Policy Discussions Archive
Revised posiiton statement: Self-Treatment and Treatment of Family Members
Discussion Ended on 02/28/2025
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:
1. 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.
2. 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.
3. 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.
4. 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 patientâs 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.
References
Comments
There are nurse practitioners and PAâs opening their own private practices right and left and declaring themselves âspecialistsâ. One PA who just opened in my town and actually offered me $1,000 a month to be her âMedical Directorâ in a pop up med spa that she âownsâ and where she provides 100% of the care. My answer was a clear NO! The NC Med Board should stop this practice and not focus on non-problems. I agree that we should not prescribe controlled substances to family members but non-controlled meds are within our scope of practice.
By Jamie L. Ramsey, MD, FACOG on Feb 27th, 2025 at 6:34pm
This restriction on physician prescribing and treating family members is a proposed agency ruling, not proposed for codification in state law. Family members of physicians have the same civil rights as members of the general public, which allows them to select the physician of their choice. These family member patients should be allow to sign a informed consent waiver of the medical board ruling. This medical board waiver would not apply to the prescribing of narcotic controlled substances. Thank you for allowing me to present my personal opinion. Dan W. Bolton, III, ESQ, DO
By Dan W. Bolton, III, ESQ, DO on Feb 26th, 2025 at 11:51am
Dear NC Medical Board:
I agree with not allowing a physician to prescribe controlled substances (narcotics, sedatives, and stimulants) to oneself or to family members.I do think that physicians who travel internationally should be able to prescribe antibiotics and anti-malarials for themselves and for their family members/colleagues.
I have been in the position of prescribing short-term medication for a parent who has run out of their anti-coagulant on a 3 day weekend. I have also prescribed Tamiflu for elderly family members when we were on a multi-day family group trip and someone became ill and tested positive for Flu.
I think most physicians have been trained with enough depth and breadth that they can make good judgements for their family members. It is probably wise for family members to have another physician as their primary care provider. However, there are times that lack of access to care makes it compassionate and necessary to prescribe for a family member or staff member. We should not be penalized for this.
These are my comments.
By Heather G Krueger on Feb 26th, 2025 at 8:47am
Dr. Heather Krueger
Newborn Hospitalist Pediatrician
Arden, NC
It is my opinion that restrictions on treating oneself or family members is generally irrational and suggests that the board harbors a general mistrust and suspicion of its licenseesâ professionalism, clinical expertise, and motivations.
I first request that the board clarify exactly who or what public interest it seeks to protect by enacting such restrictions and fear-mongering. It does not follow that the board grants a licensee the ability to practice medicine essentially upon anyone within the boarders of the state with full trust, but it does not believe that a licensee may practice medicine upon those closest to them and meet the standards of care. This suggests the board believes that a licensee would provide a higher quality of care to a complete stranger, rather than to oneâs one child or parent. The argument that a lack of objectivity, infringement upon autonomy, and lack of informed consent are more likely to occur with someone the licensee actually cares about rather than a complete stranger does not make sense. First, objectivity in medicine is a farse. If we wish for complete objectivity then we must pursue the creation of AI physicians so as to completely eliminate emotion and personal experience from the delivery of medical care. I would further argue that it is our subjectivity, or our ability to empathically connect with patients, that promotes with the delivery of good care. The more one cares about their patientâs wellbeing the more one will strive to deliver the best care one can. Regarding autonomy and informed consent, these arguments are irrelevant in instances of treating oneself, and should not be significantly different when considering the treatment of family members vs complete strangers. If there is objective evidence that autonomy in infringed upon or informed consent is not provided in instances of treating family members I urge the board to provide this, otherwise the premise of this rule is born out of nothing but conjecture and catastrophic thinking.
Physicians should be held to account whenever they deliver medical care, regardless of who the patient is. There is no limitation on family members reporting a treating physician to the medical board who also happens to be a relative . If the primary argument against this is that those family members may feel unable to report substandard care due to fear of reprisal, then the delivery of improper care is most likely but a symptom of a greater underlying problem. The delivery of care upon the unwilling is battery. I would assume that the vast majority of care delivered to family members is requested, not forced. If the board has objective evidence to the contrary it would be best to provide this in support of the position statement.
I would finally repeat the complaint that many other commenters have made, that it is infantilizing to place such restrictions on physicians. By virtue of being granted a license we are imbued with the privilege and public trust to provide medical care to our community. We have spent over a decade in training, navigated a gauntlet of knowledge and competency based exams, and struggle against a medical system that seems more interested in cost savings than quality of care. It is insulting to be told by the board âSorry, we just donât trust that you will do a good jobâ should we dare try to provide appropriate medical care to ourselves or our loved ones. Lawyers may represent themselves or family members should they so chose. An accountant may prepare and file their own tax returns. An electrician may wire their own home. A plumber may install their own toilet. Why may a competent and duly licensed physician not provide appropriate medical care to themself or a family member?
I request that the board provide a detailed and justified rational for this rule, lest it be seen as nothing other than arbitrary. If the board wishes the public to place trust in the physicians it grants license to, then perhaps the board should extend the same trust to the physicians it licenses.
