Haole

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Is it legal to call in a prescription for yourself, ie an antibiotic for a tooth abscess, or maybe a little propecia for the old balding noggin? I'm not talking about narcotics or benzos...
 

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Is it legal to call in a prescription for yourself, ie an antibiotic for a tooth abscess, or maybe a little propecia for the old balding noggin? I'm not talking about narcotics or benzos...
What's the problem, you don't have a doctor?
 

med2UCC

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by the way, how come you are a resident but don't know perscription laws?
Prescribing laws are not something that most med schools obsess about, and most programs don't lay out specific rules either.
Where I am, it is considered unethical to prescribe for oneself (and unwise) but not illegal. I do it if it's for something I a) get routinely (pulmicort) and for some reason can't get someone else to write it or b) need urgently and am pretty sure I know what I need (augmentin to keep the nasty bronchial infection at bay when I get an URTI - happens every winter and if I start the augmentin in time I don't get the green goo).
If at all possible we all (the residents in my program) get the paper from someone else, even if it is only the person sitting next to us in journal club. The unwritten rules are not antidepressants (or antipsychotics - fortunately not an issue so far), not benzos, not sleep aids and not narcs. Cheers,
M
 

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Part of the reason it's not taught in med school is that rules vary by state. Note that except for controlled substances, it's usually legal to write your own prescriptions. However, most state laws require that you keep records on all patients for which you treat, which would include yourself. Theoretically, if someone wanted to make a big deal of it, you could get into trouble for treating yourself without keeping records. Honestly this is a stretch and is unlikely to happen.

Still, I tell all of my residents not to do this. refilling a chronic med may be OK, but prescribing new ones, like abx, is best avoided.
 

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What about refilling prescriptions for basic meds like metformin or simvastatin for family members?

I have close relatives who must pay out of pocket for office visits and labs as they don't have health insurance and really can't afford care beyond an annual exam ($200 a visit)? What if I do their physical exam and pay for them to get basic labs, could I then take care of their diabetes, HTN, etc as a resident to help stretch out how often they need to see their PMD?

And no, they haven't taught us a thing about this stuff in the last 4 years.
 

doctorFred

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What about refilling prescriptions for basic meds like metformin or simvastatin for family members?

I have close relatives who must pay out of pocket for office visits and labs as they don't have health insurance and really can't afford care beyond an annual exam ($200 a visit)? What if I do their physical exam and pay for them to get basic labs, could I then take care of their diabetes, HTN, etc as a resident to help stretch out how often they need to see their PMD?

And no, they haven't taught us a thing about this stuff in the last 4 years.
it varies from state to state, but i believe the short answer is, if you keep the appropriate and standard documentation for your "patient visits", there is nothing illegal about treating and prescribing for your family members.

(insert the generic, obvious "ethics/slippery slope/etc." counterpoint here.)
 
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Thanks a lot, I've been getting a lot of questions from family members about this issue and wanted to see what the general consensus was (legal vs blatantly illegal). Obviously some might have some ethical issues with this, but hey, if my mom needs her statin (that she's been on for years) and I check her LFTs and lipid profile before prescribing/filling it, I personally don't see anything wrong with being the MD to do that. (Naturally, I would not be prescribing narcotics, etc.)
 

aProgDirector

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What about refilling prescriptions for basic meds like metformin or simvastatin for family members?

I have close relatives who must pay out of pocket for office visits and labs as they don't have health insurance and really can't afford care beyond an annual exam ($200 a visit)? What if I do their physical exam and pay for them to get basic labs, could I then take care of their diabetes, HTN, etc as a resident to help stretch out how often they need to see their PMD?

And no, they haven't taught us a thing about this stuff in the last 4 years.
As a resident you will have a training license. It allows you to practice medicine under supervision. Seeing friends/family members on your own time away from your program is called "moonlighting", even if you don't charge for it. It's illegal, you'd be practicing medicine without a license.

The chances of getting caught or anyone caring is very small. If someone does notice / care, you could get terminated from your program esp if you lose your training license.
 

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Thanks for the replies. It sounds like its best to just avoid it.
 

