What prescriptions are we authorize to write?

[Smile786]

Hi everyone. I've been wondering about some things regarding what podiatrists can do. I understand that we work on any conditions below the knee. But does that include treating ACL or any other knee problems? Also, what kind of prescriptions are podiatrists allowed to write. I have seen podiatrists write prescriptions for pain, but can we write prescriptions for patients with the flu? How does the system of what prescriptions you can prescribe work? I'm just clueless about this area, so any info will help.

Thanks!

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[jonwill]

Scope of practice is determined on the state level. Concerning prescriptions, a podiatrist can write any rx that they can justify. for instance, when I write for a patient after surgery, I'll write for pain, sleep, constipation, itching, nausea, and abx if needed. These are all directly related to my surgery and it's post operative complications. Anything chronic in nature should be managed by the pt's FP.

 

[ohhyourgod]

please refer here:

http://forums.studentdoctor.net/showthread.php?t=585020

this too has been discussed extensively

 

[devilpup]

please refer here:

http://forums.studentdoctor.net/showthread.php?t=585020

this too has been discussed extensively

yea, I remember this classic thread. Good read.

 

[krabmas]

Hi everyone. I've been wondering about some things regarding what podiatrists can do. I understand that we work on any conditions below the knee. But does that include treating ACL or any other knee problems? Also, what kind of prescriptions are podiatrists allowed to write. I have seen podiatrists write prescriptions for pain, but can we write prescriptions for patients with the flu? How does the system of what prescriptions you can prescribe work? I'm just clueless about this area, so any info will help.

Thanks!

In my mind and most others the knee belongs to ortho.

There is no list of meds that pods are restricted to. If the flu is coming from the foot then yes you can prescribe meds for it.

Basically you can write for anything that you want but the pharmacists may become suspicious if you write for birth control pills since there is no use that I can think of even off label for BCP in the foot.

 

[diabeticfootdr]

In my mind and most others the knee belongs to ortho.

There is no list of meds that pods are restricted to. If the flu is coming from the foot then yes you can prescribe meds for it.

Basically you can write for anything that you want but the pharmacists may become suspicious if you write for birth control pills since there is no use that I can think of even off label for BCP in the foot.

Krabmas, even BCPs can be justified. In many clinical trials, the FDA requires the patient be on 2 forms of contraception. So if I happen to have a diabetic patient with a foot infection or ulcer that is of child bearing potential that I'm enrolling into a clinical trial (for their foot), I'm obligated to Rx contraception.

That being said, since I've never written for BCPs nor am I up to date on all the side effects, interactions, etc., I'd phone their PCP and ask which one they prefer for that patient and write for that one.

 

[PADPM]

I think the simple answer to this question is you have to be able to justify your rationale for writing the prescription. As a general rule as a DPM we will usually not be writing an RX for BCP's. Additionally, since as a general rule it is not within our scope to treat the signs/symptoms of the flu, it is not the norm to write for Tamiflu, etc.

Just in case one of our younger members is inquiring about this issue in the event a family member or neighbor has a medical problem, etc., and he/she wants to simply call in an RX or write an RX for a relatively "non-podiatric" problem, my recommendation would be to not get involved with this type of scenario for friends OR family.

I would strongly recommend never writing a prescription or calling in a prescription of any kind for anyone if you do not have a chart for that person. It's great to be a "nice guy", "great neighbor", etc., but if you are going to prescribe any medication it is imperative that you have a chart for that person (who is now a patient).

I can recount dozens and dozens of cases where this ended up biting the prescribing doctor in the ass.

So, write for any prescription you believe is indicated if you can justify it's use, and have a chart for that patient. Don't write RX's as a "favor" for friends or family, it's not a good habit or practice in my opinion, even if it's for simple medications.

 

[NatCh]

I think the simple answer to this question is you have to be able to justify your rationale for writing the prescription. As a general rule as a DPM we will usually not be writing an RX for BCP's. Additionally, since as a general rule it is not within our scope to treat the signs/symptoms of the flu, it is not the norm to write for Tamiflu, etc.

Just in case one of our younger members is inquiring about this issue in the event a family member or neighbor has a medical problem, etc., and he/she wants to simply call in an RX or write an RX for a relatively "non-podiatric" problem, my recommendation would be to not get involved with this type of scenario for friends OR family.

I would strongly recommend never writing a prescription or calling in a prescription of any kind for anyone if you do not have a chart for that person. It's great to be a "nice guy", "great neighbor", etc., but if you are going to prescribe any medication it is imperative that you have a chart for that person (who is now a patient).

