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
With primary care providers being so busy and it being so difficult to get in and be seen for a minor issue needing a short-term prescription, I believe that it is reasonable for a licensee in those situations to be able to prescribe to self or family.
I agree that a Record Should Be kept for future reference but not necessarily be sent to the PCP each time since the issue was minor. Of course if the issue becomes more complicated, then the record should be sent to the PCP.
Keeping controlled substances policy for family as it is now, is reasonable.Thank you.
By Sohail Bazel on Feb 22nd, 2025 at 6:02pm
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.
By Nadiya Kaesemeyer MD on Feb 22nd, 2025 at 3:58pm
I mostly agree with the policy. Availability and quality of care are lacking in rural Eastern NC. It can take months to get an appointment with a physician, and the ER is rarely a good choice. Sometimes, treating a close friend or family member is the only acceptable choice. I agree that addicting medications should never be prescribed under this situation.
By R Daniel Bohl on Feb 22nd, 2025 at 3:53pm
I am taking a variety of prescription meds, none of them controlled; I have been on them for 5 to 40 years, they are well-tolerated and effective. I have the relevant blood work and vital signs checked at my annual physical, during which I also review those meds.
Please explain to me why I can not prescribe the pills I have been taking for years - or decades - for MYSELF, rather than having to be the mediator between the pharmacy (which leaves a voice-mail message with my PCP and then drops the ball) and my primary care doc (whose office promises to ârespondâ, i.e. leave a message on THEIR voice-mail, within three âbusiness daysâ), if there is a problem with pill availability, prior approval, or any of the other things which have blocked my access to MY OWN medications in the last few years.
Is there a black market for antihistamines of which I am unaware? Is my âobjectivityâ so impaired that I am incapable of determining when the sun has risen (the time of day at which I take some of those meds), or when my day has ended and I retire to bed (for other ones)? You wouldnât strip a physicianâs license for dementia until they were reported to the Board, but you will PROACTIVELY prohibit me from renewing my own long-term prescription medications?
Whom, exactly, are you âprotectingâ here?
By Barry M. Lamont, M.D. on Feb 22nd, 2025 at 3:26pm
Agree 90% with the board recommendations. Make sense
Each person should have a PCP
Emergency and urgent prescriptions are common
Now the main problem is the âmedical crisisâ which is getting worse
You have an emergency or urgent call and you call the doctor and you
get the PA or NP on call. âCall in AM or call Monday and talk to the officeâ
You call the office and you get the PA or NP for an office visit. You follow instructions well. The office make an app to see the real doc in 2 weeks. If you are alive you see the doc in 2 weeks. All fineâŚ..you are a survival !These days: more PAs and NPs, less time to see the docâŚnow we are down to 10 min
By Cesar Alvarez Ruiz on Feb 22nd, 2025 at 3:18pm
for office visit.
While these are important boundaries to set these are common principles any physician will abide by. Please focus efforts on appropriate oversight for nurse practitioners instead of nit picking physicians.
By Sarah on Feb 22nd, 2025 at 2:34pm
While I was a surgical resident after 3 years of general practice, and early during my practice as a cardiothoracic surgeon, I occasionally prescribed oral antibiotics to treat my small children with otitis media. This was faster and safer than exposing them to other infections by waiting in a pediatricianâs office. The pharmacist never âflinchedâ, but this was 30 - 40 years ago. I believe it was the correct action.
By Thomas Egan on Feb 22nd, 2025 at 2:26pm
What are expecting as the Most likely sources reporting violations?
By Joseph Furst on Feb 22nd, 2025 at 2:02pm
JF MD
Can you clarify what ârecurrent acute problemsâ means?
By Stephanie Martin on Feb 22nd, 2025 at 1:43pm
I would like to see a little more definition on direct family member. Would this include an uncle, second cousin, etc? What about a close family friend that you grew up with your whole life an and is âlike a cousinâ. My concern is how do you define closeness.
We should be more lenient on self prescribing. Refilling my on albuterol that is used for pre exercise treatment is low risk. Yes I could easily have my PCP do this but if I forget to ask them or run out and canât get time in my schedule for 2 months I should just go without.
What if you are specialized and offer specific services that are not easily found or there is no one else close or in network for this family member. Can that be considered and exception?
No mention of osteopathic manipulation. Should I be allowed to perform OMT on my wife, mother, child, sister? Sure they could see another DO but again I can easily do this for them at home. But it is the practice of medicine and if someone decided to report me for doing it what would the board say/do.
Personally I am always in favor of leaving a policy more vague and less stringent so I am not suggesting to add all of these clarifications but instead loosen the language.
By Elec Atkinson on Feb 22nd, 2025 at 12:53pm