Is ADHD within scope of practice for an Ob gyn?

[crossurfingers]

Would you accept a prescription for a C2 med for ADHD written by an obgyn?

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[Ra1nMak3r]

Would you accept a prescription for a C2 med for ADHD written by an obgyn?

Definitely not within their scope of practice so no

 

[PharmDminus]

Would you accept a prescription for a C2 med for ADHD written by an obgyn?

they are an MD so although I find it questionable I would still fill it

 

[Rouelle]

<deja vu>

 

[nlax30]

There are certainly instances where an OB/GYN may essentially functioning as a woman’s PCP. Theoretically the patient could have been seen/evaluated by a psychologist/therapist for the ADHD diagnosis and the OB is just the prescriber based on whatever recs they received from the mental health provider.

 

[Rouelle]

But to go along with your question:

1. Is the patient a kid or a grown woman?

2. If a kid, does the doc moonlight anywhere (such as a free pediatric clinic)?

3. If adult woman:
a. Does the patient get any other meds from the dr?
b. Would you accept phentermine from an obgyn? Adderall is sometimes used for weight loss.

You might do a quick search...a year or two ago there was a big thread on here debating whether an MD had the entire human body in the scope of their practice or if they should be limited to their sub-specialty (I think ADHD meds were discussed, probably not obgyns). A similar thread (maybe the same one) questioned the prescriptive authority of dentists.

 

[Slippers]

They are an MD so technically it is a legal prescription, but if you felt unsure, you could always call the office just to double check that it is legit and clarify the circumstances...

 

[Rouelle]

dentist prescribing benzaclin

Here you go. Read beyond the first few posts to get to the physician discussion.

 

[owlegrad]

Adderall is sometimes used for weight loss.

I thought it was illegal to prescribe amphetamines for weight loss?

 

[johnpharm01]

I would consult your states BOP website. Mine has a chart which helps with this very question. With the information you have given I don't see a reason to refuse it. PCPs can treat adhd and adults do suffer from it. Does this dr. prescribe it to other patients? Is the dosing appropriate? Are multiple mds prescribing similar items?

 

[Old Timer]

An OB/GYN is an MD with additional specialization. Any pharmacist who would refuse simply because they are an OB/GYN is a complete and total *****. Would you fill an Adderall Rx from PCP if you had a question about it? If you have a question you call the doctor and verify the RX. It is within their scope of practice and anyone who says otherwise is wrong. It's your corresponding responsibility to ascertain that it is being used for a "legitimate medical purpose". Any MD can prescribe Adderall or any other drug. They don't stop being an MD just because they specialize. Their license does not say anything bout their specialization. They either have a license to prescribe or they don't.

 

[ranger99rx]

Need to call. I called to document why and the OB/GYN just wrote one time for the patient until her next appointment with her psychologist.

 

[HandsomeVampire]

I heard from an colleague that they had a Rx for Adderall from an plastic surgeon.

 

[FinallyOnTrack]

Would you accept a prescription for a C2 med for ADHD written by an obgyn?

FWIW; my doctor is an OB/GYN but he’s also a specialist.. he prescribes Vyvanse for binge eating.. I haven’t seen any issues with his Rx’s.. the only issue I have seen is that he writes nothing but brand name stuff... maybe the occasional generic here and there but 80% of the time it’s brand name this, brand name that..


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[CetiAlphaFive]

An OB/GYN is an MD with additional specialization. Any pharmacist who would refuse simply because they are an OB/GYN is a complete and total *****. Would you fill an Adderall Rx from PCP if you had a question about it? If you have a question you call the doctor and verify the RX. It is within their scope of practice and anyone who says otherwise is wrong. It's your corresponding responsibility to ascertain that it is being used for a "legitimate medical purpose". Any MD can prescribe Adderall or any other drug. They don't stop being an MD just because they specialize. Their license does not say anything bout their specialization. They either have a license to prescribe or they don't.

*insert the video from literally ANY deposition here so that people don't listen to this horrible, dumb advice*

**except the part where he says you should call.of course.

 

[radio frequency]

Sometimes OBGYNs cover regular meds for pregnant and postpartum women. That seems like a possibility here.

 

[johnpharm01]

It is unusual though. I have worked with psychiatrists just like I am sure the others on this thread have worked with MDs. They may legally be able to prescribe most medications, but drugs like insulin, beta blockers are out of their practice. Anything unusual should result in additional scrutiny.

 

[WVUPharm2007]

An OB/GYN is an MD with additional specialization. Any pharmacist who would refuse simply because they are an OB/GYN is a complete and total *****. Would you fill an Adderall Rx from PCP if you had a question about it? If you have a question you call the doctor and verify the RX. It is within their scope of practice and anyone who says otherwise is wrong. It's your corresponding responsibility to ascertain that it is being used for a "legitimate medical purpose". Any MD can prescribe Adderall or any other drug. They don't stop being an MD just because they specialize. Their license does not say anything bout their specialization. They either have a license to prescribe or they don't.

