Dentist prescribing anything???

[3rdMolarRoller]

Here is something my gf just wrote in an email to me:

"We had a pharmacy guy come in today and tell us that a dentist prescribing birthcontrol pills was illegal because it was out of his scope of practice and one actually got fined for doing it."


Is this true?

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[UBTom]

One can get into trouble for abusing prescription priviledges, yes.

Even though as a dentist you can prescribe anything up to and including Schedule-II Controlled Substances, for meds outside of our usual spectrum we need to document why the script was necessary.

 

[3rdMolarRoller]

So if I want to prescribe birth control to my gf, then I have to write in I believe it will prevent gingivitis???

Women do get inflammed gums while pregnant...so I'm helping out their oral health

 

[UBTom]

LOL... Except if you do that you'll probably run afoul of malpractice laws, because taking birth-control meds will screw up a pregnancy.

You really gotta treat pregnant women with kid gloves... They should only be prescribed Pregnancy Category A meds that do not cross the placenta (such as acetaminophen or penicillin VK), and only in life-threatening situations that warrant it should drugs in other categories be prescribed (Cat B, C, D, and X), such as if a woman has Ludwig's Angina AND allergy to Pen.

HTH!

 

[3rdMolarRoller]

Well what I meant was killing two birds with one stone...no pregnancy and no gingivitis.

Damn, I will figure something out!!!

 

[UBTom]

I hear ya, you darn joker.

I'm in a jocular mood too now that the semester is OVER!!!!!

Two days from now I will be home on Long Island, a mug of Egg Nog in one hand and a stogie in the other.

 

[larryt]

Brocnizer2007,

as long your gf promises not to sue and if there is no serious complication associate with it, you can write any kind of prescription for her. My dentist and I had this discussion few days ago.

 

[3rdMolarRoller]

How about this: someone once told me that a pharmacist can refuse to fill the prescription if they feel the dentist does not have a dental reason to prescribe it, i.e. birth control pills.

Not too worried about getting sued by my gf bec we are soon to be married

And yes Tom...I'm in a goofy mood also bec today was my last day and i do not go back until Jan 5th

 

[larryt]

Originally posted by Brocnizer2007
How about this: someone once told me that a pharmacist can refuse to fill the prescription if they feel the dentist does not have a dental reason to prescribe it, i.e. birth control pills.
:

well, the dentist should go after that pharmacist by lodging his complaint to the State Board of Pharmacy. They may recommend the dentist the reason but not refuse to fill. DEA gives the dentist this power to prescribe under law.

 

[River13]

Yea, but if he's prescribing like that, he'll soon have no DEA liscence. I wouldn't give the drugs out if I was the pharm. either. Unethical if you feel something's not right about it, and dispense it anyway. Not only that, but even though the pharm only dispenses the drugs, he/she is still medicolegally responsible for what they fill. Sorry to rain on your parade.

 

[ItsGavinC]

Originally posted by Brocnizer2007
Here is something my gf just wrote in an email to me:

"We had a pharmacy guy come in today and tell us that a dentist prescribing birthcontrol pills was illegal because it was out of his scope of practice and one actually got fined for doing it."

Any pharmacist that has the time to do this has WAY too much time on his hands. I'm sure that any pharmacy that refused to fill scripts in "unethical" situations would loose a decent chunk of their busines.

Of course, this exact same scenario applies to physicians as well. IE, a cardiologist prescribing OCPs for his girlfriend or whatever. This problem/scenario is NOT limited to dentistry.

As a dentist I wouldn't worry about this one bit. When my kid needs antibiotics, or the wife needs more OCPs, guess who's writing the script? Me. If not me, then one of my physician buddies will be more than happy to crank one out.

Right or not, it's the real world.

 

[larryt]

Originally posted by River13
Yea, but if he's prescribing like that, he'll soon have no DEA liscence. I wouldn't give the drugs out if I was the pharm. either. Unethical if you feel something's not right about it, and dispense it anyway. Not only that, but even though the pharm only dispenses the drugs, he/she is still medicolegally responsible for what they fill. Sorry to rain on your parade.

I don't know if it is unethical or not, but I know that it's legal.

 

[ItsGavinC]

Originally posted by larryt
I don't know if it is unethical or not, but I know that it's legal.

And certainly enforcing anything like this would like enforcing drivers who go 4 mph over the speedlimit.

The benefits of enforcing that simply don't outweigh the enormous costs/time that go into it.

 

[River13]

You guys don't realize how many dentists lose prescription privileges each year, often for continually giving something beyond the scope of dentistry. There were 4 this year in my state alone, at least 1 for that very reason (others were wrongful narcotics use). State dental boards release all the info each year on who got disciplined and for what. I know a couple of pharms. well, and they've made several calls when something doesn't jive...look at how boring their job is! They've got time and motivation. And look how much more they know about all drugs than any MD or DDS/DMD. In Dschool we get a class...they get years. The best way around it is like Gavin said, get a buddy with a MEDICAL liscence to write the script for you--- a cardiologist still has a medical liscence so he can legally treat/manage problems anywhere on the body. Same with most DMD, MD oral surgeons-most have dental and medical liscences so they can write scripts for anything legally.

