Prescription rules

[racerx]

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I haven't log-rolled my wife and done a rectal and declared "Sphincter tone intact, no gross blood,"

Then son, you haven't lived!

I kid, I kid.

 

[VA Hopeful Dr]

I don't know where you live or the rest of the laws. However, my read on what you describe is.... there is some issue with friend/family/self prescribing.... thus, you
"...personally perform and document an appropriate history and physical examination, make a diagnosis, and formulate a therapeutic plan".
Then you call a buddy/colleague and ask them to prescribe the medication on the patient they have not taken a history or examined....? No, I don't think that description falls under the partial excerpt you have provided. It appears a little wink-wink, nod-nod attempt to squeeze into these laws and guidelines. The entire gist of this thread is the issue of providing for care of self/friends/family outside your practice. A visiting friend is not within your practice. Further, they are apparently getting care by you and this is not "on-call" coverage. Are you saying this individual is being evaluated by you, then you request the "on-call" physician provide certain care, and then this individual is now going to be seen in your clinic or the "on-call" physician's clinic on Monday? Or, are they simply hopping a plane back to BFE and you are going to scribble down a progress note and place into some sort of chart on Monday? All these hoops suggest there is a real concern with appropriateness of treating yourself/friend/family.

Again, that kind of hoop hopping and justification creates some real dilemmas. not the least of which are very germane to trainees. By that explanation, you can be pressured to telephone provide scripts for attendings, their friends, and family!!!

I get where you're coming from, and you might very well be correct in your interpretation were it to be an issue. I'm just explaining the reality as I've seen it. I looked back at board disciplinary actions, and the only cases that come up pertaining to this involve controlled substances to immediate family (and almost always for a duration of at least 2 weeks, though I certainly won't be testing the limits myself).

 

[anon-y-mouse]

You may want to update... you list as a "med-student".

As to everything else, you really need to take a step back and have a reality check. Prescribing is not just a minor thing. It is a significant responsibility. Aspirin kills numerous patients yearly... without a script. Do not be so cavalier about what medications are "benign". Just about every medical/professional society has clear positions on the appropriateness and professionalism of prescribing meds and treatment outside of your practice and/or outside of your specialty. They also have positions on treating friends and family. You in theory have chosen to enter into a "profession". You might want to find out what that means and what are the expected standards of conduct within that profession as opposed to simply promoting a course of action because you don't know anyone that got in trouble (of which there are numerous).

You can surf the disciplinary action publications by different state med boards to learn of folks disciplined for "unprofessional behavior".

I thoroughly checked the board publications for many states, and the only things I could find were doctors who got dinged for prescribing narcotics to family members / close friends. Not one mention of someone who got dinged for prescribing antibiotics, stool softeners, anti-emetics, etc. I can't see any argument, which doesn't assume that I'm an idiot without proper judgment, that says prescribing 10 Zofran is somehow gravely wrong. Chlorhexidine is actually also a legend substance, and something like peri-dex is available only with a prescription. That's also pretty ridiculous to me. All these sanctimonious arguments sound like they are coming from an apologist for jaywalking or something - yes, it's "illegal" but I am sure all of us have exercised our judgment in terms of which streets we can cross and which we shouldn't.

I don't think the culture of my program is really vindictive or malicious (I couldn't find any mention of prescribing outside the program in anything I signed, or heard from my PD), but I can see the argument for not doing something for fear of enraging a program director. If you get fired for self-prescribing peridex, then perhaps that's a pretty crappy program.

 

[tkim]

I thoroughly checked the board publications for many states, and the only things I could find were doctors who got dinged for prescribing narcotics to family members / close friends. Not one mention of someone who got dinged for prescribing antibiotics, stool softeners, anti-emetics, etc. I can't see any argument, which doesn't assume that I'm an idiot without proper judgment, that says prescribing 10 Zofran is somehow gravely wrong. Chlorhexidine is actually also a legend substance, and something like peri-dex is available only with a prescription. That's also pretty ridiculous to me. All these sanctimonious arguments sound like they are coming from an apologist for jaywalking or something - yes, it's "illegal" but I am sure all of us have exercised our judgment in terms of which streets we can cross and which we shouldn't.

I don't think the culture of my program is really vindictive or malicious (I couldn't find any mention of prescribing outside the program in anything I signed, or heard from my PD), but I can see the argument for not doing something for fear of enraging a program director. If you get fired for self-prescribing peridex, then perhaps that's a pretty crappy program.

Totally anecdotal, but what hasn't been in this thread? My moonlighting hours at a local urgent care were about to be drastically reduced because they were hiring a full-time attending. But then those plans fell through - that guy had his FL license suspended for four years for prescribing his wife antibiotics, after he divorced his wife, she went to the FL BOM and reported him. Now, I don't know if the FL BOM wanted to make an example of him, or if these 'antibiotics' were really antibiotics, but this guy was essentially screwed. Needless to say, I got to keep moonlighting.