I can recount dozens and dozens of cases where this ended up biting the prescribing doctor in the ass.

So, write for any prescription you believe is indicated if you can justify it's use, and have a chart for that patient. Don't write RX's as a "favor" for friends or family, it's not a good habit or practice in my opinion, even if it's for simple medications.

I knew a guy who was on the State Board of Medical Examiners and he said that the biggest cause for physician disciplinary action was writing prescriptions without a legitimate doctor-patient relationship (e.g., calling in a script for a colleague, no chart existed).

You can treat a colleague, friend, or family member but make sure that you do it officially. Sign them in, create a chart, make it legit. You don't have to bill them if you don't want to, but you have to work "by the book."

Nat

 

[diabeticfootdr]

I would strongly recommend never writing a prescription or calling in a prescription of any kind for anyone if you do not have a chart for that person. It's great to be a "nice guy", "great neighbor", etc., but if you are going to prescribe any medication it is imperative that you have a chart for that person (who is now a patient).

This is great advice and absolutely, doing someone a "favor" can get you in a lot of trouble.

Just because you're doing a "favor" doesn't mean you can operate out of your scope of practice.

You should keep a chart on all family members/friends you treat.

 

[krabmas]

Krabmas, even BCPs can be justified. In many clinical trials, the FDA requires the patient be on 2 forms of contraception. So if I happen to have a diabetic patient with a foot infection or ulcer that is of child bearing potential that I'm enrolling into a clinical trial (for their foot), I'm obligated to Rx contraception.

That being said, since I've never written for BCPs nor am I up to date on all the side effects, interactions, etc., I'd phone their PCP and ask which one they prefer for that patient and write for that one.

Not to argue, but...

So you have, then, written for BCP's? Why not just ask the PCP/OBGYN to write for it?

 

[diabeticfootdr]

Not to argue, but...

So you have, then, written for BCP's? Why not just ask the PCP/OBGYN to write for it?

Because as the principal investigator I'm responsible to the FDA and have to be 100% sure that the patient gets the methods prior to enrollment into the study.

It would be fine if you were in the same office building as the PCP and could have them write it and physically hand it to the patient or if you delay the enrollment of the patient until after you can be sure they have it.

I've never had to do it yet, since our patient population is not typically of child bearing potential.

 

[Sundarban1]

What about insulin for your IDDM patient?

 

[diabeticfootdr]

What about insulin for your IDDM patient?

Depends. I have my own hospital service and admit patients. When they are admitted I continue their home medications which includes almost anything you can think of a co-morbid diabetic taking. I am writing the orders for them, therefore, prescribing them. Sometimes I write for insulin sliding scales inpatient or pre-op. It's justifiable as part of my practice in order to perform surgery on the lower extremity.

Anyone who needs an I-med consult, gets one. Likewise, anyone who is unstable and requires care beyond what I can deliver, gets admitted by I-med and I become the consultant.

 

[APharmacist]

This is great advice and absolutely, doing someone a "favor" can get you in a lot of trouble.

Just because you're doing a "favor" doesn't mean you can operate out of your scope of practice.

You should keep a chart on all family members/friends you treat.

Like the Tamiflu prescriptions for an entire family I received from a DPM that consisted of "Pt Name,Tamiflu pills, Take as Directed, Dr. Signature". When I informed the patient I couldn't fill these because they were incomplete and I was going to need a Dx from the Dr. relating Tamiflu to the ankle/foot the pt's response was "Well you see he wrote them for us because we are going to Mexico." Swine flu prophylaxis. Pretty sure these Rx's fall into the favor category. I'll have to keep my eyes on the state disciplenary web site to see if he gets dinged.

 

[diabeticfootdr]

Like the Tamiflu prescriptions for an entire family I received from a DPM that consisted of "Pt Name,Tamiflu pills, Take as Directed, Dr. Signature". When I informed the patient I couldn't fill these because they were incomplete and I was going to need a Dx from the Dr. relating Tamiflu to the ankle/foot the pt's response was "Well you see he wrote them for us because we are going to Mexico." Swine flu prophylaxis. Pretty sure these Rx's fall into the favor category. I'll have to keep my eyes on the state disciplenary web site to see if he gets dinged.

Exactly!

While I don't know all the circumstances in this case (what state, etc.), it seems like it is out of scope. It is definitely out of the standard practice for any doctor to write 1 prescription for the whole family, I doubt she/he kept a chart on all patients. Not to mention, the CDC is not recommending Tamiflu for H1N1 prophylaxis.