I interpreted this differently. The wording of the law reads that the prescription needs written for a "legitimate medical purpose AND while acting within the USUAL COURSE of their medical practice." If they are treating them in office, documenting the diagnosis, and writing the script, it is legal. If they are just writing it without seeing the patient (i.e. for a friend) then it becomes not legal. So if a radiologist rolls up with an Adderall script, you best get some sort of documentation that they are acting within the usual course of their medical practice.

 

[CetiAlphaFive]

I interpreted this differently. The wording of the law reads that the prescription needs written for a "legitimate medical purpose AND while acting within the USUAL COURSE of their medical practice." If they are treating them in office, documenting the diagnosis, and writing the script, it is legal. If they are just writing it without seeing the patient (i.e. for a friend) then it becomes not legal. So if a radiologist rolls up with an Adderall script, you best get some sort of documentation that they are acting within the usual course of their medical practice.

Exactly this.
The pharmacist has no way of knowing exactly what the case is.

Usually I'll call and ask the nurse to read me the notes relevant to the prescription.

If there aren't any or if they refuse, I don't fill out

 

[nlax30]

It is unusual though. I have worked with psychiatrists just like I am sure the others on this thread have worked with MDs. They may legally be able to prescribe most medications, but drugs like insulin, beta blockers are out of their practice. Anything unusual should result in additional scrutiny.

Do you mean psychologists?

Psychiatrists are physicians (MD/DO).

 

[johnpharm01]

Do you mean psychologists?

Psychiatrists are physicians (MD/DO).

Nope psychiatrists. Had one get very worried about prescribing insulin, but had to because it was for an inpatient psych patient. Had a different dr have a patient develop bradycardia from a beta blocker and sent the person to primary care. Drs maybe LEGALLY to prescribe a wide variety of medication, but they usually are only familiar with a narrow scope. While the rx that the OP posted on might be legal, I would still give it a second look.

 

[ancienbon]

An OB/GYN is an MD with additional specialization. Any pharmacist who would refuse simply because they are an OB/GYN is a complete and total *****. Would you fill an Adderall Rx from PCP if you had a question about it? If you have a question you call the doctor and verify the RX. It is within their scope of practice and anyone who says otherwise is wrong. It's your corresponding responsibility to ascertain that it is being used for a "legitimate medical purpose". Any MD can prescribe Adderall or any other drug. They don't stop being an MD just because they specialize. Their license does not say anything bout their specialization. They either have a license to prescribe or they don't.

I agree.

 

[Old Timer]

I interpreted this differently. The wording of the law reads that the prescription needs written for a "legitimate medical purpose AND while acting within the USUAL COURSE of their medical practice." If they are treating them in office, documenting the diagnosis, and writing the script, it is legal. If they are just writing it without seeing the patient (i.e. for a friend) then it becomes not legal. So if a radiologist rolls up with an Adderall script, you best get some sort of documentation that they are acting within the usual course of their medical practice.

This is exactly what I said. They are legally allowed to prescribe any drug. You as the pharmacist has a corresponding responsibility to determine if it is being used for a legitimate medical purpose. They can't legally prescribe Keflex for IV drug users to sell on the street to treat skin infections. The this is a two part issue. They are separate. It can within the scope of their practice and still be illegal.....

 

[W19]

Call the MD to find out why...

MD/DO can prescribe anything but they must have a reason...

 

[zelman]

It is unusual though. I have worked with psychiatrists just like I am sure the others on this thread have worked with MDs. They may legally be able to prescribe most medications, but drugs like insulin, beta blockers are out of their practice. Anything unusual should result in additional scrutiny.

Just nitpicking, but beta-blockers are actually very useful in treating some psychiatric conditions. Maybe ACE inhibitors would be a better example.

 

[nlax30]

Nope psychiatrists. Had one get very worried about prescribing insulin, but had to because it was for an inpatient psych patient. Had a different dr have a patient develop bradycardia from a beta blocker and sent the person to primary care. Drs maybe LEGALLY to prescribe a wide variety of medication, but they usually are only familiar with a narrow scope. While the rx that the OP posted on might be legal, I would still give it a second look.

I see. And for the most part I agree. Some psychiatrists may be comfortable with using Beta blockers and insulin, some may not be.

First part mentioned psychiatrists and then mentioned MDs, was just pointing out that they are the same.

 

[Apotheker2015]

I thought it was illegal to prescribe amphetamines for weight loss?

