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Is it ever OK to prescribe for friends and family?

 

If you’ve been practising for any length of time, you’ve undoubtedly faced the dilemma of a friend or family member asking you whether you could write a prescription for them. Often it’s a repeat script for a treatment they’re already on, when it’s inconvenient for them to go to their GP. You might think that’s fair game – but is it really wise and safe to go ahead and write that script?

It’s a complex issue. First up, there’s the question of whether there could be any legal ramifications in prescribing for people with whom you have a close, non-patient relationship. The trouble is that legislation on this varies from state to state. Broadly, it is legal to prescribe for family members everywhere except in South Australia, where S8 medications can only be prescribed in a “verifiable emergency”.

Prescribing for you own use is more contentious. All states and territories ban self-prescription of S8 drugs, although NSW, NT, Queensland and South Australia will allow it under certain emergency conditions. All states except Victoria allow self-prescription of S4 drugs, but with varying levels of restrictions.

But even if it’s legal to prescribe for friends and family, there are other questions to consider. Many professional indemnity insurance policies specifically exclude claims arising from elective medical treatment provided to a doctor’s immediate family, which could leave you significantly out of pocket should anything go wrong.

And if things do go wrong, there’s not just insurance coverage to think of. The practice is not recommended by the Medical Board of Australia and there have been cases where it has led to disciplinary action.

A recent case involved a NSW doctor who had been in private practice for 30 years, with no previous disciplinary record or conditions on his registration.

He was found to have provided wrongful and inappropriate prescriptions to his adult children and spouse, including S4D medications. Conduct issues were confined to his prescribing habits for his family and did not involve the day-to-day treatment of his patients.

In handing down its decision of professional misconduct, the tribunal referred to the Medical Council of NSW guidelines for self-treatment and treating family members, which supplements the recommendations of the Medical Board’s Good Medical Practice.

Here’s what the latter document has to say about prescribing for family, friends or oneself:

“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 upshot of this and other advice from the regulatory bodies is that:

  • It is not advisable to treat family members, friends, or yourself;
  • In an emergency situation, provide only the immediate treatment needed before handing the person over to an independent doctor;
  • You can collaborate with a family member’s treating doctor, as long as you’re not the primary doctor;
  • If you do treat a family member, document the treatment and provide it to the primary doctor;
  • Make sure you have your own GP.

It’s not always easy to resist emotionally-based pressures, especially when they come from friends or loved ones. But it’s precisely these subjective emotions that don’t mix well with the appropriate and objective care of a patient. A good idea is to prepare a sympathetic explanation beforehand as to why you can’t prescribe for them. It might run along the lines of: “I’d love to help out, but I’m afraid that kind of thing is frowned upon by the Medical Board. Let me see if I can get hold of a colleague for you.”

And remember that each time you do prescribe for someone, you are entering into a doctor-patient relationship with that person, even if she or he is a family member.

Sources: Avant, MDA National