Unless you reported this to the state board of podiatry, no one will ever know and you'll never see a discipline.

 

[Smile786]

Thanks for clearing things up. It's risky to do "favors" like that. I'm just going to stick to following the rules.

 

[Podmeister]

I know of 3 podiatrists in CA who recently got in trouble with the state board for prescribing medications to themselves or family members. One had prescribed Flomax for his father in law as a favor, another had prescribed Xanax and Ambien with 10 refills to herself, and another had prescribed Darvocet to himself while using a fake alias.

 

[PADPM]

I know of 3 podiatrists in CA who recently got in trouble with the state board for prescribing medications to themselves or family members. One had prescribed Flomax for his father in law as a favor, another had prescribed Xanax and Ambien with 10 refills to herself, and another had prescribed Darvocet to himself while using a fake alias.

These docs were simply foolish. The first doctor had to know that there was no podiatric indication to write an RX for Flomax for his father-in-law, especially because I'm willing to bet he didn't even have a chart for him. And as I've stated, NEVER write ANY RX for anyone if you don't have a chart for that person. NEVER.

The other two docs were simply waiting to get caught. Any doc that writes an RX to himself/herself for a medication like Xanax or Ambien is just waiting for a call from the authorities. And of course if you write for a narcotic type drug using an alias, you're DEFINITELY going to be getting a phone call!!

I don't think your local pharmacist will mind if you've got a hacking cough and call up and ask for 20 antibiotic pills for yourself on a Sunday afternoon, but any medication that has the potential for abuse is a much different story.

 

[NatCh]

...I don't think your local pharmacist will mind if you've got a hacking cough and call up and ask for 20 antibiotic pills for yourself on a Sunday afternoon, but any medication that has the potential for abuse is a much different story.

...although I've heard that self-prescribing (anything) red-flags you with the DEA. Even if I never break a law I'd just as soon not have a government agency scrutinize me more closely than everyone else. It's like driving the speed limit past a state trooper. You know you're not doing anything wrong but still there's some anxiety involved.

 

[PADPM]

NatCH,

You're absolutely correct, but I was simply using that as an example. My point was simply an "extreme" example that if it was a Sunday, and you were hacking up green sputum, I don't believe you'd get scrutinized for calling in an RX for yourself for a "benign" medication such as an antibiotic, especially if you call in that RX to a local pharmacy that knows you well.

It's obviously not a practice I condone, but once again I was simply using this as an extreme example vs. one of the geniuses in the above post that was writing an RX for their own use for a narcotic, anti-anxiety med, sleep med, etc.

But, ultimately you are 100% correct.

So who do YOU get to call in those Viagra RX's?

 

[NatCh]

NatCH,

You're absolutely correct, but I was simply using that as an example. My point was simply an "extreme" example that if it was a Sunday, and you were hacking up green sputum, I don't believe you'd get scrutinized for calling in an RX for yourself for a "benign" medication such as an antibiotic, especially if you call in that RX to a local pharmacy that knows you well.

It's obviously not a practice I condone, but once again I was simply using this as an extreme example vs. one of the geniuses in the above post that was writing an RX for their own use for a narcotic, anti-anxiety med, sleep med, etc.

But, ultimately you are 100% correct.

So who do YOU get to call in those Viagra RX's?

Viagra? What, is it Valentine's Day already???

 

[smartman716]

Viagra? What, is it Valentine's Day already???

Dr. Natch,

It's summer vacation! It's Fiday! And better yet, it's the Friday before my honeymoon.
Can I get an Rx for Viagra?
Oh, don't tell me that I'm too old. *sarcasm

Thanks,

Sm716

 

[diabeticfootdr]

...although I've heard that self-prescribing (anything) red-flags you with the DEA. Even if I never break a law I'd just as soon not have a government agency scrutinize me more closely than everyone else. It's like driving the speed limit past a state trooper. You know you're not doing anything wrong but still there's some anxiety involved.

NatCh, I don't believe there are "red flags". The red flag is getting turned into the state board. There's no computer system that cross references Dr. name with patient name etc. Just like there are no red flags in Medicare (like if 42% of your business is 11721, etc.). The government waits for a whistleblower because they're not that efficient. I know a former DOJ attorney who specialized in healthcare fraud.

Saying that, I've Rx'd several times for myself and my wife (antibiotics, NSAIDs). I keep a digital record of these on my computer. I knew a Dr. that Rx'd Vicodin for herself after she tripped and hurt her back. It is not illegal to Rx for yourself (including narcotics), but I think if there is a pattern that would raise an eyebrow of a pharmacist, one might get a complaint filed with the state board.