No, you have Vyvanse for Binge Eating Disorder. Evekeo has indication for obesity. So does desoxyn and that is straight up methamphetamine hydrochloride.

 

[ldiot]

This is exactly what I said. They are legally allowed to prescribe any drug. You as the pharmacist has a corresponding responsibility to determine if it is being used for a legitimate medical purpose. They can't legally prescribe Keflex for IV drug users to sell on the street to treat skin infections. The this is a two part issue. They are separate. It can within the scope of their practice and still be illegal.....

What you are failing to understand is that usual course of practice and scope of practice are two entirely different things

If you thought your child had ADHD, and no other medical issues, would you take them to an OB/GYN? No? Then it's not in their USUAL COURSE OF PRACTICE

It doesn't mean they they don't have the training, it just means that it's not usual and you need to figure out what is going on before you fill it.

 

[GypsyHummus]

Does that mean DPM can prescribe insulin to their diabetic foot patients, or Blood pressure medication?

Im surprised there is such a roll with it vibe from PharmD about MDs prescribing medication outside of scope of practice.

 

[W19]

Does that mean DPM can prescribe insulin to their diabetic foot patients, or Blood pressure medication?

Im surprised there is such a roll with it vibe from PharmD about MDs prescribing medication outside of scope of practice.

I don't see why not...

 

[johnpharm01]

I don't see why not...

Worked with a DPM who was a former pharmacist. He NEVER would prescribe these drugs. Usually topicals, an occasional antibiotic.

I guess the way to settle this would be to call the prescriber and say I never see ob gyn prescribe this drug so it seems unusual to me and see what kind of response you get.

 

[W19]

Worked with a DPM who was a former pharmacist. He NEVER would prescribe these drugs. Usually topicals, an occasional antibiotic.

I guess the way to settle this would be to call the prescriber and say I never see ob gyn prescribe this drug so it seems unusual to me and see what kind of response you get.

I 100% agree...

By the way, I have met a few docs who were pharmacists. Interesting to find a pod who was a RPh or PharmD

 

[owlegrad]

Im surprised there is such a roll with it vibe from PharmD about MDs prescribing medication outside of scope of practice.

Riddle me this. What is an MD’s scope of practice? There is only one right answer and it boggles my mind that everyone here wouldn’t already know the answer.

Unlimited scope of practice does not mean that the pharmacist lacks a corresponding responsibility though and the lack of understand around this concept is also mind boogling.

Maybe it seems like a distinction without a difference and that is what is tripping people up?

 

[GypsyHummus]

I would think that a MD scope of practice is whatever he went to residency for. Why would a Dermatologist prescribe Neuro medication, or Heart Medication?

Does just having an MD give you unlimited scope? I was under the assumption one needed to go to a residency to have those privileges.

Riddle me this. What is an MD’s scope of practice? There is only one right answer and it boggles my mind that everyone here wouldn’t already know the answer.

Unlimited scope of practice does not mean that the pharmacist lacks a corresponding responsibility though and the lack of understand around this concept is also mind boogling.

Maybe it seems like a distinction without a difference and that is what is tripping people up?

 

[owlegrad]

I would think that a MD scope of practice is whatever he went to residency for.

You would think incorrectly. Scope of practice for a dentist is the mouth. For a vet it is animals. For an MD it is unlimited.

 

[radio frequency]

You would think incorrectly. Scope of practice for a dentist is the mouth. For a vet it is animals. For an MD it is unlimited.

it is limited to humans though...I have denied doctors trying to prescribe for their pets.

 

[GypsyHummus]

So a graduate from a Caribbean School could write prescriptions without going to a residency just by virtue of having a MD degree? Is this true for a DO student without a residency?

You would think incorrectly. Scope of practice for a dentist is the mouth. For a vet it is animals. For an MD it is unlimited.

 

[PharmDminus]

So a graduate from a Caribbean School could write prescriptions without going to a residency just by virtue of having a MD degree? Is this true for a DO student without a residency?

yes so long as they are licensed. i believe all MD need some sort of residency for license though, correct?

 

[GypsyHummus]

I think one state allows for MDs to be "assistant physicians" without a residency/ a one month residency.

yes so long as they are licensed. i believe all MD need some sort of residency for license though, correct?

 

[nlax30]

yes so long as they are licensed. i believe all MD need some sort of residency for license though, correct?

State dependent but usually once you complete an intern year and complete step 3 of the boards then we can apply for full state licensure.

The state license for us doesn’t necessarily specify what we can or can’t do. The issue of what can legally do is different from what’s under one’s “scope of practice” and different from “priveledges” which a hospital will give us.

Theoretically I could have gotten my full license after intern year and hung my own shingle seeing patients. Getting credentialed by a hospital and/or by an insurance company is a different issue, but I could have opened a cash based practice and practiced.