Haole

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What's the problem, you don't have a doctor?
I haven't seen a doctor in ??? I really would like to establish myself with a PCP, but scheduling a visit is tough during internship.
 

Haole

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If at all possible we all (the residents in my program) get the paper from someone else, even if it is only the person sitting next to us in journal club.
M
I thought about that, but because I wasn't sure what the laws were I didn't want to get anyone in trouble. I would imagine that things are more closely monitored when you have a training license.
 

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What is the advantage of having someone one else write one for you instead of yourself? It's not like the resident sitting next to you in rounds is going to document the encounter either...
 

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Can you ask your fellow residents or fellow to write prescription for you? Most fellow do have medical license?
 
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As a resident you will have a training license. It allows you to practice medicine under supervision. Seeing friends/family members on your own time away from your program is called "moonlighting", even if you don't charge for it. It's illegal, you'd be practicing medicine without a license.

The chances of getting caught or anyone caring is very small. If someone does notice / care, you could get terminated from your program esp if you lose your training license.

That makes sense, thanks aPD. I made nobody any promises to "treat" them anytime soon, but I never knew what to say when they asked me about it. So after taking Step 3 and getting a state license, it would be okay to moonlight in such a fashion?
 

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That makes sense, thanks aPD. I made nobody any promises to "treat" them anytime soon, but I never knew what to say when they asked me about it. So after taking Step 3 and getting a state license, it would be okay to moonlight in such a fashion?
With a full license and DEA, it is completely legal. Again, your state likely requires you to keep records, which you could easily do on a computer. And, the chances of anyone caring are miniscule.

Remember though that you would have no medmal for this. If Uncle Vinny takes your prescription and something bad happens, if he sues you, you are completely on your own.
 

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Is it legal to call in a prescription for yourself, ie an antibiotic for a tooth abscess, or maybe a little propecia for the old balding noggin? I'm not talking about narcotics or benzos...
I'm pretty sure it's legal but as aProgDirector says.. make sure you document it. I don't think the DEA is going to be knocking on your door for prescribing yourself propecia.

However, they may take a look if they notice anything suspicious with your prescriptions for controlled substances. You can't prescribe these drugs to yourself or family members for obvious reasons.

I got curious about the law and I found this to be pretty helpful:
DEA - Information & Legal Resources
 

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I'm pretty sure it's legal but as aProgDirector says.. make sure you document it. I don't think the DEA is going to be knocking on your door for prescribing yourself propecia.

However, they may take a look if they notice anything suspicious with your prescriptions for controlled substances. You can't prescribe these drugs to yourself or family members for obvious reasons.

I got curious about the law and I found this to be pretty helpful:
DEA - Information & Legal Resources
Good points all. I will only add on that many states have prescribing laws that are more restrictive than the DEA so you need to be aware of the laws in the state in which you are licensed in addition to the national laws.
 

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I prescribe my own flonase for myself but that's it and don't prescribe for anyone else. I've been taking it for >10 yrs and don't have time to find/see a PCP in residency. I can't really imagine a more benign drug to prescribe for oneself, esp. as if it's something that's been taken for a while (i.e. not a new diagnosis).

But other than something like that, I would not get into the habit of prescribing yourself drugs, esp. new drugs that you haven't taken before, or drugs for anyone else.
 

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I haven't seen a doctor in ??? I really would like to establish myself with a PCP, but scheduling a visit is tough during internship.
Somebody always has a snarky comment on SDN. I haven't had a chance to get a PMD yet (working on the Leeward side), so I write for my own meds. When I had a doc in my prior location (which I am not naming), my PMD had no problem with me refilling my own.
 

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Does anyone know where sildenafil falls on the drug schedule list?

Also, I'm sure it would be "unethical" to crush it up and put it in significant manboy's orange juice.. but would it be "frowned upon"?

Just wondering. Thanks!
 

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I can do better. I promise. ;)

Keeping it on-topic, doctors saying they can't be bothered to see a doctor is, frankly, lame.
I don't think it's quite that simple. I'm pregnant, and you can bet I make time to see my ob/gyn which can really mean creative schedule planning with my coresidents and appointments where I'm falling asleep during the pelvic exam post call and have to call my husband to drive me to and from the appointment because I'm so tired.

