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Treating Self and Family

 Comments on this article:

I believe a physician should be allowed to prescribe medication or treatment for any patient (including family members) for which they are qualified to treat.  This includes treating ear infections in family members by a radiologist, if they feel they are still qualified to treat this disease.  They are afterall doctors.

By Dr. V on Jul 22, 2011 at 3:12pm

The NCMB should have a formal position on this issue, but it should be simply to state that care rendered to self, family or friends MUST meet the same standard of care as for a paying stranger. If and only if it does not, then the Board should intervene.

We are trained to use good judgment and we should do so for EVERY patient. It should be up to the doctor’s judgment (not a government entity)whether he or someone else can best care for his patient, no matter who that patient is.

If the Board wants to WARN doctors about the potential pitfalls of treating self, family and friends, that is fine. We should have been taught that in Medical School and in Residency already, but maybe a few weren’t listening. But beyond ensuring that the physician meets the standard of care IN ALL INSTANCES, it should not be the Board’s concern who the patient is or what their relationship is to the doctor. The quality of care rendered should be the only concern.

I do not currently live or practice in North Carolina. It is this exact issue which has kept me from moving to NC. I’ve chosen to live in a state who’s Medical Board allows me to exercise MY OWN best judgment about when I treat my own family & friends and when I refer them to someone else. I sincerely hope the NCMB relaxes their stand on this issue. I would LOVE to live in NC!

By James Winans on Jul 22, 2011 at 3:48pm

I do think physicians should be able to treat family members with medical conditions that are w/i their field of practice.  There are other advantages beside the time savings noted. The biggest advantage is the savings of healthcare dollars in not going to the ER or Urgent Care; not to mention taking up the valuable time needed for other patients in those settings.  Of course, one should not practice outside his/her scope.

By Dr. TV on Jul 22, 2011 at 4:45pm

I believe a physician should feel free to treat a friend or family member as he feels necessary whatever the condition was as long as he feels comfortable, after all any physician should be able to manage simple or primary care conditions and some specialty condition.

By DR. A on Jul 22, 2011 at 8:39pm

I feel it is appropriate to treat family members for uncomplicated acute illnesses, but should not generally be managing chronic conditions or prescribing controlled substances. As apediatrician, I did not examine or prrscribe for my children when they were infants and toddlers. But as school age/adolescent children, I don’t mind taking care if simple issues, OM, strep throat, a minor skin infection etc.

By Christopher Clapp on Jul 22, 2011 at 8:42pm

I agree with Dr. Winans. I also do not endorse the position that one should not treat outside the trained specialty. For example, would that mean a cardiologist, neurologist, radiologist would not be able to treat UTI? There has to be flexibility and not a chiseled in stone policy.

As long as good medical practice is followed, no other requirement is necessary. I do agree that in view of abuse of controlled substances, self prescription of these medications should be prohibited.

By William McElveen on Jul 22, 2011 at 9:57pm

Physicians should be able to prescribe medications within their area of practice. This can be for themselves, family or friends. They should examine the patient (of course a little hard to do self exam) and keep a progress note. This helps the providers to get back to work, instead of cancelling the clinic for taking care of themselves or family members to see another provider.

By Dr. S. on Jul 22, 2011 at 10:15pm

I recently prescribed antibiotic eye drop to my G.daughter. I am an anesthesiologist and Ophthalmologist is a friend of mine . I think it is nice to have a doctor in the family who may be very helpful in case of an emergency,or prescribe an antibiotic when it is hard or inconvenient to call family doctor or just to save money. Yes doctors should be allowed to prescribe medications to family members.

By Thomas Mathew on Jul 22, 2011 at 11:40pm

I would not recommend making a habit of self-treatment but there are circumstances in which it is appropriate to write a prescription for yourself or your family particularly if you or your family member have already been evaluated by another physician and he or she has approved the treatment.
Ihe Medical Board’s prohibition against writing appropriate prescriptions for yourself needs to be re-examined.

By M. Chipman on Jul 23, 2011 at 3:39am

for minor illness, yes, we should be able to treat our family. i have done just as the article described and treated otits externa for my 6 yr old after the beach, and pinworms for my 4 year old-i didn’t want to wake the pediatrician for a script at midnight and topical acne medication for myself.  i don’t think you should prescribe controlled substances for a family member-unless they are a formal member of your practice-and in some small towns there is only one practice to choose from, and that doctor is on call, but is should be fully documented as any other patient you gave these meds to would be.  but i don’t want to have to take time off work drive to see the peds for things i treat in other people all day long in my own office.  i don’t think physicians should treat anything serious in family members.

