Everyone loves to have a doctor in the family. However, as a doctor, it is inevitable that a friend or family member will ask you for a prescription.
A recent call from a junior doctor member to Avant’s Medico-legal Advice Service (MLAS), highlights the difficulties doctors experience when they are asked for prescriptions by friends or family.
The junior doctor called for advice wondering if she could prescribe a contraceptive pill for a friend who had made the request. Her script had expired and she couldn’t get in to see her normal GP.
These requests usually occur at functions or in situations that reside well and truly outside of the typical doctor-patient relationship. Sometimes these prescriptions will be for a new medication (for example, pain relief or antibiotics), but mostly they will be for repeat prescriptions of medications your family member or friend will have already been prescribed.
It is important to remember that every prescription you write comes with clinical, ethical, and legal responsibilities. All medications that require a prescription to be dispensed are Schedule 4 or higher. Some medications, like drugs of dependence, carry important legal responsibilities. For more information, read our article ‘Authorities required for opioid prescribing’ and new position paper ‘Prescribing drugs of dependence’.
What does the code of conduct say?
Doctors have an ethical duty to act in accordance with professional standards. The Medical Board of Australia’s Good medical practice: a code of conduct for doctors in Australia (the Code) outlines the conduct that is expected from doctors in Australia. The Code is designed to assist the Medical Board’s function of protecting the public by setting the standards of conduct by which doctors are expected to abide. A doctor will be expected to explain and justify their conduct should they depart significantly from that standard. As for the treatment of friends and family, the Code 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."
8 critical factors you need to consider
Although, prescribing for friends and family is not necessarily strictly prohibited in all circumstances, doctors should judge each situation on its own merits. If you are asked to prescribe a medication that they are already taking, you should consider the following issues:
- What are the effects, side-effects, indications, contraindications, and drug interactions with this medication?
- Do you need to take a full medical history? What other medication is your friend/family member taking? What clinical conditions does your friend/family member have?
- What is the potential for harm if you prescribe the medication requested?
- What is the potential for harm if you don’t prescribe the medication requested?
- Is there an appropriate minimal amount that you should prescribe in order to ensure the safety of your family member/friend?
- Should you communicate this prescription to your family member/friend’s usual prescribing doctor?
- What medico-legal risks would this prescription pose?
- With reference to the Code, how would you be judged by your colleagues in this situation?
Requests for new medications
In addition to these issues, requests for a new medication from a family member or friend raise more complex issues. Implicit in such a request is that you will be prescribing for a new problem. From a clinical, ethical, and legal perspective, your duty of care is arguably greater. Extra care is required, and the following key issues also need to be considered:
- Would you be entering into and encouraging a long term doctor-patient relationship?
- Would you be interfering with an existing doctor-patient relationship?
- Would a reasonable standard of care dictate that you take a full history, perform an examination, and order any tests or investigations for this new ailment?
- Can you really make an objective clinical judgment on the person who asked you for the prescription or are you too close to them?
- How would you be judged by your colleagues in this situation in relation to the Code?
Like many situations in medicine, there is no universally right or wrong answer. However, if a family member or friend asks you to prescribe a medication the following advice should assist you to make the appropriate decision:
- Whenever you write a prescription, you are (to some extent) entering into doctor-patient relationship.
- Unless the risk of harm of not writing the prescription outweighs the risk of harm of writing it, you should avoid doing so.
- Prepare a respectful and empathetic explanation as to why you can’t assist by writing a prescription. For example: “I would love to help, but the Medical Board doesn't allow prescriptions to be written for friends and family unless it is urgent. Perhaps I can help you get an appointment to see another doctor”.
- Avoid entering a continuing doctor-patient relationship with a family member or friend. This also applies to anyone with whom you have a business or working relationship.
- Keep an appropriate record of any prescription you write, including the date, name of medication, strength, dose, and quantity prescribed, as well as the circumstance surrounding the request.
- Avoid prescribing Schedule 8 and other drugs of dependence (such as benzodiazepines and sedatives) at all costs.
- If you feel that you should agree to writing a prescription, consider whether it may be prudent to consult the family member or friend in your practice (if available), so that you can take a full history and perform an appropriate examination. This also helps to ensure that the doctor-patient boundary remains well defined.
The real world of medicine brings with it many challenges, and it is never easy to say “no” to friends and family. While there are some circumstances where prescribing for family or a friend can be justified, you also need to remember that should something go wrong, in addition to adversely affecting your relationship with your family or friend, you may be asked to justify your decision to the Medical Board, court or tribunal.
You might also be interested in…
Avant’s new position paper ‘Prescribing drugs of dependence’.
View the webinars ‘Prescribing perils: opioids, polypharmacy and medication errors’ and ‘Prescribing perils part 2: Drugs of dependence’ from the Avant Learning Centre and obtain CPD points.
View the webinar ‘Doctor shoppers, the law and addiction: prescribing drugs of dependence,’ now on-demand.
Avant Learning Centre fact sheet ‘Prescribing drugs of dependence’.
Avant Connect magazine ‘Addictive prescription medications: the Doctor Shoppers inquest’.