Self Diagnosis?

[HurricaneKatt]

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Hey, so this is probably a stupid question but I am asking anyways...

Are doctors allowed to a.) diagnose themselves, and b.) prescribe themselves medicine - either for their own diagnosed illness or an illness diagnosed by another physician?

Seems to me with all of that "doctorly knowledge" it would be pretty easy to get a cold, overreact, and diagnose yourself with something else and start taking some un-needed med... I hear doctors make the worst patients.
Are there any rules against that kind of stuff? I am sure there are, but what are they?

 

[Droopy Snoopy]

Hey, so this is probably a stupid question but I am asking anyways...

Are doctors allowed to a.) diagnose themselves, and b.) prescribe themselves medicine - either for their own diagnosed illness or an illness diagnosed by another physician?

Seems to me with all of that "doctorly knowledge" it would be pretty easy to get a cold, overreact, and diagnose yourself with something else and start taking some un-needed med... I hear doctors make the worst patients.
Are there any rules against that kind of stuff? I am sure there are, but what are they?

I guess anyone can diagnose themselves, but it is unethical to treat oneself or one's family. And if I'm not mistaken it is illegal to treat anyone without appropriate documentation (medical records, coding, etc.). The AMA publishes a guide to medical ethics annually, but a physician is ultimately responsible to and bound by the state medical board through which s/he is licensed.

Unofficially though, it's not unheard of to write an abx script for your sick niece or something.

 

[HurricaneKatt]

I guess anyone can diagnose themselves, but it is unethical to treat oneself or one's family. And if I'm not mistaken it is illegal to treat anyone without appropriate documentation (medical records, coding, etc.). The AMA publishes a guide to medical ethics annually, but a physician is ultimately responsible to and bound by the state medical board through which s/he is licensed.

Unofficially though, it's not unheard of to write an abx script for your sick niece or something.

Yeah I have heard of stuff like that happening, but it seems it would be rather easy for docs to get their own meds too...? Unethical maybe, but is it possible and/or allowed? Say they fill out all the right forms and all, just add it in to their own medical records or whatever they need to, decide they have such and such and write a script to treat it?

 

[nogolfinsnow]

I have heard from friends whose parents are physicians that pharmacists are a little skeptical if the last name of the prescribing physician matches the last name of the patient. I can imagine they'd be even more skeptical if the name were the exact same. Of course, I don't know what would stop a physician from taking the free samples home, etc.

As an aside, a dermatologist I recently saw said physicians are notorious for letting dermatologists hack them up because they're afraid that every mole they see is melanoma.

 

[cpants]

It's not unethical to treat members of your own family. As long as you do proper history and exam and properly document everything, you are golden.

 

[footballrules]

It's not unethical to treat members of your own family. As long as you do proper history and exam and properly document everything, you are golden.

Translation: They are a patient like all others.

 

[HurricaneKatt]

I have heard from friends whose parents are physicians that pharmacists are a little skeptical if the last name of the prescribing physician matches the last name of the patient. I can imagine they'd be even more skeptical if the name were the exact same. Of course, I don't know what would stop a physician from taking the free samples home, etc.

As an aside, a dermatologist I recently saw said physicians are notorious for letting dermatologists hack them up because they're afraid that every mole they see is melanoma.

 

[supernareg]

that's the STUPIDEST thing i've ever heard.... unethical to treat your family members? wow... hell i'd want to treat my own family members so i know they're gettin' the best treatment out there, and i sure as hell PLAN on doing it, and i dont think it's unethical at all...

stop living in a bubble

 

[doc20]

Yeah I did not go through 8 Years of school and 3+ years of residency so I CANNOT treat/ddx myself or my family members

 

[JPMD03]

Supernareg, I don't think that it is that STUPID to ask the question.

It might not be unethical to treat your own family, but your judgment is certainly not as good as it should be.

Actually, that is the feeling I have whenever I prescribe something to my wife or my kids. I wouldn't want to treat more than a cold or seasonal allergy.

 

[smq123]

that's the STUPIDEST thing i've ever heard.... unethical to treat your family members? wow... hell i'd want to treat my own family members so i know they're gettin' the best treatment out there, and i sure as hell PLAN on doing it, and i dont think it's unethical at all...

stop living in a bubble

Actually....it may be "the STUPIDEST thing" you've ever heard, but it's kind of a risky practice.

After poking my head outside of a bubble, I found this thread: http://forums.studentdoctor.net/showthread.php?t=295643

I would NOT want to treat my own family members. There's no way that I could guarantee that they'd be getting the best treatment out there - in fact, it's a good way to make sure that they're getting CRAPPY treatment. Recently, someone very close to me had to go to the hospital for emergent surgery. Despite being a senior med student, I couldn't make myself think like a med student - I was so worried about him that it was hard to kick start myself into "healthcare provider" mode.

Taking care of your family members and loved ones is very difficult, because you really do lose all objectivity. Leave it to someone else (someone else that you know to be talented and skilled) to take care of your family members.

 

[Haemulon]

A wise mentor of mine once replied to a similar question with the following:

"A physician who treats himself has a fool for a patient, but a physician who treats his own family is just an idiot."