 

[NatCh]

NatCh, I don't believe there are "red flags". The red flag is getting turned into the state board. There's no computer system that cross references Dr. name with patient name etc. Just like there are no red flags in Medicare (like if 42% of your business is 11721, etc.). The government waits for a whistleblower because they're not that efficient. I know a former DOJ attorney who specialized in healthcare fraud.

Saying that, I've Rx'd several times for myself and my wife (antibiotics, NSAIDs). I keep a digital record of these on my computer. I knew a Dr. that Rx'd Vicodin for herself after she tripped and hurt her back. It is not illegal to Rx for yourself (including narcotics), but I think if there is a pattern that would raise an eyebrow of a pharmacist, one might get a complaint filed with the state board.

Yeah, I was wondering if there was some sort of database. I was dubious, as it sounded kind of "big brother-ish."

 

[smartman716]

NatCh, I don't believe there are "red flags". The red flag is getting turned into the state board. There's no computer system that cross references Dr. name with patient name etc. Just like there are no red flags in Medicare (like if 42% of your business is 11721, etc.). The government waits for a whistleblower because they're not that efficient. I know a former DOJ attorney who specialized in healthcare fraud.

Saying that, I've Rx'd several times for myself and my wife (antibiotics, NSAIDs). I keep a digital record of these on my computer. I knew a Dr. that Rx'd Vicodin for herself after she tripped and hurt her back. It is not illegal to Rx for yourself (including narcotics), but I think if there is a pattern that would raise an eyebrow of a pharmacist, one might get a complaint filed with the state board.

diabeticfootdr,

I've been thinking about this scenario. If a DPM who lived in Seattle, and who was on hydroxyurea, happened to be in Vermont, then all of a sudden he/she noticed that he/she had run out of hydrea, would that DPM be justified to self-Rx hydrea. Assuming there was no way to get a hold of his/her oncologist or visit a local hospital in Vermont.

 

[smartman716]

EDIT:

The DPMs condition was not podiatric-related.

 

[diabeticfootdr]

EDIT:

The DPMs condition was not podiatric-related.

No, if you state that the condition is out of scope, then you can not prescribe it for yourself. It doesn't matter if you're writing the medication for yourself, you must still abide by your scope of practice.

Furthermore, the DPM probably didn't have a VT license. Making it illegal for him to write the Rx anyhow.

Rarely will this be an issue, but it could be. You can Rx for a patient across state lines as long as they are your patient and you are treating them in a state where you have a valid license.

 

[smartman716]

No, if you state that the condition is out of scope, then you can not prescribe it for yourself. It doesn't matter if you're writing the medication for yourself, you must still abide by your scope of practice.

Furthermore, the DPM probably didn't have a VT license. Making it illegal for him to write the Rx anyhow.

Rarely will this be an issue, but it could be. You can Rx for a patient across state lines as long as they are your patient and you are treating them in a state where you have a valid license.

Thanks for the clarification.

 

[smartman716]

No, if you state that the condition is out of scope, then you can not prescribe it for yourself. It doesn't matter if you're writing the medication for yourself, you must still abide by your scope of practice.

Furthermore, the DPM probably didn't have a VT license. Making it illegal for him to write the Rx anyhow.

Rarely will this be an issue, but it could be. You can Rx for a patient across state lines as long as they are your patient and you are treating them in a state where you have a valid license.

Double post.

 

[NatCh]

Dr. Natch,

It's summer vacation! It's Fiday! And better yet, it's the Friday before my honeymoon.
Can I get an Rx for Viagra?
Oh, don't tell me that I'm too old. *sarcasm

Thanks,

Sm716

Congratulations on your honeymoon! Here's some Viagra, an antibiotic, some No-Doz...have you had all your shots?

 

[smartman716]

Thanks Dr. NatCh,

I'll be calling you when I'm ready for those shots. I'll also need 4-year refills on the
No-doz + Redbull

Congratulations on your honeymoon! Here's some Viagra, an antibiotic, some No-Doz...have you had all your shots?

 

[NatCh]

Thanks Dr. NatCh,

I'll be calling you when I'm ready for those shots. I'll also need 4-year refills on the
No-doz + Redbull

4-year-long honeymoon? In that case, here's:

Viagra 50mg
14 pounds!
1 po prn doing the devil's business

 

[smartman716]

Ha, ha 4-years of pulling all nighters. I have to get the boards out of the way