A dentist has no restrictions on his prescribing, this is true, so you could say legally a dentist could prescribe anything...but if he ever did for something that was outside the scope of dentistry he would be practicing medicine w/o a liscence, which is definitely illegal and very much enforced.

 

[Doctor Bagel]

why risk it? seriously, why would you prescribe bc pills for your wife, when she needs to get her annual exam anyway where she can very easily get a year-long prescription? also, if your kid needs antibiotics, you should take said kid to a doctor instead of just writing a script on your own. i had a friend whose dad was a pharmacist and he got antibiotics for her for colds and whatnot which is absolutely ridiculous.

seriously, if you're going to be such highly paid people, why not just have your family see md's when necessary? an annual exam and taking your kids to the doc when they're pretty sick isn't exactly asking for much.

okay, i am editing this to add that there are some prescriptions where i see no need to see a doctor. i had to shell out $95 for a 15 minute consultation with my doctor to get allegra, which i had already taken. admittedly, in that situation, i would bypass the doctor visit is possible. with antibiotics (especially since they're so overprescribed) and bc pills, though, i don't see any reason to skip the doctor appointments.

 

[JTLUK001]

"Don't let the "Dr" in front of your name cloud your judgement" is my advice to any dentist who wants to take advantage of their prescribing authority.
That being said I have only run into a few cases where dentists were prescribing for their immediate families. Most are receptive when I'd recommend that they get their family doctors to order the new meds or refills.
Refusal to fill brings back a lot of memories. I was taught in pharmacy school that we could refuse to fill any prescription that we were uncomfortable filling. If the refusal to fill is for personal (ethical or religious) reasons we were to refer the prescription to fellow pharmacists who would fill the prescription.
I usually tell patients and friends to try to visit pharmacies where pharmacists are there to take in the prescriptions or greet you when you are lost in the cough and cold aisle. All of you are probably aware of how much help or lack of that you find in some of the larger drug stores.
If a pharmacist had no time to evaluate each rx that comes in you are visiting the wrong store!
Anyways 4 months to graduation.
James L.
ULSD 2004

 

[River13]

well said Luk!!

 

[DrJeff]

Comfortable classes of drugs that you'll likely be Rx'ing in practice will be:

Pain meds(both narcotic and non narcotic)
Antibiotics/Antifungals
Antianxiety/Sedatives
Muscle Relaxants
Antihistamines(Rule out sinusitis vs. pulpitis)
Antidepressants(used in low doses for some TMJ treatment)
and Flouride supplements

Realistically the vast majority of what you'll be writing for is antibiotics, pain meds, and flouride. The remaining types might make up 5% of the total Rx's I write per year.

You will though write for a few doses of cardiac meds, broncho dialators, dextrose and epi pens though each year to keep you medical emergency kit upto date.

Basically though you'll write for 6 or 7 things most of the time: 2 narcotic pain meds for the codeine allergic and non codeine allergic folks, a non narcotic pain med, a couple of antibiotics for your penicillin/amoxicillin allergic/non allergic folks and pre meds, and then Fluoride supplments. You'll know those dose strengths and schedules by heart, the other classes of drugs, you'll likely need to check the PDR to refine the script (i.e. exact dose strength and frequency)

 

[3rdMolarRoller]

Lots of useful info...thanks everyone

 

[UBTom]

Bottom line, as I've mentioned previously:

1) you CAN get in trouble for abusing prescription priviledges.

2) if you need to prescribe something out of the normal scope for dentists, always document the reason in the patient chart.

That way you will never get in trouble.

 

[thisisit]

Let me simplify things. As a practicing dentist, you are not allowed to:

1- Rx anything for a non-patient
2- Rx anything unrelated to your practice
3- Are not allowed to abuse narcotics for self or others

Dr Jeff is right on.

larryt, once again you are wrong. It is unethical and illegal. The pharmacist has every right to question MDs and DDSs. They are also obligated to refuse to fill an RX if they feel the practitioner has made a mistake, done anything unethical, or committed an illegal act. Please do not feel that I am picking on you. Just consider it tough love

 

[larryt]

Originally posted by thisisit
Let me simplify things. As a practicing dentist, you are not allowed to:

1- Rx anything for a non-patient
2- Rx anything unrelated to your practice
3- Are not allowed to abuse narcotics for self or others

Dr Jeff is right on.

larryt, once again you are wrong. It is unethical and illegal. The pharmacist has every right to question MDs and DDSs. They are also obligated to refuse to fill an RX if they feel the practitioner has made a mistake, done anything unethical, or committed an illegal act. Please do not feel that I am picking on you. Just consider it tough love

hehehe Thanx... We are here to share our experiences and wisdoms.