Scope of Practice

[VCU07]

Quick question. Got a Rx today for Flexeril from an opthamologist (MD). When asked what the patient was using it for she indicated that she was an employee of his and that he did it as a favor. I know this depends on state law, but would this be out of his scope of practice, even though he is technically a MD? In Virginia, you must have proper records of physical exams and history kept in the office to comply with having a proper Physician-patient relationship. She was clearly not a "patient," but an employee who needed a favor. How do you guys handle these situations?

 

[sdn1977]

Quick question. Got a Rx today for Flexeril from an opthamologist (MD). When asked what the patient was using it for she indicated that she was an employee of his and that he did it as a favor. I know this depends on state law, but would this be out of his scope of practice, even though he is technically a MD? In Virginia, you must have proper records of physical exams and history kept in the office to comply with having a proper Physician-patient relationship. She was clearly not a "patient," but an employee who needed a favor. How do you guys handle these situations?

I'm usually pretty firm on this. I don't outright refuse this. I usually call the prescriber & usually ask a bit aghast that is this your employee? Are you seeing her for muscle spasms, etc.....

They either get arrogant or say this was a favor she asked & he/she knew it was out of the scope.

Then, I write my notes on the rx, documenting the phone call & all comments - ie not a patient of record, no evidence of ocular spasms - anything which relates to the rx being outside the scope. Then, I mention I cannot fill this rx, but will give it back to her.

I do that with all the explanations. I've not refused the rx, just felt I could not fill it give the information I had. But, I've documented on it so no other pharmacist would fill it either.

Now - if it were a family member - thats a different issue. I'd extend professional privilege there. I had two local situations in which prescribers got caught in this - one a dentist & one a physician. A small, but tempting thing to gt involved in.

 

[Old Timer]

When this situation occurs, I usually call the prescriber and nicely warn him/her that while he is legally permitted to prescribe this medication, he is not absolved of the requirement to keep medical records. I try to do it in the I'm doing you a favor mode....

True story:

Way back in the 80's we had a patient with a disc problem that was managed with Demerol injection. Patient was seen by a orthopod and a neurosurgeon. Patient's husband was also a physician. In consultation with the specialists he was prescribing the Demerol. Patient had an automobile accident and the police found the Demerol with the pharmacy label. In comes the State Board of Pharmacy and the State Board of Medicine Inspectors to view the prescriptions. Noted the husband was the prescriber. They attempted to revoke his license because he did not keep medical records. It was not because the patient was not under the influence and the other physicians testified. Needles to say he kept records after that.. I tell that story to all prescribers who write for friends and family....

 

[MountainPharmD]

The laws are different in every state. I do believe an M.D. or D.O. regardless of specialty can write a prescription for whatever they want. Every Doctor was trained initially as a general practioner and then went on to specialize. Technically their scope of practice is whatever they want it to be. The only trouble you can get into is if they start writing large numbers of RX's for narcotics or RX's for family members but that goes for any Doctor not just a specialist.

The scope of practice question is more applicable to Dentists, Orthodontists, Podiatrists and Optometrists. Here the laws also differ from state to state but usually are much more specific than for an MD or DO.

sdn1977 has a good story about Dentists and scope of practice...