Prescribing to Friends and Family as a Resident in Texas

[RandomPseudonym]

Hello,
I have a quick legal question. I am fully aware that it's not likely a great idea, but can I legally prescribe medication to friends or family in the state of Texas as a resident outside of a formal encounter?



Specifically, I am an intern in internal medicine; new to to the state, and I'd like to prescribe OCPs to my girlfriend who currently does not have insurance.

---

Members don't see this ad.

 

[VA Hopeful Dr]

As an intern, nope. You have a limited license and doing anything outside the residency with one of those is not kosher.

 

[psych md jd]

["I have a quick legal question"] No such thing.

["outside of a formal encounter?"] IMO the standard of care these days is that a good-faith exam has to be performed prior to treating and there has to be documentation.

["I am an intern in internal medicine"] As an intern, do you have an unrestricted license, DEA#, or NPI#? Some pharmacies will ask for those items. A restricted license (training licence) limits the holder to residency supervised educationally related misadventures only.

A good time to start studying for the Texas Medical Jurisprudence Exam.

Overall, not a good idea, just like this:
http://forums.studentdoctor.net/threads/writing-letter-for-emotional-support-animal.1156022/


Better call Saul.

 

[Crayola227]

Send her to Planned Parenthood.

See if you can get her in to your institution's clinic somewhere.

It's better to ask your senior or attending how to help in this case. You can even ask some of the SW or CM where you are.

The inside track being in medicine isn't writing your friends and family Rx's, but easily curbsiding people to help you help people you care about.

My clinic preceptor was able to take on a poor friend of mine on as a favor, when otherwise their panel was closed, and they were able to work out the money thing too.

Residency means you get to ask for help practicing, not run off with an Rx pad on your own.

 

[typhoonegator]

Agree completely with all of the above. In general, you should be looking for excuses NOT to prescribe medications or offer medical advice to friends and family. Your primary mode of assistance to those close to you should be your contacts and knowledge of the system. Anything else can get so messy. What if you prescribe something to her and she starts spotting? Or she gets a DVT? Are you well versed enough in the myriad options for contraception that you feel confident being a solo practitioner for her? Why is she not considering an IUD? People do entire fellowships after OB/GYN residencies to become experts on family planning issues. You are doing a disservice to her by short circuiting the system.

She needs insurance. Help her figure that out and you will have done far more for her than prescribing Ortho Tri Cyclen Lo. Planned Parenthood is a great option, although the great state of Texas has done much to limit the number of PP locations in that state.

 

[ThoracicGuy]

Agree completely with all of the above. In general, you should be looking for excuses NOT to prescribe medications or offer medical advice to friends and family. Your primary mode of assistance to those close to you should be your contacts and knowledge of the system. Anything else can get so messy. What if you prescribe something to her and she starts spotting? Or she gets a DVT? Are you well versed enough in the myriad options for contraception that you feel confident being a solo practitioner for her? Why is she not considering an IUD? People do entire fellowships after OB/GYN residencies to become experts on family planning issues. You are doing a disservice to her by short circuiting the system.

She needs insurance. Help her figure that out and you will have done far more for her than prescribing Ortho Tri Cyclen Lo. Planned Parenthood is a great option, although the great state of Texas has done much to limit the number of PP locations in that state.

You can also go to http://www.goodrx.com and enter in the prescription name and your location and it will give you pharmacies that you can buy the medication for a cheap price. I had one family member that did not have any prescription plans with a script that cost about $475. After a search on GoodRx, we found the same medication at a nearby pharmacy for $27. No insurance plan was needed for that. It's quick and easy and doesn't put you in a hard spot for writing prescriptions.

 

[PistolPete]

I second the above posts about not prescribing to friends or family.
I further second GoodRx.com, I love that website and it's helped several of my patients who are uninsured or underinsured!

 

[ThoracicGuy]

I second the above posts about not prescribing to friends or family.
I further second GoodRx.com, I love that website and it's helped several of my patients who are uninsured or underinsured!

It helped me today with my own prescription...

 

[b-real]

While not a good idea to prescribe for family and friends, in Texas an NPI number and a PIT permit is sufficient for non-scheduled medications. Generally speaking the pharmacist will not know whether or not you're prescribing within the confines of your residency program. The caveat is not to even think about prescribing controlled substances.

 

[Crayola227]

While not a good idea to prescribe for family and friends, in Texas an NPI number and a PIT permit is sufficient for non-scheduled medications. Generally speaking the pharmacist will not know whether or not you're prescribing within the confines of your residency program. The caveat is not to even think about prescribing controlled substances.

Point will still be that with a temporary license to practice under supervision, who is the attending that directly or indirectly supervised this care via the Rx you wrote? If no one looks or finds out about this, great.

If later down the road you get in *any* trouble, deserved or not, if from medmal attorney, med license board, or your program, and dirt is being looked for, this is exactly the kind of thing they'll look for and use against you.

Low chance of that happening.... but if it does, this will so *not* be worth it if you could have addressed this by referring her to a colleague. Or even just have been above board enough by running it by an attending. I've known people in programs Rx'ing for them and theirs, but the i and t I would dot and cross would be a documented note and attending cosigner before writing this script.

Your hosital and program are privvy to the rules you are to follow, not the pharmacist. The fact that the pharmacist did not stop you from writing a script you shouldn't have will not save you, even as an attending.

Learn the rules and follow them, or not I guess. As a doc it will never be about what you *could* do or *could* get away with, but what standard you were expected to hold yourself to and if you did.

Claiming ignorance won't cut it either.

 

[b-real]

Point will still be that with a temporary license to practice under supervision, who is the attending that directly or indirectly supervised this care via the Rx you wrote? If no one looks or finds out about this, great.

If later down the road you get in *any* trouble, deserved or not, if from medmal attorney, med license board, or your program, and dirt is being looked for, this is exactly the kind of thing they'll look for and use against you.

Low chance of that happening.... but if it does, this will so *not* be worth it if you could have addressed this by referring her to a colleague. Or even just have been above board enough by running it by an attending. I've known people in programs Rx'ing for them and theirs, but the i and t I would dot and cross would be a documented note and attending cosigner before writing this script.

Your hosital and program are privvy to the rules you are to follow, not the pharmacist. The fact that the pharmacist did not stop you from writing a script you shouldn't have will not save you, even as an attending.

Learn the rules and follow them, or not I guess. As a doc it will never be about what you *could* do or *could* get away with, but what standard you were expected to hold yourself to and if you did.

Claiming ignorance won't cut it either.

I'm sorry, did I say it was a good idea? The question was asked whether you can write an Rx with a training license and it was answered. But please, go on and continue your lecture.

 

[Crayola227]

Please, go on pointing out what OP can technically do, that it isn't a good idea, but then get your biscuits burned when someone continues on explaining that yes, the script will likely get filled, but no, the caveat is not just "avoid scheduled drugs", but a whole world of trouble you fail to mention