By Marc Bouchard on Feb 25th, 2025 at 7:48pm
While I appreciate that prescribing controlled substances to family members should be âverbotenâ, my humble recommendation would be to spare select schedule V compounds. Schedule V means: The drug or other substance has a low potential for abuse relative to the drugs or other substances in schedule IV. (Of course)
By Jeffrey Segal on Feb 25th, 2025 at 3:52pm
The drug or other substance has a currently accepted medical use in treatment in the United States. Many Schedule 5 drugs are used for treating epilepsy (Cenobamate / Lacosamide). Anyone aware of lacosamide abusers? Not me.
The only time this would be relevant is when one cannot get a timely refill from a childâs epileptologist, and the weekend is fast approaching.
Iâve read all the comments and the jist seems to be to leave us alone. We are already well burdened with enough regulation and we donât need another one seemingly insearch of a reason. Has there been an abuse of Metoprolol Iâve not heard about? âWhoa there buddy, you best be careful with that self prescribed Atorvastatin.â It is absurd to say I cannot prescribe myself Lisinopril but a NP can prescribe it for me. Besides, we physicians make terrible patients and our egos probably ensure that we are more likely to follow our own advice than the PA across town.
By Jan A. van Ravesteyn on Feb 24th, 2025 at 6:33pm
Improperly prescribing controlled substances can create victims. Bentyl, not so much. I think following the harm to self or others adage is a reasonable standard and if there is not a victim then why does there need to be another regulation? âDr. Smith, you are being reprimanded for controlling your own asthma. My Good Sir, what were you thinking? Symbicort! While on duty! Weâll have your license for this.â
Yes, there is a line to not cross. Your job is to come up with that line, frame it wisely and decide if it needs to be a regulation, guideline or suggestion.
Howâs this; Do not prescribe regular controlled substances to yourself or immediate family and use common sense in an acute situation. Otherwise, maintain the standard of care and, regarding the care of yourself and family, do not act foolishly.
History has shown that I follow up with myself a heck of a lot better than I do my dermatologist or gastroenterologist. Which reminds me, I am overdue for my 10 year colonscreen. No, I wonât do that myself. Iâm not that flexible.
The jist, again, seems to be that there are better things for the board to spend its time on to improve the health of our communities than to come up with a fix for something that doesnât seem to be broken.
I think we should be able to prescribe malaria prevention meds and oral typhoid vax for ourselves or travel companions, as well as meds for travelerâs diarrhea and elevation sickness. I have traveled all over the world [7 continents] and hate to go to a travel clinic when I am perfectly capable of researching CDC recommendations and getting what I need.
By Lynn E Wesson, MD on Feb 24th, 2025 at 6:29pm
I am aware of numerous benefits associated with the ability to self-prescribe non-addictive medications. The Boardâs intent to âprotectâ physicians from themselves is misguided. In much of the world, anyone can walk into a pharmacy and buy most medication without a prescription. Given their extensive medical training it is insulting to insinuate that American physicians are not well-equipped to manage their own non-addicting, uncontrolled prescriptions responsibly.
Self-Experimentation
There are numerous instances where self-prescribing is justified and aligns with the long-standing tradition of ethical medical practice. As a medical scientist, I am aware of many historical examples when âmaverickâ physicians, faced with critical scientific questions impacting the health of others, conducted experiments on themselves with drugs to advance scientific knowledge. This new regulation would outlaw this long-standing avenue that has led to improvements in medical care.
Early Treatment with Targeted Naltrexone
Years of alcohol research at NIH gives me an expertise in the early treatment of alcohol use disorder, an issue impacting perhaps than ten percent of North Carolina Medical Practitioners. I have found that most, if not all, are reluctant to get professional help when they initially become aware that they have a problem with alcohol. However, it is at this time - long before the diagnosis is obvious or patient care is at risk - when medications such as targeted naltrexone are most efficacious. Such therapy is available OTC in England but is less known here. The reality of the situation is clear to me as an addiction medicine specialist: prohibiting self - prescribing of safe, non- controlled medications that reduce alcohol craving could delay early treatment and cause unnecessary harm. Sadly, misguided policies and stigma promote delay in self-disclosure, and self-prescribing targeted naltrexone has the potential to alleviate this issue.
Maintaining Medical Licenses for Physicians
I have a friend, a 90-year-old retired physician, who keeps up with continuing medical education requirements to maintain his medical license. Although he is no longer in practice, he is motivated by his ability to prescribe for himself and his wife, even though he rarely does. This scenario raises the importance of encouraging all physicians to maintain their licenses actively. Doing so ensures that they can provide backup medical care in emergencies, which offers great value to the community. Additionally, maintaining an active license generates a source of income for the medical board. Why remove an important incentive for my friend to keep his license active?