It may be one thing to prescribe some Abx for your own child if they have strep or otitis media or something minor in order to tide them over during the weekend until they can get in to see the pediatrician on Monday. Something minor like that might be able to slide. But it is just foolish to serve in the role of a family member's physican, for many reasons. You just can't be objective and ensure they are getting the correct care, let alone the best.

Can it technically be done if you establish a formal doctor-patient relationship complete with fully documented medical record? Maybe. But it is still a bad idea. And it is absolutely illegal to prescribe certain controlled substances to yourself or to family members.

The best role that one can play for their family and friends, and even to one's self, is to be able to educate and to counsel about health concerns. Reassurance, explaination, maybe even verification that they are getting the best treatment. Be able to question intelligently when diagnoses and treatment don't seem right (tactfully, without side-seat driving). Be able to suggest that they see a physician when appropriate ("Buddy Joe, a bp of 170/98 is not good. You need to get that checked out by your doc. Likewise that exertional chest pain with radiation you have been experiencing"). Sometimes putting their minds at ease that nothing needs to be done ("No, that birthmark is not a melanoma. But if you are concerned, definitely mention it to your Dermatologist the next time you are there.") That's my plan anyway. And am thrilled to be able to do it (when I finally learn a thing or two that is 😉 ).

 

[Hiram Coggin]

that's the STUPIDEST thing i've ever heard.... unethical to treat your family members? wow... hell i'd want to treat my own family members so i know they're gettin' the best treatment out there, and i sure as hell PLAN on doing it, and i dont think it's unethical at all...

stop living in a bubble

I will forgive you since you are a premed.

This is directly from the state medical board website:

"It is the position of the Medical Board that, except for minor illnesses and emergencies, physicians should not treat, medically or surgically, or prescribe for themselves, their family members, or others with whom they have significant emotional relationships. The Board strongly believes that such treatment and prescribing practices are inappropriate and may result in less than optimal care being provided. A variety of factors, including personal feelings and attitudes that will inevitably affect judgment, will compromise the objectivity of the physician and make the delivery of sound medical care problematic in such situations, while real patient autonomy and informed consent may be sacrificed.

When a minor illness or emergency requires self-treatment or treatment of a family member or other person with whom the physician has a significant emotional relationship, the physician must prepare and keep a proper written record of that treatment, including but not limited to prescriptions written and the medical indications for them. Record keeping is too frequently neglected when physicians manage such cases.

The Board expects physicians to delegate the medical and surgical care of themselves, their families, and those with whom they have significant emotional relationships to one or more of their colleagues in order to ensure appropriate and objective care is provided and to avoid misunderstandings related to their prescribing practices."

 

[JeffLebowski]

I will forgive you since you are a premed.

This is directly from the state medical board website:

"It is the position of the Medical Board that, except for minor illnesses and emergencies, physicians should not treat, medically or surgically, or prescribe for themselves, their family members, or others with whom they have significant emotional relationships. The Board strongly believes that such treatment and prescribing practices are inappropriate and may result in less than optimal care being provided. A variety of factors, including personal feelings and attitudes that will inevitably affect judgment, will compromise the objectivity of the physician and make the delivery of sound medical care problematic in such situations, while real patient autonomy and informed consent may be sacrificed.

When a minor illness or emergency requires self-treatment or treatment of a family member or other person with whom the physician has a significant emotional relationship, the physician must prepare and keep a proper written record of that treatment, including but not limited to prescriptions written and the medical indications for them. Record keeping is too frequently neglected when physicians manage such cases.

The Board expects physicians to delegate the medical and surgical care of themselves, their families, and those with whom they have significant emotional relationships to one or more of their colleagues in order to ensure appropriate and objective care is provided and to avoid misunderstandings related to their prescribing practices."

Personally, I'm kind of glad this is the position of the medical board (or at least your state's). It'd be nice to have the "let me refer you to a colleague of mine, it's against the rules to treat you myself" excuse for your aunt with fibromyalgia. Or hell, anyone with something you don't want to be responsible for ****ing up on, or being held incorrectly responsible for a bad outcome. And it's pretty vague..."minor illness or emergency"? I mean, you could argue that anything that a physician can treat at home is minor. I mean you jot down what you did/prescribed, and send it with the kid to his next peds appointment for his chart. Incidentally, there was a thread about self-prescribing/family/friends in...I think the General Residency forum a while back? It was interesting, residents/attendings were talking about the rules, etc.

 

[Droopy Snoopy]

And it's pretty vague..."minor illness or emergency"? I mean, you could argue that anything that a physician can treat at home is minor. I mean you jot down what you did/prescribed, and send it with the kid to his next peds appointment for his chart. Incidentally, there was a thread about self-prescribing/family/friends in...I think the General Residency forum a while back? It was interesting, residents/attendings were talking about the rules, etc.

That's just it. Technically it's against the rules, in reality we're given a little leeway by the powers that be and trusted to police ourselves. Nobody's taking out family members' gallbladders, prescribing chemo, or managing schizophrenia meds on the dl thinking it's ethical.