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 patientās 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
Given the current challenges in accessing primary , urgent and emergency care ālong wait times (for many months) for new and existing patients, financial burdens associated with these visits, wait times and risk of viral exposure in waiting rooms, and the inconvenience of prolonged waiting, particularly for frail individuals or single parents with little kidsāit is reasonable to liberalize restrictions on physicians treating family members. While concerns exist, the NCMB should also consider the benefits: increased access to timely care, reduced strain on the healthcare system, and respect for patient autonomy. Patients should have the right to seek medical advice from a trusted physician-relative and discontinue that relationship at their discretion. A balanced approach that acknowledges both risks and benefits would better serve the needs of North Carolinians. Do agree with not using family relationships to prescribe opioids and other controlled substances.
By TD on Feb 23rd, 2025 at 10:37am
Board members, thank you for your service.
Itās very common in many medical practices to provide neurotoxin (Botox) injections to employed staff members. This is appreciated by the staff and provides education for patients because the staff can more authentically speak about the procedure. Would this practice be banned under the new guidance?
I agree with Mr. Atkinsonās comments that more vague wording would be helpful.
By Brandon Coakley MD on Feb 23rd, 2025 at 8:20am
I think that the definition of acute minor illnesses should be expanded. The two examples cited couldnāt be less complex. The definition should include limited courses of antimicrobials for acute infectious diseases.
Also, the documentation clause is problematic. With HIPPA rules being so restrictive, it is unreasonable to expect providers to ādocumentā in the current sense. This requirement should be dropped.
By Jonathan Thomas Mitchell on Feb 23rd, 2025 at 7:36am
I agree with restriction on controlled substances among family members, but I see no reason we should not be able to prescribe antibiotics for immediate family members or specialty specific medication.
By Kaitlin on Feb 23rd, 2025 at 6:46am
While the potential for abuse is there, when prescribing something simple like an antibiotic for otitis media or cellulitis, a strong steroid cream for eczema/psoriasis, or providing refills for a stable chronic condition on occasion, our knowledge and experience combined with our affection should help us make better decisions for family or self, not worse.
My patients often ask me āwhat would you tell your mom if I was her?ā, when discussing treatment options, because they know there is an innate desire for the best treatment plan for family.
If I might be punished for helping family out, I would reconsider working in this state. Guidelines and position statements are helpful for best practice, but it should not lead to discipline unless there is evidence of abuse (i.e. antipsychotics to control someone) or controlled substances involved.
By Tim Cox on Feb 23rd, 2025 at 6:33am
I agree with exceptions that allow us to use our judgement to treat acute conditions or renew medications (not controlled substances) when more harm could come from not being able to do that for various reasons. UTIs in elderly family members who have difficulty getting out from home, URIs, flu and covid that can be tested and IDād with OTC tests, etc. It is safer for us to fill in for efficient treatment of uncomplicated problems for people we know extremely well than it is for on call strangers or triage nurses following protocols to advise or attempt to treat. Also consider that our families cope with the demands of this profession and should have the benefit of some conveniences.
By Rebecca Love, MD on Feb 23rd, 2025 at 12:26am
Could the NCMB possibly create a survey to send to the physicians statewide about this then shape the policy based on the responses?
It seems in discussions with other physicians the feeling is that there are much bigger issues for the board to focus on (for example corporate practice of medicine and all of the issues that come with that, physicians in corporate medicine settings bullying subordinates to practice medicine not in the best interest of patients with threat of job loss/noncompete issues). There are far more pressing things that really need defined and sorted out rather that this. It feels like a regulation is being added while ignoring other much scarier things. Many patients are already afraid of bankruptcy with corporate medicine encounters, and now you seem to want to add another layer of things to worry about if they want to seek medical help from a physician they know. Patients typically do not mention things to physician family members if they do not want that opinion.By Kelly Forb MD on Feb 22nd, 2025 at 10:57pm
I think we all agree that physicians should not prescribe controlled substances to themselves or those with whom they have intimate relationships, and those that do are typically reprimanded. I do not think itās necessary to go beyond that for many cases. Please consider surveying all of us.
In this current time we need support from our medical board that allows us to take care of ourselves or close family members within the scope of our practice. There are times when it not appropriate or professional to continue treatment, and we are well trained to know when the recommendation would be to seek care from another physician. Putting a burden on us to seek a physician for minor meds, even chronic ones (for example migraines that are well controlled under the current regimen) is not helpful, adds to our already overloaded stressful days of taking care of ourselves, our community, and our families. A pharmacist could also be considered a second line check on anything inappropriate since the board has expanded their scope of care. Healthy doctors that provide the best care for their patients are those that have professional autonomy and take our oath of causing no harm seriously. The medical board should also frame the position not on worst case scenarios, but from a position of āfirst, do not harmā to those physicians you are there to support.
By Melissa Jones on Feb 22nd, 2025 at 8:53pm
Agree with prohibiting narcotics to self/family.
Agree with everything else EXCEPT if the physician is prescribing for an issue within their scope of practice, I think itās ok to prescribe to self/family.
By Eric Halvorson, MD on Feb 22nd, 2025 at 8:45pm
I would never consider writing a script for myself for anything. However, I have encountered situations where a family member or friend have been in a situation that meets the acceptable criteria above. I have found some situations where a provider failed to meet standard of care (antibiotics or even pain control) and wanted to help in the short term. I feel if something like this happens we should be able to help regardless the need (to include a narcotic) if it is short term, hold over and documented well.
By Dawn Ruminiski D.O. on Feb 22nd, 2025 at 7:40pm