By tc on Jul 23, 2011 at 8:07am

the physician should be able to prescribe controlled substances to his family but not himself

By anonymous on Jul 23, 2011 at 12:48pm

I appreciate the board revisiting this issue.  It makes no sense that I am at risk of censure if I prescribe for family or friends as long as I maintain the same standard of care that is required for any patient.  An accountant can assist a family member w/ taxes, and an attorney draw up a power of attorney for a loved one as long as there is no conflict of interest.  I do agree with not allowing controlled substance prescribing to self or family.

By Lisa on Jul 23, 2011 at 4:59pm

I agree with the 2 previous comments. Use good judgement and provide quality care.

By Dr. B on Jul 23, 2011 at 4:59pm

I believe that the doctor should have the decision-making role in whether to treat or not to treat family/self. I have treated family to the degree I felt it was appropriate, but when I felt they really needed to have further examination I told them so. We make the same decisions every day in the office as well as on call.
We also need to start thinking of the impact of making “rules” to our access of healthcare. I now see pediatric patients in the office for uncomplicated URIs just because the school now believes a mother can’t decide that a child of hers isn’t feeling up to the task of school for a day. Now she has the additional burden/cost to take the child to see me, at which time I tell her what she already knew and give her a doctor’s note for the child. We should start using common sense in medicine.

By Cathy Fanning on Jul 23, 2011 at 5:46pm

I agree with the proposed board policy of minor rx only, and keep a record of everything…no narcotic rx’es.

By James Carraway, MD EVMS Plastic Surgery, Norfol on Jul 24, 2011 at 2:02pm

The Board is overzealous in its attempt to micromanage physicians.  As long as doctors are not routinely prescribing addictive medications for themselves or immediate family,  there should be no reprimands for routine medical needs. 
Quite frankly, I was shocked when I moved to NC.  This policy should never have been implemented, and should be reversed as soon as possible.

By Laura Allen, MD on Jul 25, 2011 at 12:05pm

The board should quit acting like the JCAHO and stop micromanaging physicians. An MD should be able to use his training and judgement to treat anyone regardless of genetic ties.

By G. Rieser on Jul 25, 2011 at 4:19pm

This is a very unnecessary question. We are physicians.  If we can not treat our self, family or close friend correctly, how can we treat general patients correctly.  If all doctors can honestly do both with equal amount of concern and consideration, we will be much better doctors. Also after 33 years of practice, many of my patients become my close friends.

By John Chang, MD on Jul 25, 2011 at 6:52pm

Doctors ARE allowed to prescribe and treat whoever they wish, saving some states, like NC. They HAVE been doing it, so asking should they be allowed confers to the board and the government, illegal and unconstitutional powers- powers over natural rights of people to engage in their jobs without interference. Just another power grab by agencies and government that’s taken through the power of enforcement but without the power of legal laws. Goodbye America, Hello Fascism.

By D. Hopkins, MD on Jul 26, 2011 at 4:44am

I agree that the Board should revisit this policy, with an eye toward flexibility, common sense, and compassion; and avoiding the draconian zero-tolerance prohibitions and penalties currently so fashionable.  We should not need to fear for our livelihood when our kids are sick.

By Bruce Robillard, MD on Jul 28, 2011 at 2:23am

WE SHOULD NEVER TREAT OURSELVES NO MATTER HOW QUALIFIED WE ARE.
WHEN IT COMES TO FRIENDS AND FAMILY,PERHAPS AND ONLY IF THERE IS A DOCUMENTED RECORD OF CARE.IF WE OR OUR FRIENDS AND FAMILY NEED A CONTROLLED SUBSTANCE WE SHOULD CONSULT ANOTHER QUALIFIED PRACTITIONER. THAT IS HOW I SEE IT.WE NEED TO LEARN TO ASK OTHERS TO HELP US RATHER THAN PRACTICING “MEDICAL SELF SUFFICIENCY”-THE LIFE WE SAVE MAY BE OUR OWN.