When it comes to needing my flonase which I have taken for 10 years, why go through the hassle of doing all that especially when I don't have a pre-existing relationship with an internist anyway? Unlike with the obgyn who I have seen for pap smears and annual exams before I was pregnant. I'm guessing a lot of women may feel this way about their obgyns sort of standing in as a pcp when they're otherwise young and healthy.

If I was in my 40s, I might feel differently than I do in my late 20s.
 

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What about refilling prescriptions for basic meds like metformin or simvastatin for family members?

I have close relatives who must pay out of pocket for office visits and labs as they don't have health insurance and really can't afford care beyond an annual exam ($200 a visit)? What if I do their physical exam and pay for them to get basic labs, could I then take care of their diabetes, HTN, etc as a resident to help stretch out how often they need to see their PMD?

And no, they haven't taught us a thing about this stuff in the last 4 years.
I'm surprised no one has posted an answer to this specifically.

Most would agree that there's nothing unethical or unwise about refilling a family member's (non-scheduled) prescription for a chronic condition ... if it's done so they don't run out before their next appointment with a doctor that isn't you.

The problem in actually being a family member's doctor is that it's almost universally unwise. However objective you think you are, you probably aren't. However complete and honest you think they are in answering your questions, they probably aren't. You really think Uncle Fred is going to bring up his erectile dysfunction during your informal diabetes followup? You might save them a couple bucks but at the cost of the professional, complete, and private appointment they deserve.
 

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So what if you're playing b-ball with a friend who tears a ligament and it's the weekend, you know that the ER won't do anything for him and he needs to see an orthopedic surgeon but the dude is in a lot of pain. you can't simply call in a prescription for some Tylenol #3? to hold him over until he sees an orthopedic surgeon on monday or tuesday?
 

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So what if you're playing b-ball with a friend who tears a ligament and it's the weekend, you know that the ER won't do anything for him and he needs to see an orthopedic surgeon but the dude is in a lot of pain. you can't simply call in a prescription for some Tylenol #3? to hold him over until he sees an orthopedic surgeon on monday or tuesday?
Your friend actually has a fair prescription drug habit that he doesn't bother to tell you about. The DEA or local police eventually pick him up buying oxycodone behind a Waffle House at three in the morning. During the search of his house they turn up a bottle with your name on it. You are called into your PDs office and find the police waiting to talk to you. Try "whats the harm" as a defense.
 

Apollyon

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So what if you're playing b-ball with a friend who tears a ligament and it's the weekend, you know that the ER won't do anything for him and he needs to see an orthopedic surgeon but the dude is in a lot of pain. you can't simply call in a prescription for some Tylenol #3? to hold him over until he sees an orthopedic surgeon on monday or tuesday?
Do you even read what you write? In your magnanimity, why would the ED give him the short shrift, whereas you are the upstanding casual drug peddler? If you can diagnose the ligamentous injury, then an actual practicing EM doc should be able to, so, why, again, would the doc not help out your friend? Is it the sketchy FMG friend with him? (And I am an FMG, from your school.)

core0 has it dead on. When you get called into your PD's office, and there's another PD there with a gold badge, that's a great way to make an impression.
 

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funny guys.. so you're saying my ex-gf's mom was acting illegally when she called in a prescription for tylenol #3 at 9pm when i burned my hand, and she drained the boil the next day.


my friend didn't want to wait in the ED for 4+hours just to get a script for pain killers, something i would be able to call in and it would take me less than 3min. it's an honest injury i was there when it happened.

don't you ask your lawyer friends for advice on stuff all the time? it's like not charging a friend for a visit. where is your sense of profesional courtesy?
 
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Apollyon

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funny guys.. so you're saying my ex-gf's mom was acting illegally when she called in a prescription for tylenol #3 at 9pm when i burned my hand, and she drained the boil the next day.


my friend didn't want to wait in the ED for 4+hours just to get a script for pain killers, something i would be able to call in and it would take me less than 3min. it's an honest injury i was there when it happened.

don't you ask your lawyer friends for advice on stuff all the time? it's like not charging a friend for a visit. where is your sense of profesional courtesy?
You're changing your tack here, and positing several points. First, you describe a therapeutic relationship with your ex-gf's mom - she got you pain meds, then did a procedure on you. I hope she kept a record. What if the burn got infected, and you needed your hand amputated?