 

[JackADeli]

I thoroughly checked the board publications for many states, and ....

Yep, sure. I can't speak to what your licensing board investigation has found. The fact that certain innapropriate behavior (as defined by professional societies and licensing boards) may be rampant and/or rules not enforced does not make said conduct OK. Just 20 yrs ago it was allowed for physicians to be abussive and engage in rampant sexual or other abussive misconduct. We can turn on the TV and hear about plenty of laws not being enforced. None of which makes it correct. It is often true that folks trying to defend/support an imagined ~"right" to certain behavior are often trying to allow for themselves soem agendas/flexibility within rules/laws/etc... You have PD that turns blind eye to certain conduct because he/she gets scripts from residents. The hospital division chief that turns a blind eye to certain behavior because they engage in said behavior.....

You are free to practice how ever you want. You can choose to ignore the codes of ethics, professional guidelines and positions, medical licensing board if you want. Chances are, with reported upwards of 40-50% physicians engaging in this behavior and we don't see massive licensing activities, you may get away with it. But, there is no real argument/defense to simply proclaim it is all sanctimonious, etc, etc.... You would be making a choice and taking a chance. You will be gambling that you will be one of the majority that gets away with it. Good for you!😴

...All these sanctimonious arguments sound like they are coming from an apologist for jaywalking or something - yes, it's "illegal"...

...If you get fired for self-prescribing peridex, then perhaps that's a pretty crappy program.

Interesting psychology and thought process. I can't speak so much to peridex prescribing. But, it seems the argument you have made is ~ a zero tolerance policy towards violation of professional standards and medical board licensing standards makes a program "crappy". Interesting.... I guess, therefore, for by extension, a program to remain competitive and attractive to applicants, it should be flexible with the rules, laws, and professional standards, a little free spirited if you will.... a millenium gen esque.

 

[anon-y-mouse]

Yep, sure. I can't speak to what your licensing board investigation has found. The fact that certain innapropriate behavior (as defined by professional societies and licensing boards) may be rampant and/or rules not enforced does not make said conduct OK. Just 20 yrs ago it was allowed for physicians to be abussive and engage in rampant sexual or other abussive misconduct. We can turn on the TV and hear about plenty of laws not being enforced. None of which makes it correct. It is often true that folks trying to defend/support an imagined ~"right" to certain behavior are often trying to allow for themselves soem agendas/flexibility within rules/laws/etc... You have PD that turns blind eye to certain conduct because he/she gets scripts from residents. The hospital division chief that turns a blind eye to certain behavior because they engage in said behavior.....

You are free to practice how ever you want. You can choose to ignore the codes of ethics, professional guidelines and positions, medical licensing board if you want. Chances are, with reported upwards of 40-50% physicians engaging in this behavior and we don't see massive licensing activities, you may get away with it. But, there is no real argument/defense to simply proclaim it is all sanctimonious, etc, etc.... You would be making a choice and taking a chance. You will be gambling that you will be one of the majority that gets away with it. Good for you!😴Interesting psychology and thought process. I can't speak so much to peridex prescribing. But, it seems the argument you have made is ~ a zero tolerance policy towards violation of professional standards and medical board licensing standards makes a program "crappy". Interesting.... I guess, therefore, for by extension, a program to remain competitive and attractive to applicants, it should be flexible with the rules, laws, and professional standards, a little free spirited if you will.... a millenium gen esque.

No. You have made an incorrect inference. Your "extension" is incorrect. I am merely arguing for flexibility, common sense. Think of someone driving 100 miles an hour to get to a hospital because they are driving someone critically ill... they get pulled over by the police. In a world where rules were strictly enforced with zero tolerance, they would get a ticket / bad consequences would occur. The reasonable thing for the cop to do is to exercise his judgment and let the motorist go. Not doing so is sanctimonious and despicably intransigent. You can argue that rules allow for emergency prescribing to anyone, but I can still come up with other examples (such as prosecution of jaywalking) that are equally illustrative. 9 out of 10 (or more!) reasonable people would agree that prescribing peridex or colace to friends, loved ones, and to yourself, is a complete non-issue. A residency program which is not run by reasonable people who think reasonably is not desirable whatsoever. If this is a "millennial" attitude, then I think yours is a crotchety one from the 1900's during the time of prohibition.

 

[JackADeli]

...Think of someone driving 100 miles an hour to get to a hospital because they are driving someone critically ill... they get pulled over by the police...

apples and lettuce.... That example can reasonably be understood by the multitude of "emergency exceptions". I don't believe colace, ?peridex, or Jay-walking can be classified the same...

