5 questions to ask if prescribing to family and friends
Prescribing for family and friends is a difficult topic that has been raised again in a recent article in Australian Prescriber.
Manager of the Medico-Legal and Advisory Service at MDA National, Sara Bird writes that it’s not prohibited by law, however isn’t recommended by the Medical Board of Australia.
“It is only considered ethically and professionally appropriate to prescribe in exceptional circumstances, and there are potential risks to you and your family member or friend if you do,” she writes. She advises to think carefully before prescribing to family and friends.
According to Section 3.14 of the Medical Board of Australia’s ‘Good medical practice: a code of conduct for doctors in Australia’:
Whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends, those you work with and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the doctor and patient. In some cases, providing care to those close to you is unavoidable. Whenever this is the case, good medical practice requires recognition and careful management of these issues.
The Board highlights a recent example of a decision by a medical practitioner ‘to not call an ambulance for their unconscious friend and to monitor them instead, resulted in that friend’s death from a medication overdose. The doctor was inappropriately influenced by the friend’s family’s potential embarrassment.’
They say the standard of care for family and friends can be compromised because the relationship can cloud professional objectivity. It also makes it difficult for the doctor to obtain a complete medical history and perform a proper examination.
Legally, there are different restrictions depending on the state or territory however there are generally no legal restrictions on prescribing Schedule 4 or 8 drugs for family and friends, except in South Australia which says it must be a ‘verifiable emergency’.
Sara Bird writes that before you consider prescribing, you should ask yourself the following five questions:
Am I able to provide appropriate medical care to my family member or friend in this situation?
Am I following my usual practice in providing a prescription or repeat prescription in this situation?
Would my peers agree that prescribing in this situation was consistent with good medical practice?
If I prescribe, does this mean that my family member or friend is my patient?
Would our personal relationship survive an adverse outcome of treatment?
She concludes that the starting point for a request to prescribe for family or friends should always be no unless there are exceptional circumstances.