As for your friend, you change your point - first, you said that the ED would do nothing for him. Then, you say your friend didn't want to wait to get the script - those are two VERY different things.

And the last paragraph has a few laughable things: "lawyer friends?" Hahahaha! In truth, though, I knew a few lawyers in the 90s. "Professional courtesy" was when he cut an hour off the charges when I got a speeding ticket. When I had other questions about another issue, I posted the questions to him, and he sent back an estimate of how much it would cost me for him to answer them. Another was the high-powered attorney friend of my friend. He had one of his lackeys/minions/toadies fix a speeding ticket for me in a local rural court (which, coincidentally, I had legal ground to argue if I actually had to go to court), knocking it down to a parking violation, and never sent me a bill for services (although I asked several times, saying "no one works for free").

Oh, and irony is misspelling "professional".
 

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So what if you're playing b-ball with a friend who tears a ligament and it's the weekend, you know that the ER won't do anything for him and he needs to see an orthopedic surgeon but the dude is in a lot of pain. you can't simply call in a prescription for some Tylenol #3? to hold him over until he sees an orthopedic surgeon on monday or tuesday?
There are a lot of assumptions in this situation.

- You're assuming that you know enough to correctly diagnose a torn ligament (without missing anything potentially more serious, like an avulsion fracture) with minimal diagnostic equipment.

- You're assuming that the Tylenol #3 will be enough to hold him. It probably will, but what if he calls you up at 11 PM and says "I'm in too much pain; these pills aren't doing anything for me." Then what?

- You're assuming that the ER "won't" do anything for him. At the very worst, they can rule out anything potentially more serious and give him adequate analgesia. They may even be able to put a brace on it should that be necessary.

- You're assuming that your friend actually WILL go to the orthopod on Monday or Tuesday. If he goes to the ER and they send him home with instructions for followup, but he doesn't, at least they have documentation that he was neurovascularly intact, that they told him to followup, etc. If he doesn't go to ortho, and something goes wrong, and he points the finger at you, then what? What are you going to say when he says that you didn't tell him to go to ortho? Or that you just gave him pain meds but didn't make him go to the ER for x-rays?

A friend called me a few weeks ago. She said that she was having suprapubic pain, with a lot of urinary urgency. She had had a UTI a few weeks ago and "cipro really helped," so could I call some more cipro in for her? I told her no, sorry, but if it was that unbearable that she was calling me on a weekend, she should go to the ER. You know what that "suprapubic pain" turned out to be? An incarcerated hernia - she was in the OR 12 hours after I talked to her. You never know.
 

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The tension in this thread is rising and it's not because I mentioned sildenafil in my last post.

I think some of the experienced docs in the last few posts are right about being cautious and following the correct guidelines about writing prescriptions (even in the fake torn ligament scenario). If you just started residency and had an attending who wrote Rx's like it was going out of style for family & friends, you would be more comfortable and start doing the same thing. We all know that docs help their buddies out with non-schedule Rx's sometimes.. but they have better judgment which only comes from experience. A new resident trying to follow an example like this right from the get-go is gonna F something up and then it will be their license/job on the line.

I get the feeling that the experienced docs are just trying to look out for the new residents because an over-confident youngin' with no time on the front lines is just gonna get themselves shot. They just want us to be careful and consider the consequences of our newbie actions.

Anyway, can someone write me a prescription for vicodin? Thanks!
 

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Hell no I wouldn't write the script. Plenty have folks have been disciplined by state medical boards for scenarios just like this. Chances are nothing would happen. I don't like to take chances though.

So what if you're playing b-ball with a friend who tears a ligament and it's the weekend, you know that the ER won't do anything for him and he needs to see an orthopedic surgeon but the dude is in a lot of pain. you can't simply call in a prescription for some Tylenol #3? to hold him over until he sees an orthopedic surgeon on monday or tuesday?
 