...Interesting psychology and thought process. I can't speak so much to peridex prescribing. But, it seems the argument you have made is ~ a zero tolerance policy towards violation of professional standards and medical board licensing standards makes a program "crappy". Interesting.... I guess, therefore, for by extension, a program to remain competitive and attractive to applicants, it should be flexible with the rules, laws, and professional standards, a little free spirited if you will.... a millenium gen esque.

...I am merely arguing for flexibility, common sense. ...reasonable people would agree that prescribing peridex or colace to friends, loved ones, and to yourself, is a complete non-issue..

Again, as i stated, I can't speak to peridex and/or indications and to whom or why and/or when such would become necessary. I don't know when peridex requires an emergency script necessitating a lack of associated appropriate clinic evaluation? I believe colace is an over the counter med.... As I stated, it appears you want individuals to be "flexible" with these standards. As to 1900... presumably you are suggesting ~old fashion? well old fashion argument is actually almost the one you are making. Physicians for decades have established a "free to do what I want cause I'm a physician attitude". They prescribed for friends and families indiscriminantly somewhat based on attitudes of superiority. More "modern generations" seem to now come back around and make the argument based on freedom and/or entitlement. The actual ~newer concept is the one of certain professional standards and following the laws.

 

[Taurus]

I don't know why this thread has gone on for so long. This is straight-forward. No matter how someone tries to rationalize it, you're playing dice with your future if you try to play the gray areas of medicine. Some people may look the other way. Some people may just slap you on the wrist. Then some people may come down hard on you and pretty much end your career. You have no idea and it's not wise to test the boundaries. Residency is very political and they will fire you reasons that you thought were not significant infractions. Writing prescriptions outside of your residency for friends and family is foolish. Period. It's pretty clear that this is a no-no. I've personally known people who have been fired from residency for less things. Then you hear many other stories of people getting fired for whatever stupid reasons. If you get fired from residency, it's a huge black mark on your record that you have to explain for the rest of your career. Getting back into residency is very difficult. Bottom line, keep your nose super-clean.

 

[JackADeli]

...No matter how someone tries to rationalize it, you're playing dice with your future if you try to play the gray areas of medicine. Some people may look the other way. Some people may just slap you on the wrist. Then some people may come down hard on you and pretty much end your career. You have no idea and it's not wise to test the boundaries...

I agree. Maybe some folks are venting and will actually be smart and not act according to their rationalizations on this forum. But, fortunate or unfortunately, when you bend rules and/or act within gray areas, you may be putting you destiny in someone elses hands. The same with off color and/or sexual oriented jokes, etc...

You need to decide what it is worth and if you want to put this power in other peoples hands. You may likely get away with questionable prescribing practices. As I noted, I think the published survey data suggests upwards of 50% physicians engage in such practices. But, if someone is aware of these actions, and they one day get angry, think you wronged them, etc.... they report you. Maybe you get off with a slap on the wrist or something, but your record is forever tarnished.

 

[Arch Guillotti]

Agree wholeheartedly with above two posters. It is silly to risk your future in any way. I don't care what the residencies policy is, although they have ultimate control over your destiny. Depending on what state you are in, the state medical board probably has a specific position statement on this, and they may care a little or they may care a lot. I have seen read of physicians getting publically reprimanded for self-prescribing and prescribing to family members (aka a slap on the wrist). These warnings MUST be reported when you apply for a medical license and anywhere you credential. This is a major hassle. I would not prescribe anything unless it was an extreme circumstance and even then I would think twice.

 

[Winged Scapula]

Interestingly it appears that all the attendings are in favor of not writing scripts for friends/family. Perhaps seeing what can happen to our colleagues plays a role.

 

[VA Hopeful Dr]

Interestingly it appears that all the attendings are in favor of not writing scripts for friends/family. Perhaps seeing what can happen to our colleagues plays a role.

I don't know the stories of all of the players involved, but I'm wondering if it might be the difference between newer (out of residency 15-20 years or less) compared to older (out more than that) attendings.

 

[Winged Scapula]

I don't know the stories of all of the players involved, but I'm wondering if it might be the difference between newer (out of residency 15-20 years or less) compared to older (out more than that) attendings.

Perhaps. All of us responding on here are newer attendings...and yes, I do see that because we live in a more litiginous society, perhaps we are more cautious than our forefathers.

 

[VA Hopeful Dr]

Perhaps. All of us responding on here are newer attendings...and yes, I do see that because we live in a more litiginous society, perhaps we are more cautious than our forefathers.

Wisely so, I suspect. The only non-academic physicians I've encountered are older (youngest finished residency in '85), so my way of looking at this could be outdated in the current climate.

 

[Arch Guillotti]

I don't know the stories of all of the players involved, but I'm wondering if it might be the difference between newer (out of residency 15-20 years or less) compared to older (out more than that) attendings.

Maybe. Medical board actions are readily viewable these days on the net whereas in the past before the explosion of the internet actions were probably not so transparent.