By CHARLES E KOBER PAC on Jul 29, 2011 at 5:41pm

There clearly should be a “rule of reason” here. Physicians should clearly not prescribe controlled drugs for themselves, nor outside of brief, self limited periods for immediate family members. Nor should we be treating ourselves or immediate family for chronic conditions. The use should be appropriate and within the standard of care. Why should it be appropriate to treat your girlfriend’s UTI or her kids’ swimmer’s ear one week and inappropriate if you marry her the next? If your sister decides a few Ambien for an international trip might help and she can’t see her doctor for six weeks and the nearest urgent care is an hour away should there be a problem?
Let’s focus on the docs doing the big time pill mill routine and ask if short term or acute treatment contributed to a poor outcome. If not, let’s not waste the time of the Board dealing with something that is not a problem.

By Charles Davant, MD on Jul 29, 2011 at 7:06pm

I agree with most of the above.  The board has definitely overstepped its bounds on this issue.  The supposition that physicians emotional involvement could affect their judgement in caring for family members is paternalistic and condescending.

By Dennice Herman, MD on Jul 30, 2011 at 2:28pm

I agree that the board should revisit this policy. I believe that a physician should be allowed to treat family, friends or close contacts, if the physician is competent and comfortable treating that condition. I think it is reasonable to treat family or friends if otherwise, there would be a delay in treatment or an unnecessary expense to have them go to the ER or urgent care, incur a significant cost, which is unnecessary.  Our ER’s are already full of patients that don’t need that level of care. This only delays treatment for those that really need Emergency care and increases the costs of medical care, further

By Philip Mondi, MD on Jul 31, 2011 at 12:17pm

we should be free to tx what we are competent to tx. As an FP, I can and should be able to Tx routine ailments I see every day for my family as I do for my patients. If I am not competent to care for those I love and care about the most, then maybe I shouldn’t be treating anybody.
  Mr Kober is way out in left field on this one

By john sealander on Aug 01, 2011 at 5:56pm

Agree with most comments above. We should not live in fear of being reprimanded for treating a family member’s minor illness from time to time. Limit the position statement to avoidance of controlled substance prescribing for self, family and friends, and call it a day!

By G. Velazquez, MD on Aug 02, 2011 at 10:28am

I am in agreement with the majority of the comments.  There are very minor issues that we should be able to treat both for ourselves and family members if we feel competent. regardless of specialty and current practice.  Things like a minor skin infection, otitis externa, a UTI.  I have treated myself and family for several of these things, but would never prescribe any controlled substance or anything that has the potential for abuse.  We are physicians and should be able to judge when this is appropriate and can save the system and our colleagues otherwise wasted time and effort.

By Dr. T on Aug 02, 2011 at 11:54am

I would favor an ADVISORY statement that balances the comfort and convenience of self/family prescribing with the physician’s obligation to assess carefully his ability to provide expert, objective advice and care. Clearly there are cases where self/family treatment can be done safely and expertly, and others where another physician should be consulted. We should trust physicians to make the correct choice, and not try to generate blanket rules that will inevitably be too cumbersome and lead to inappropriate and intrusive enforcement action.

By Stephen Leonard MD on Aug 02, 2011 at 11:55am

The area of concern for the Board should be controlled substances. Otherwise, treatment of family, friends, and self should be guided by common sense, experience, and the same ethics one uses daily in the care of his/her patients.

By Charles D. Yoder, MD on Aug 02, 2011 at 12:00pm

As a PA I feel that if my supervising MD is comfortable with me treating say a coworker for a sinus infection or UTI then it should be okay. AS stated above good judgement and training should prevail. I do agree however that we (MD’S and PA’S) should not be prescribing controlled substances to family members etc. Then I believe the temptation can be too great. I work with PA’S and MD’S in recovery. There is a fine line that sometimes is too easy to cross.

By DeLois Coggin, PA-C on Aug 02, 2011 at 12:01pm

No controlled substances or psychotropics to any family members, self, or friends!  No prescribing/practice outside your scope. Something along the line of antibiotics should be fine after history/exam is performed.

By J. Puhr, MD on Aug 02, 2011 at 12:20pm

“WE SHOULD NEVER TREAT OURSELVES NO MATTER HOW QUALIFIED WE ARE.”

Mr. Kober has clearly never evacuated a subunguinal hematoma after a mishap with a hammer.

And I would still maintain that appropriate, brief, short term use of some controlled medications should be allowed. I’m not talking dilaudid or MS, but situations like deaths in a family, a child in ICU, your brother’s fifth gout flare on New Year’s Eve where you are offering short term anxiety treatment or pain control.

I would question, too, how the Board becomes aware of cases like this? If I became aware my partner was Rxing Percocet for his wife, I’d turn him in. But if he treated her sinusitis on a ski trip, I’d not even consider it a problem. Since roughly half our relatives have a different last name, same for step-kids, only in a small town would a pharmacist have a clue as to a relationship.

