plain weird. So, each time I get one of these reports, I have to a) call the pharmacy, b) be put on hold c) fill out paperwork and d) fax it off to the pharmacy and request they verify the script and the author and e) report the discrepancy to the state.
Ergo, pharmacists out there, if the Rx is not for a schedule substance the only way you'll get my DEA number is bamboo splints under the fingernails. Once burned, twice shy.
I too am waiting for someone to cite laws against self prescribing. I have been asked by people in our office for Rx for relatives, too and routinely tell them I have to see their relative, but I have given Bactrim for UTIs in people I know well.
Oh, and as an oncologist, I do treat pretty much everything cancer related, so while I would not prescribe digoxin for a cardiac arrythmia, without at least calling the patients treating cardiologist, if the tumor is in the mediastinum. I might prescribe gabapentin for TG-neuralgia referred for facial pain if it hadn't been tried, before we move on to radiation ablation of the nerve. I am not a neurologist, and this is well within my scope of practice.
How does the pharmacist determine what is and is not within my scope having not seen my practice? Do they know who practices what and why? I don't recall ever writing an "indication" for a drug on an Rx pad and I don't think PRN pain qualifies.
Sorry! If you have read this whole thread you'd realize the ONLY way for an insurance company to identify you as a prescriber right now on Sept 12, 2006 is to use your DEA #. That is the only way they know who you are!!!!And - no - we do not choose the closest sounding physician's name! If I can't read your name on the rx - I don't fill it - easy! Its just not done! If you choose to not have your name clearly printed on the rx - too bad - you're asking for your own trouble. It doesn't matter if you're writing for amoxicillin or phenergan with codeine - the insurance won't pay if you can't be identified. Also...you're DEA # is online - who are you hiding it from - not me for sure!!! I can find it & get it if I know your name & where you're licensed!
Yes....I am audited by insurance companies. They do come look at the actual prescription. They look at the original copy - either the one you wrote or the one I wrote from the verbal rx given to me. You are identified to them by your DEA # - how can you not have gotten this from this thread?????? When I have an auditor come into my pharmacy they look at anywhere from 500-800 rxs - do you realize how many that is to find??? It takes a whole day to pull each and every one of them!
That is the WHOLE reason the system is changing to a different form of identification of a prescriber. BUT...until that changes....the way you - as a prescriber is identified by the insurance company, their third party processor & by my computer software is by your DEA # - it is unique & solely your own. It doesn't matteer if they are paying for oxycontin or oxybutynin - they need your DEA #!
Now...as for the scope of practice...give me a break! I know exactly what your scope of practice is!!!! If I know you're are an oncologist & you are prescribing Benzaclin for your daughter - forget it - unless she is off to college in the next week - then I'll fill it. I know you're an oncologist because I've received rxs from you before for other patients. We know who are local prescribers are & I am in a huge urban area. I know you prescribe many medications outside of antineoplastics, analgesic & antiemetics....I'm not comletely stupid. But..please...I know when you are prescribing something for your relative & Nuva Ring is totally outside your scope of practice - I'll give you slack once...but not twice.
I can cite my actual laws - it will take me days & days to find them exactly. But....argue all you want....I will bend the laws which affect me to the extent I CHOOSE - not you! You can go along to get along or become admant in your opposition & get nowhere at all! Its your choice.......
I have read the whole thread.
sdn1977 said:
This is not true and you know it or should know it. My office phone number and address are on the scripts. It is not like we scribble an Rx on a sheet of legal pad and hand it to the patient. You lose credibility when you make this type of statement. And if this is true, then why do the forms I get from the state have a column on the form saying, "Not My Rx," and "Not My Patient."
Maybe your pharmacy doesn't, but I can assure you that others do.
Where did this come from? You have never seen my scripts or you would know that my name is Printed on the Form by the printer. And I believe that CA still requires a secure paper preprinted forms for Scheduled substances.sdn1977 said:
sdn1977 said:
Then you can go look it up, and don't waste my time. I will not write it, nor will I ask for or write a patient's soc number on an Rx as one pharmacist insisted. Their ssn is not used in my medical records and I will not ask for it. I will be pleased to amend this policy if you will cite the code that requires it for non-scheduled medications.
