Should I Prescribe for Family and Friends?

Medico-legal issues

In short, the answer is that in the vast majority of situations prescribing for family and friends is not considered to be good medical practice. 

In SA, the legislation specifically prohibits the prescription of drugs of dependence to family members, unless it is a “verifiable emergency”. While the legislation in other states and territories does not specifically prohibit medical practitioners prescribing for family members or friends, this would generally be considered
inappropriate especially where drugs of dependence (Schedule 8 drugs) are involved. 

It is also important to be aware that self-prescribing is inappropriate and it is specifically prohibited by legislation in the ACT (interns), NT and Victoria. There is also legislation in each state and territory which prohibits the self-prescription and/or administration of drugs of dependence or addiction.

The Medical Board of Australia strongly discourages all medical practitioners from providing medical care to family and friends (this would include prescribing), and there is the possibility of disciplinary action arising from this practice.

Section 3.14 of the Medical Board of Australia’s “Good Medical Practice: A Code of Conduct for Doctors in Australia” states:

“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”.

There may also be issues in terms of medico-legal assistance or indemnity in the event of an adverse outcome, claim or an investigation arising out of prescribing for family and friends.

Discussion

The issue of prescribing for family and friends is complex and potentially fraught with difficulty. While only legally prohibited in SA, there are ethical and professional issues that need to be considered in this situation. In particular, providing medical treatment to someone with whom you have a close relationship can affect your ability to provide good quality care. Concerns include:

• compromised quality of care due to increased informality of the “consultation”
• failure of the person to communicate openly and honestly, especially sensitive information or facts which might necessitate a physical examination
• failure to obtain an adequate history by relying on existing knowledge about the person 
• failure to keep a proper record of the consultation.

A survey of US physicians found that 75% had been asked to provide a prescription for a first or second degree relative, and 51% had been asked by their spouse. 

86% had refused to write a prescription on at least one occasion for a friend or family member. The following reasons “strongly influenced” their decision to refuse a prescription request:

1. outside of practitioner’s expertise (88%)
2. patient’s need for his or her own physician (70%)
3. not medically indicated (69%)
4. need for a physical examination (65%).¹

Risk management strategies

• Say “no” to requests from family and friends for prescriptions – it’s only considered ethically and professionally appropriate to prescribe in exceptional circumstances.
• Consider in advance how you might refuse a request to provide a prescription e.g. “Professional guidelines mean that I am not able to prescribe for family and friends.”
• Think very carefully before you prescribe for family and friends – there are potential risks to both you and your family member/friend if you proceed. 

References

1. Walter JK, Lang CW, Ross LF. When physicians forego the doctor-patient relationship, should they elect to self-prescribe or curbside? An empirical and ethical analysis. Journal of Medical Ethics 2010; 36(1)19-23.