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I am only a sophomore in college, so I have a while until I even start med school. I do have a question for the future though.

I have been on Zoloft since the 7th grade for anxiety. I see a GP once a year and they refill it for the next 12 months. I haven't had any issues since I have started the meds and I haven't had a change in dose in over 5 years. Would I be able to write my own prescriptions for this or would I still need to get another doctor to do it for me?
 

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I am only a sophomore in college, so I have a while until I even start med school. I do have a question for the future though.

I have been on Zoloft since the 7th grade for anxiety. I see a GP once a year and they refill it for the next 12 months. I haven't had any issues since I have started the meds and I haven't had a change in dose in over 5 years. Would I be able to write my own prescriptions for this or would I still need to get another doctor to do it for me?
This is the same situation discussed above.

Yes, you CAN write your own prescriptions for non-scheduled drugs.

Whether or you should is a different discussion.

I have a personal policy that I do not write prescriptions for co-workers or friends except in extreme circumstances and I always document that I have examined that person. I now never write for a narcotic for any one not a patient of mine (and yes, I have been asked). I made the latter mistake once during fellowship with a nurse who wanted Percocet for a migraine - I said yes once and then she kept coming back to me for more because for some reason or another she couldn't get into see her neurologist. It was uncomfortable seeing her for awhile since I think she was mad at me, but the risk of losing my DEA or medical license was not worth it.

RussianJoo - you would be setting a precedent that will spread rapidly - your friends, family and co-workers will know you write prescriptions (especially for narcotics) and will flock to you for antibiotics for sore throats, Diclox for their UTI and narcs for their sore back. I don't know if the above scenario you wrote is real, but please take our advice and do NOT write prescriptions for friends/family/co-workers, especially for narcotics. Our state medical board website is full of letters of reprimand and even license probation and relinquishment for physicians doing the same.
 
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RussianJoo

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Why did everyone assume that the scenario i talked about is a drug seeker, are all your close friends drug seekers? Unethical and illegal are two different things i wanted to know if it was legal, but since laws change from state to state i'll have to look up specific laws for my state. I am not saying I'll start writting scripts as a resident to all my friends or family, in fact i won't be able to because they'll all have to be co-signed. But one of the nice things of having a friend who's a professional; be it a doctor, lawyer, accountant, police officer, whatever, is to get things done right away or free of charge...

What I meant by the fact that the ED wouldn't do anything for him, is that all the ED would do is splint him and write him a script for pain killers,until he would go see an orthopedic surgeon and schedule surgery or whatever. and do some imaging and would find out exactly what a good physical exam and history would show. And all those things except for the imaging i would be able to do for him, so why have him wait in the ED for 3 hours or more when I could do the same thing they would in under 10min.

Who ever posted about their lawyer friend billing them must either not be close friends with the lawyer or the friend is a dirt bag, because I would never charge my friends for medical advice, and already have friends who are corporate lawyers who I asked advice on different things, and they didn't charge me at all.

SMQ123 has some excellent points though that something serious could be miss diagnosed, and that would be the only reason why I would suggest going to an ED.. But how many times have you guys stitched up a friends cut instead instead of sending themto the ED. In fact I know of parents who stitched up their kid in their office after hours and not taking him to the ED.

These favors might not be talked about openly and I might have opened up a taboo topic but stuff like this happens everyday by most people.
 

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My point was not that your friend is or isn't a drug seeker, but that this is a slippery slope.

The fact is that if you friend/family member/co-worker has a complication or even if a friend of their's uses the meds and has a complication, you can face legal action (yes, even in the latter situation - it has happened). You may be suprised at what little it takes for someone to decide to report you to the board or to sue you if they have a problem; if you have no record of treating this person (and especially if the injury/disease was out of your scope of practice), the board will not look kindly on you and your license. And yes, most of us do it anyway, but we/you should be careful about it especially in the case of narcotics.

As an aside, I still have the antibiotics in my medicine cabinet from when a friend misdiagnosed me as having diverticulitis when I had a completely different problem requiring emergency surgery. Sometimes the ED is where your friend needs to be.
 

