The North Carolina Medical Board just proposed a revision to its current policy on self-treatment and prescribing to family members. It does not look dramatically different from prior policy statements. The updated policy draft was posted for comments (below). Not surprisingly, our colleagues have strong opinions.
2.2.3: Self-Treatment and Treatment of Family Members
Treating oneself or a family member presents unique and significant challenges, including risks to professional objectivity, concerns about patient autonomy, and difficulties ensuring informed consent. These factors can lead to ethical and practical dilemmas that compromise the quality of care.
The North Carolina Medical Board enforces rules 21 NCAC 32B.1001, 32S.0212, and 32M.0109, which strictly prohibit licensees from prescribing controlled substances, including all narcotics, to themselves and their immediate family members under any circumstance.
Furthermore, it is the position of the Board that licensees should not prescribe non-controlled medications or manage chronic conditions for themselves, their immediate family members, or those with significant emotional ties. In these situations, professional objectivity is at risk, and personal feelings may unduly influence clinical judgment, thereby interfering with the delivery of optimal care. In addition, family members may hesitate to express a preference for another physician or decline a recommendation due to a fear of causing offense.
There are, however, limited and specific situations where treatment of oneself or a family member may be acceptable:
- Emergency Conditions. In an emergency situation, when no other qualified licensee is available, it is acceptable for licensees to treat themselves or their family members until another licensee becomes available.
- Urgent Situations. There may be instances when licensees or family members do not have their prescribed medications or easy licensee access. It may be appropriate for licensees to provide short term prescriptions.
- Acute Minor Illnesses Within Clinical Competence. While licensees should not serve as primary or regular care providers for themselves or their family members, there are certain situations in which care may be acceptable. Examples would be treatment of antibiotic-induced fungal infections or prescribing ear drops for a family member with external otitis. It is the expectation of the Board that licensees will not treat recurrent acute problems.
- Over-the-Counter Medication. This Position Statement is not intended to prevent licensees from suggesting over-the-counter medications or other non-prescriptive modalities for themselves or family members, as a lay person might.
Licensees who act in accord with this Position Statement will be held to the same standard of care applicable to licensees providing treatment for patients who are unrelated to them. Thus, licensees should not treat problems beyond their expertise or training.
The Board expects licensees to maintain an appropriate medical record documenting any care that is given. It is also prudent for the licensee to provide a copy of the medical record to the patient’s provider.
Licensees who inappropriately treat themselves, their family members, or others with whom they have a significant emotional relationship should be aware that they may be subject to disciplinary action by the Board.
One commenter wrote:
“This is my position that physicians should have right to treat themselves and their family members if they feel professionally and ethically comfortable to do so. Each physician should make the most responsible and ethical decision for themselves. Rx of controlled substances to self, family members and friends should be allowed in emergency situations only. There is no reason for a physician who is well qualified to treat his HTN to pay another physician for this service. There is no car mechanic who would pay another car mechanic for doing work on his car which he can get done himself.”
It’s hard to disagree.
Many of the commenters agreed that controlled substances should never be prescribed to family members. Even there, an argument could be made for some flexibility in select cases. Here’s why. While I understand why it would not be a great idea to prescribe 90 Dilaudid to one’s spouse, how about specific Schedule V compounds, such as those used to treat epilepsy? Imagine your family member has medication resistant epilepsy, but seizures are less severe and less frequent with lacosamide. Lacosamide is a schedule V compound. Have you ever heard of a Lacosamide abuser?
I found one note, in the Federal Register.
“Clinical studies also indicate that lacosamide has abuse potential. In a clinical study with recreational abusers of sedative hypnotic drugs, lacosamide, similar to alprazolam, produced subjective responses of “sedation,” “high,” “euphoria,” “drug liking,” and “good drug effects” similar to alprazolam. These effects of lacosamide were shorter in duration as compared to those of alprazolam. In clinical pharmacokinetic and electrocardiographic studies, healthy subjects reported a high rate of euphoria-type responses following lacosamide administration, suggesting its ability to produce psychological dependence. The data from animal and human studies indicate that chronic administration of lacosamide does not produce physical dependence, as there were no withdrawal symptoms upon its discontinuation.”
Still, providing a “rescue” prescription with the amount limited to just the weekend would be less onerous and burdensome than trying to get the same job done in an urgent care clinic or ED.
Every state treats this issue differently. Apparently, Tennessee allows one to prescribe a controlled substance to a family member in an emergency. One cannot prescribe that same substance to oneself.
A list of self-prescribing laws by state can be found here: https://worldpopulationreview.com/state-rankings/self-prescribing-laws-by-state
Not sure how accurate that list is.
What do you think?
A physician should be able to treat his family or himself if he is qualified. A mentor of mine performed a thyroidectomy on his wife because as he said “ I only want the best for my family as for my patients. I know of no person more qualified than myself to perform this surgery.”
Has my children needed sinus surgery I would have done it because I was more qualified than my colleagues. For years I ran a well known nationally recognized endoscopic sinus surgery course at a great medical school.
Also one should be able to prescribe non narcotic medications for their family or themselves.