Emergency provision for rare disease prophylaxis
Many exotic disorders and diseases rarely seen by North Carolinian medical practitioners are a serious concern in remote and developing regions. Physicians who travel to such places often become experts in the use of medications rarely used in North Carolina. These physicians themselves, not their local PCP, are often the most qualified to prescribe such medications. During times spent in areas with no healthcare providers or even an ability to make a phone call, the ability to travel with self-prescribed, rarely used, non-controlled medication for a potential emergency can be lifesaving.
A personal example
Parents often make tremendous sacrifices to enable their children to attend medical school. In her final years, my mother was completely homebound, and finding a physician who would visit her in her home was impossible. On one occasion, she fell, hurt her chest, and later developed a cough. I knew pneumonia is a risk after rib fracture. How urgently did she need treatment? I made the choice to treat her myself with antibiotics; later evaluation proved that my assessment was correct. Had I not been able to treat her myself, she likely would have died. The proposed policy of the board would have forced me to risk losing my medical license to save her life. Why should I have to make such a choice?
Conclusion
In conclusion, maintaining the ability of physicians and other prescribers to self-prescribe non- controlled medications benefits both the medical community and potentially all North Carolinians. The practice encourages experienced professionals to maintain their licenses, and thereby remain available for emergency care while supporting the financial stability of medical boards. It is also consistent with the ethical practice of medicine. I agree with the comment posted by Tim Cox on Feb 23rd, 2025
âIf I might be punished for helping family out, I would reconsider working in this state.â
CDR(ret) John C. Umhau MD MPH CPE FASAM
By CDR(ret) John C. Umhau MD MPH CPE FASAM on Feb 24th, 2025 at 4:38pm
While I agree that physicians should not prescribe controlled substances for themselves or family members, there are individuals with whom the physician may have relationships beyond purely doctor-patient who need our care. Some of us are specialists in fields with few providers, making access to care difficult and expensive. There are times we observe the care our friends, family and staff are receiving to be substandard, ineffective and potentially harmful, feeling compelled to jump in. When comprehensive medical records are kept and there is clear communication between the patient and any other providers involved in the patientâs care, everything is transparent. The rationale for this position statement is thin, essentially implying that the provider will coerce the family member into doing something they donât want to do. This is generally the opposite, the individual requesting help from the person who likely knows them the best, needing to fill in gaps in management. I believe this position statement is too strict and suggests the Board doesnât have a comprehensive understanding of how this may adversely patient care.
By John Pittman, MD on Feb 24th, 2025 at 3:53pm
Subject: Concerns Regarding Board Policy on Physician Self-Treatment
Dear Medical Board Members
I am writing to express my strong concerns regarding the current board policy on physician self-treatment and treatment of family members. I believe this policy is outdated, unreasonable, and detrimental to both physicians and patients.
The landscape of medicine has evolved significantly over the past 20-30 years, including the impact of events like the COVID-19 pandemic. Current healthcare costs, exacerbated by the Affordable Care Act, have created significant financial burdens for physicians. The high cost of insurance, coupled with exorbitant out-of-pocket expenses, makes accessing timely and affordable care a major challenge. For example, I recently faced a $400 charge for a routine medication refill, a cost I find unacceptable. The current system forces physicians, who are experts in their field, to seek care from other providers for routine matters, often incurring unnecessary expense and delays.
I believe physicians are qualified and capable of managing their own health and that of their immediate family members. A brief telemedicine consultation or a rushed appointment with a non-physician provider cannot replace the in-depth knowledge a physician has of their own medical history and that of their family.
The financial burden imposed by current insurance premiums and deductibles is unsustainable. My own calculations, based on unsubsidized bronze plan premiums for a family of four, project monthly costs of $1600-$1700 with a $12,000-$13,000 deductible. This is simply unaffordable.
Furthermore, I believe the current restrictions on prescribing controlled substances for oneself or family members are overly stringent. In cases of chronic conditions, such as my sonâs ADHD, where a stable treatment regimen has been established by specialists, physician family member-managed refills could be a safe and efficient alternative. Perhaps a requirement for annual visits with a primary care physician could address any potential concerns. The focus should be on identifying and addressing actual abuse, rather than imposing blanket restrictions on all physicians.
The proliferation of non-physician providers (NPs and PAs) also raises concerns. Given their comparatively less extensive training, I believe restrictions on their scope of practice, particularly regarding self treatment and prescribing controlled substances, are warranted.
I understand the boardâs need for oversight, but I also believe in physician autonomy and the right to manage oneâs own health and that of oneâs family. The current policy seems to overstep its bounds and infringes upon this right. The recent experience of paying $400 for a primary care visit to establish care, only to have the physician subsequently leave the practice, highlights the absurdity of the current system.
I urge the board to reconsider this policy. It is outdated, overbearing, and does not reflect the realities of modern medical practice. I believe it is vital to respect physician autonomy and allow qualified physicians to manage their own healthcare needs and those of their families. Furthermore, I suggest the board consider reducing medical licensing fees and extending the duration of licenses to alleviate some of the financial burdens currently faced by physicians.
Thank you for your time and consideration.
Sincerely,
R. Strickland DO FACOEP
By R. Strickland DO FACOEP on Feb 24th, 2025 at 2:14pm