Audit Risk: Prescriber Scope of Practice and Treating Self or Family

prescriptions written by prescribers that are outside of their designated specialty, or to treat themselves or family members, pose numerous ethical, legal and professional dilemmas and must be managed carefully. These situations may occur more frequently in small towns where there are limited prescribers.

While most states allow prescribers to write prescriptions beyond their specialty and to treat themselves or family members with non-controlled medications – the boundaries of when it is appropriate rely on professional judgement and opinions of both the prescriber who writes the prescription and the pharmacist who receives it.

The American Medical Association (AMA) states that, in general, physicians should not treat themselves or members of their own families. However, the AMA recognizes that it may be acceptable in limited circumstances such as emergency situations when no other qualified physician is available or for short-term, minor problems. The AMA outlines some of the possible concerns about professional objectivity, patient autonomy, and informed consent in its policy opinion.

When the patient is an immediate family member, the physician’s personal feelings may unduly influence his or her professional medical judgment. Or the physician may fail to probe sensitive areas when taking the medical history or to perform intimate parts of the physical examination. Physicians may feel obligated to provide care for family members despite feeling uncomfortable doing so. They may also be inclined to treat problems that are beyond their expertise or training.

Similarly, patients may feel uncomfortable receiving care from a family member. A patient may be reluctant to disclose sensitive information or undergo an intimate examination when the physician is an immediate family member. This discomfort may particularly be the case when the patient is a minor child, who may not feel free to refuse care from a parent.

PAAS Tips:

• Most states prohibit prescribers from writing controlled substances for themselves and family members, except in emergencies.
• Prescriptions written outside of a prescriber’s specialty pose potential risk of inappropriate or ineffective treatment due to a lack of expertise.
• Documenting your rationale when choosing to dispense (or not to dispense) these types of prescriptions may protect you from PBM entanglements.
• Best practices to help pharmacies navigate these complex situations:
  • Evaluate each prescription individually – take into account the diagnosis, the medication, and the availability (or lack thereof) of alternative prescribers
  • Verify your state laws with respect to non-controlled medications (self-prescribing of controlled substances is generally prohibited)
  • Have clear communication with patient and prescriber about your concerns
  • Document any communications with patient and/or prescriber on the prescription or in your pharmacy management system (helpful whether you choose to fill or not fill the prescription).
  • Coordinate alternative treatment options with patient and prescriber (if you choose to not dispense)