 

[CetiAlphaFive]

Does that mean DPM can prescribe insulin to their diabetic foot patients, or Blood pressure medication?

Im surprised there is such a roll with it vibe from PharmD about MDs prescribing medication outside of scope of practice.

It's not the Pharm.D.s

 

[owlegrad]

So a graduate from a Caribbean School could write prescriptions without going to a residency just by virtue of having a MD degree? Is this true for a DO student without a residency?

What is your background, how is it you don’t know this stuff?

 

[CetiAlphaFive]

[QUOTE="owlegrad, post: 19986933, member: ]. Scope of practice for a dentist is the mouth. .[/QUOTE]

 

[txpharmguy]

Totally legal. As others have said, a lot of times a woman's OB/GYN is her defacto PCP. It really depends on the situation. If it's a one off fill, I probably wouldn't put much thought into it.

 

[W19]

What is your background, how is it you don’t know this stuff?

I think he is a premed... To be fair, a lot of med students don't know these things either.

 

[Old Timer]

What you are failing to understand is that usual course of practice and scope of practice are two entirely different things

If you thought your child had ADHD, and no other medical issues, would you take them to an OB/GYN? No? Then it's not in their USUAL COURSE OF PRACTICE

It doesn't mean they they don't have the training, it just means that it's not usual and you need to figure out what is going on before you fill it.

No you are wrong. A license is a license is a license. They are still an MD. Just because they have extra training does not forfeit their rights under the license they hold. You as the pharmacist have the duty to determine if it is appropriate. Just because they are an OB/GYN or a nephrologist or a cardiologist or any other ologist does not (at least in Pennsylvania) prohibit them from prescribing anything they want. I'm not saying you shouldn't question it. I'm just saying they can write it. If they examine the patient and have medical records, they can prescribe anything they want. You don't have to fill it and I'm not saying you should. I'm just saying they can write it..... Scope of practice is defined by the license they hold, not the level of training they have

 

[ldiot]

No you are wrong. A license is a license is a license. They are still an MD. Just because they have extra training does not forfeit their rights under the license they hold. You as the pharmacist have the duty to determine if it is appropriate. Just because they are an OB/GYN or a nephrologist or a cardiologist or any other ologist does not (at least in Pennsylvania) prohibit them from prescribing anything they want. I'm not saying you shouldn't question it. I'm just saying they can write it. If they examine the patient and have medical records, they can prescribe anything they want. You don't have to fill it and I'm not saying you should. I'm just saying they can write it..... Scope of practice is defined by the license they hold, not the level of training they have

"Scope of practice is defined by the license they hold". You are exactly right. But the law doesn't use the term "scope of practice". The law uses the term "usual course of practice". It's not "usual" for an OB/GYN to write and Adderall script. I don't think you even read my post. In either case, nobody here is saying that you can't fill it. Again, did you not even read what I said?

 

[Old Timer]

"Scope of practice is defined by the license they hold". You are exactly right. But the law doesn't use the term "scope of practice". The law uses the term "usual course of practice". It's not "usual" for an OB/GYN to write and Adderall script. I don't think you even read my post. In either case, nobody here is saying that you can't fill it. Again, did you not even read what I said?

Failure to understand the difference between the MD and the pharmacist. Also failure to understand the difference between state and Federal law. and by the way, the usual course of practice is MEDICINE. They are practicing medicine. They are not practicing obstetrics and gynecology. They are permitted to write for whatever they want. As a pharmacist, you have a corresponding responsibility to determine if the rx is appropriate/ You have not only the right but the legal duty to question the rx. You can even refuse to fill it, after doing your due diligence. What you shouldn't do is refuse an rx w/o questioning because it was written by a specialist instead of a generalist.

 

[Carboxide]

Does that mean DPM can prescribe insulin to their diabetic foot patients, or Blood pressure medication?

Im surprised there is such a roll with it vibe from PharmD about MDs prescribing medication outside of scope of practice.

DPMs are not physicians...they are podiatrists. They are legally limited to specific areas of the body - in my state ankle and below. This is so not comparable.

 

[GypsyHummus]

I think it depends on the state. Some states a DPM is legally allowed to call themselves “Podiatric Physicians”. This makes sense, as a physician is someone who diagnosis, treats, and manages health and illnesses, DPMs do this, just on the foot and ankle. If they are allowed unlimited prescribing rights, I’m not sure.

DPMs do a lot of things to mimick MD/DO education, some schools even have the DPMs and DO take the same courses. They also have a 3 year residency.

DPMs are not physicians...they are podiatrists. They are legally limited to specific areas of the body - in my state ankle and below. This is so not comparable.