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
In some rural areas of NC (e.g. NC mountain communities), a family physician may be the only provider nearby. Often, physicians practice in these communities because they have family there. A strict enforcement of this policy could hurt the community in which they serve as well as discourage physicians from practicing in these smaller communities.
By dericgreen@icloud.com on Feb 24th, 2025 at 1:00pm
I agree with the restriction of controlled substances. Regarding other medications as long as it is within their scope of practice, I think we should be allowed to make that determination. There is a shortage of quality primary care providers (MD) which limits access to care.
By Gabriel Fernandez on Feb 24th, 2025 at 11:31am
I am against these new restrictions. The only thing that is reasonable is the preexisting restrictions on prescribing controlled substances. These new proposed rules feel infantilizing.
By JK on Feb 24th, 2025 at 11:11am
I agreeâno CS prescriptions to self or familyâeven in âemergency situations,â as itâs a slippery slope that is wide open for problems.
As for prescribing to self, or familyâacute needs or chronic, stable issuesâI think it is reasonable and well within our scope and commitment to quality care and doing no harm.
The system is overburdened, and we as physicians and the families of physicians sacrifice so muchâthere should be minimal restriction. I agree with othersâa mechanic wouldnât hire another mechanic to take care of his own car, why would we expect that of our profession?
As for mandating records be sent to PCPs, etc, that assumes the person has a PCP. And frankly, what HIPAA compliant way would one expect this to occur?
To worry about a patientâs comfort with the physicianâthis is a patientâs choice to come to us; I donât think there is a need to concern ourselves with a million âwhat-ifsââif either party feels uncomfortable, they go elsewhere, or refer elsewhere, just as in regular practice.
Certainly, there are more important issues for the board to be focusedâa simple âno CS meds for self or familyâ should be sufficient. Leave the rest to best practices as we have been trained and trusted.
By CB on Feb 24th, 2025 at 11:02am
Prescriptions for family members with acute minor illnesses (UTI, COVID, flu, etc) should definitely be allowed. I would also favor allowing short term (1 month) prescriptions for family members with more chronic conditions, with your scope of practice (say routine HTN meds) and with appropriate PCP follow-up. This could be a refill or new med, since it can take a long time to get an appt sometimes, and what is the use of being a doctor in your own household if you canât help your own family every now and then?
Definitely no prescribing controlled substances to self or family.
By Christopher Holley, MD, PhD on Feb 24th, 2025 at 10:37am
I feel that as board-certified, licensed physicians, we should be able to use our judgment as to whether to treat family members/staff for certain medical conditions,
or not.An elderly mother who cannot drive and is being treated for diabetes and hypertension.
A family member coming in from another state and has influenza.
A staff member, whose mother has a UTI , and is not able to get a hold of her PCP in a reasonable time.
Definitely agree that narcotics and benzodiazepines should not be prescribed to family members, but these other decision should be left to the individual physician.
We already feel the impact of the insurance companies dictating medication choices, ability to order radiologic examinations, forcing lengthy bloated dictations.
How many other things do we have to raise our hand and ask â Mother , may I?â
By soon kwark MD on Feb 24th, 2025 at 10:00am
I think short courses of antibiotics or short courses of steroids (eg Medrol Dose pack) should not be a problem. Small amounts of medication when a spouse forgets on vacation like sertraline or HCTZ should not be a problem. Absolutely no controlled substances though.
By David J on Feb 24th, 2025 at 7:34am
As I am coming soon from a state that is much less restrictive, I find the NC medical board guidelines to be inappropriately restrictive to patients. While visiting NC in the past, before living in NC, I have had a pharmacist refuse to fill a silvadene prescription for my daughterâs burn injury sustained while on vacation. They cited, inaccurately, the NC medical board as the reason for prohibiting it.
By Matthew Fisher MD on Feb 24th, 2025 at 1:32am
I have treated many family members over the years, and some of those have been regular patients of mine in the office. They have known me, trusted me, and known my reputation within the community. They did not want to go to other providers. Apparently, treating these family members in North Carolina constitutes poor medical care. As a family physician, I have had family members that are not my regular patients do urine testing, rapid strep testing, and other diagnostics. Even without testing to back up my care, I have assessed family members for contact dermatitis, asthma exacerbations, and other illness that have not been in the office. To imply that a physician would do so for a family member without the same diligence they apply to patients is counterintuitive to me. I would want to be MORE sure I am treating my family member properly and assessing them properly. Please donât make patients find a doctor other than the family member they have known and trusted for decades.
Agree w comments supporting restrictions of controlled substances only.
Also agree about being more lenient for self / family prescribing that is within our scope of training and practice.
As physicians we are well trained in diagnosis and management. We are additionally trained to seek additional help / input when necessary.
We know how to do this. We understand the risks/ benefits.
We face enough regulation / scrutiny/ denials from outside entities. Please do not add to this burden.
By Dan Mackey on Feb 23rd, 2025 at 2:29pm
In my experience, pharmacists, even out of state, will usually provide a short-term refill or a few daysâ supply of meds. It seems that this should be an option, if it is not already, and might be preferable to having physicians provide for their own families.
I have seen some bad outcomes when physicians care for family members or themselves.
By Lillian Burke MD on Feb 23rd, 2025 at 11:14am