What we have here is a failure to communicate. I told you that my concern is the law and could care less about your insurance audits. They already cost me too much money in paperwork manufacture. As I stated before, my state has something very similar to CURES. I got a whole lot more "Not My RX," "Not My Patient" events when I gave out the DEA number on all Rx. I've changed my practice and the events have gone way way down.sdn1977 said:
No. They want it. Unless they cite the law that entitles them too it, they can go look it up on their own or do without.sdn1977 said:
Ahh yes. But did you also know that I am double boarded? My license says on it, Physician and Surgeon. I, and hospital credentialling boards, not you determine my scope of practice. And just how do you know who is, and who is not my relative? HIPPAA won't allow me to share their complete social history with you without their permission. Some of my relatives and friends come to me for care because they know me and trust me to give them the best possible treatment.sdn1977 said:
I don't think you know as much as you think you do.
sdn1977 said:
Took me exactly 3 minutes. Another 5 or so to read and comprehend. Wonderful thing, the internet. Time to go make make some burritos. And there are lots of pharmacists in the town I practice in that don't bug me or my patients about such things. Life's a regulatory witch for us all.
I guess you don't practice in such a town....otherwise you wouldn't have had the Justice Dept, which is over the DEA, down your throat.....
Yes - I can check exactly what you're boarded in & its easy - I call the state medical licensing board or do a DEA check on your DEA # - easy & simple in my state!!!!
If you're in CA - yes...I'll get those citations. I'd be really surprised if you could get them in 5 minutes on the internet - but you must be a wizard!
And...you'd be very surpised at how I can find out who is your relative...when your daughter gives me your insurance card to bill the rx & I put in your ID # - guess whose name comes up as the primary insured???? That would be you!!!! But..you don't see the billing - that is a private thing - especially when she bills out Plan B on your insurance, but I can see who the cardholder is. No - privacy doesn't allow me to share this with anyone - even you...but its still there. As for your friends....you'd be surprised at what they share when they have to wait for me to process their rx - they just love to talk about their "MD" friend who does them a great favor.😀
Perhaps you have developed the reputation for being "difficult" to the pharmacies which have to deal with you. You may not care about my insurance audits...but your patients care when their Xeloda is not approved because you don't want to give me your DEA # & I have to go online to get it. Why are you so difficult??? There is a reason the Justice Dept came after you........When you have to get a PA....you have to give your DEA or taxpayer ID# - what bothers you about this?? In my local area...we know who the prescribers are who are "difficult" & we go around them - we get what we need in other ways...you just don't know how we got it.
And yes....CA does require a secure provider rx form - once you've written that & it comes to me.....I've got your info in my files - which I can share with any pharmacy which calls me & I do - with pharmacies all over the country!
I don't care about a pts SSN# - it used to be used before the Patriot Act as the pts ID#, but it is no longer used. If your pt can't communicate with me (language, disease, illness,etc) - we just go to the individual who might easily know it - you - simple....easy & not subversive as you imply. Now, however....we no longer need it - the ID # is not the SSN# - anywhere - it is unique & we get it from the family - no need to involve you at all - you would never even see it since it is not usually tied to the medical coverage.
And yes....the insurance companies NEED it - otherwise..we get the rejection - "prescriber not identified" - easy - this is called REJECTION. We tell the pt the insurance company cannot identify who is writing the rx & if you are as difficult as you appear here - we'll send your patient back to you! If you aren't this difficult in real life....we'll call a pharmacy near your office who might have filled a controlled drug you have written or go online to get your DEA - we still get it - no matter what you think! Its required or your patient pays CASH.
Why can't you get along with those of us who have to work with another part of your patient's part of the payment of their treatment? I understand your frustration with having to doucument why the DEA had your number on so many controlled drugs or the rxs which had large quantities...but..oncologists & pain mangement specialists usually get audited once & unless they fall out of their past parameters....they don't get audited again.
I will get those citations for you....CA pharmacy law is extensive - altho you think its easy.
I'm not trying to be difficult just to be difficult - I want your patient to get their medication & get home as fast as possible. But...why do you appear to be so? Why can't we work together to get your patient what he/she needs????
Ultimately....next year....this will all be resolved. You'll all have your PMI & problem solved! Can we make it until next year????
