Dr. Leslie Greenberg's Blog

I recently was asked to write a prescription a controlled substance (like pain pill/ sleeping pill) for a non-patient.  This was my first time in 20 years of doctoring to address this.  I said “no” gently, but firmly.   This decision was not taken well and there was push-back of how-easy-it-would-be-to-just-take-out-my-prescription-pad-and-write-the-desired-prescription.  I held my ground and then researched this for universal guidelines on the subject…

Most physicians are not aware that ethical guidelines on the treatment of non-patients do exist.1 Section E-8.19 of the AMA Code of Medical Ethics (available online at http://www.ama-assn.org/ama/pub/category/8510.html) states that “physicians generally should not treat themselves or members of their immediate families” because their professional objectivity may be compromised in those situations. Exceptions are allowed for “short-term, minor problems” or “in emergency or isolated settings.”

The American College of Physicians (ACP) Ethics Manual (available online at http://www.acponline.org/ethics/ethicman.htm) similarly asserts that “physicians should avoid treating themselves, close friends or members of their own families.” It goes on to comment that “physicians should be very cautious about assuming the care of closely associated employees.”

Some state medical boards take these positions a step further. For example, North Carolina requires that the “physician must prepare and keep a proper written record of that treatment,” and additionally, the Medical Code of Virginia specifies that “records should be maintained of all written prescriptions or administration of any drugs.”

Insurance providers also have an opinion on this… Medicare and Blue Cross Blue Shield ban payments for the care that physicians provide for immediate family members, even in an office setting.

There are also legal considerations. Once a physician begins treatment, a patient-physician relationship is established. From that point on, the physician is liable for the interaction and its consequences. The scope of federal law for written prescriptions is limited to controlled substances. It states that a prescriber must have a bona fide patient-physician relationship, including a written record of it. At a minimum, state law follows federal statutes. However, some states (Massachusetts, for example) further require documenting a medical history and a physical exam before prescribing any medication.

The bottom line for ethical and legal guidelines: Don’t treat non-patients except in cases of minor problems or emergencies. Document what you do. Stay away from prescribing controlled substances.