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Who ever posted about their lawyer friend billing them must either not be close friends with the lawyer or the friend is a dirt bag, because I would never charge my friends for medical advice, and already have friends who are corporate lawyers who I asked advice on different things, and they didn't charge me at all.

SMQ123 has some excellent points though that something serious could be miss diagnosed, and that would be the only reason why I would suggest going to an ED.. But how many times have you guys stitched up a friends cut instead instead of sending themto the ED. In fact I know of parents who stitched up their kid in their office after hours and not taking him to the ED.

These favors might not be talked about openly and I might have opened up a taboo topic but stuff like this happens everyday by most people.
I was the one who posted about the lawyer I knew, and made the same points as smq123 (in one post before). That makes it look like you're being passive-aggressive about this. And how many times have I stitched up someone's cut outside the ED? Never. I don't even have sutures, a suture kit, or lidocaine. To say it "happens everyday by most people" is really stretching it.
 

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Even I don't have any suture material or lidocaine in the house.
I keep both steri-strips and glue in the house, but more because I'm chronically clumsy than any other reason. Oh, and the steri-strips hold my bike lights together:D. I've never used them on anyone else and probably wouldn't - just as easy to get them to meet me up at the hospital where I can do it in comfort and give the tetanus jab at the same time (I'm up to date, despite having an idiosyncratic reaction to the jab).
Occasionally, the ortho or EM guys here will examine a kid at a hockey game as a favour to one of their neighbours, but they always arrange follow-up in the clinic. It's Canada, it's a small town, so a very different medico-legal climate, but they document those encounters and call if the kid doesn't show for the follow-up visit. I've never heard of anyone suturing at home or in the office, although I did get chewed out once by my FP for going to the ED for sutures instead of having him paged. Apparently he likes to suture clumsy women in the middle of the night - who knew?
As for narcs, no one really knows who will become a problem patient in regard to narcs. It is best to not prescribe them for anyone you know personally, and to prescribe sparingly in the rest of the general population. We have a duplicate prescription pad just for narcs here and the province monitors your prescribing practices. A local doc just lost his license for good due to his practices in this regard, so we are all very cautious about how we write narcs.
Anyway, that's my 2 cents worth from north of the border. Cheers,
M
 

RussianJoo

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I was the one who posted about the lawyer I knew, and made the same points as smq123 (in one post before). That makes it look like you're being passive-aggressive about this. And how many times have I stitched up someone's cut outside the ED? Never. I don't even have sutures, a suture kit, or lidocaine. To say it "happens everyday by most people" is really stretching it.
sorry i didn't mean to be passive aggressive. a lot of people commented on my post and i didn't bother to see exactly who said what and reply individually.



i guess i am still a naive med student, all the other comments on being sued and having complications are correct, i didn't even think about being sued because these would be my very close friends, not someone who's a friend of a friend or whatever. but you guys are right, we all worked very hard to get our medical licenses and to get where we are today it would be stupid to lose all that on just one script... I guess if I want to be a good friend and move things a long i could offer that said friend a ride to the hospital and to see what i could do to get him seen faster assuming i bring him to the hospital i work at.\


also you guys are correct about practicing out of the scope of my expertise, as a future anesthesiologist it really upsets me when i see none anesthesiologists administer anesthesia, even if it is conscious sedation.

lastly i could also think of it this way, if this is a good friend of mine wouldn't i want the best care/treatment for him and that would be at a hospital/ER not at my house or the park....


thanks everyone for your comments.
 

smq123

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i guess i am still a naive med student, all the other comments on being sued and having complications are correct, i didn't even think about being sued because these would be my very close friends, not someone who's a friend of a friend or whatever.
Someone being your close friend wouldn't necessarily stop them from suing you, nor would it prevent you from feeling enormous guilt if they DID have a bad outcome because you treated them in your kitchen instead of bringing them to the ER.

I agree - the idea of being able to treat your friends and family and save them a $25 copay is tremendously appealing and tempting. Who wouldn't want to do your close friends/family a favor? But, in the long run, you aren't really doing anyone any favors.