So, I’ll state again. Short term treatment within the standard of care for acute illnesses in family members should not be something the Board should concern itself with. Physicians should not prescribe controlled drugs for themselves, or more than briefly for family. And I will continue to drain my own subunguinal hematomas as fast as I can find a paper clip to heat up.

By Charles Davant, MD on Aug 02, 2011 at 12:47pm

I have a strong feeling in this issue. As a foriegn graduate who has been practicing in US for close to 15 years I find this rule counter productive. we are licensed physicians. The standard by which we should be measured should be the quality of care we give. I hate to go to the ED carying my child for simple otitis media. it is also inappropriate use of resources. what is the rationale for any licensing board to ask me to do that? we should give physicians a room to practice medicine as long as they are comfortable, be it to family members or friends.
Having said this, I agree with restrictions on controlled substances be it for family, self or friends. I hope to see a change in this position.

By David SS on Aug 02, 2011 at 1:07pm

I think the treatment of certain conditions w/in family/friends is fine as long as the provider is knowledgeable & comfortable w/ the complaint and able to document correctly. I do not agree w/ prescribing of controlled substances to family/friends.

By JB - PA on Aug 02, 2011 at 1:50pm

I agree with Dr. Yoder and can not improve on his statement.

By Robert Crawford MD on Aug 02, 2011 at 2:08pm

As a physician, he or she should know what they can treat and what they cannot treat.  If they cannot, they should not do it. Prescription is the same thing. The bottom line is that physician should treat all the patients the same no matter who they are.

By C Yue, MD, Ph.D on Aug 02, 2011 at 2:34pm

I think we should be able to treat family member in case of minor illness. A few years back I was out of the state and my child developed an asthma exacerbation. We did not have his puff and I called it in although that is not my area of expertise…
I do not think we should be allowed to prescribe opiates, psychotropic medications to family members or friends. But what to do if you live in a small town where you “know everybody”?
I think there should be guidelines but every case has to be evaluated individually. Record keeping should be a must!

By Dr. P. on Aug 02, 2011 at 3:44pm

I believe that the New Hampshire Medical Board articulates the issues well:

“Physicians generally should not treat themselves or members of their immediate families. Professional objectivity may be compromised when an immediate family member or the physician is the patient; the physician’s personal feelings may unduly influence his or her professional medical judgment, thereby interfering with the care being delivered. Physicians may fail to probe sensitive areas when taking the medical history or may fail to perform intimate parts of the physical examination. Similarly, patients may feel uncomfortable disclosing sensitive information or undergoing an intimate examination when the physician is an immediate family member. This discomfort is particularly the case when the patient is a minor child, and sensitive or intimate care should especially be avoided for such patients. When treating themselves or immediate family members, physicians may be inclined to treat problems that are beyond their expertise or training. If tensions develop in a physician’s professional relationship with a family member, perhaps as a result of a negative medical outcome, such difficulties may be carried over into the family member’s personal relationship with the physician.

Concerns regarding patient autonomy and informed consent are also relevant when physicians attempt to treat members of their immediate family. Family members may be reluctant to state their preference for another physician or decline a recommendation for fear of offending the physician. In particular, minor children will generally not feel free to refuse care from their parents. Likewise, physicians may feel obligated to provide care to immediate family members even if they feel uncomfortable providing care.”

By Grace Thrall MD on Aug 02, 2011 at 5:39pm

Having a guideline seems sensible.  Practicing within the scope of training is always wise.  Documenting the treatment in some way protects the patient and provider of care.  Avoiding controlled substances for one’s self and family. Undue restrictions are unwelcome!

By J.Lehr, MD on Aug 02, 2011 at 5:39pm

The questions asked in the survey are too black and white.  I do think it is appropriate for most physicians to make a judgement whether or not they are qualified to treat a member of the family/friends depending on the situation.  None of us want to be involved in treating chronic conditions not any situation requiring emergency room care. Minor illnesses seem appropriate and save health dollars.

By Carolyn Ferree M.D on Aug 02, 2011 at 8:52pm

This subject has long been in debate.  The physician takes the personal risk of an error in prescribing or decision making.  If the physician is willing to assume that risk in the care of a family member, they must have decided they are willing to live with the possibility of an error in decision making.  There is no question that a physician’s treating capabilities are in fact altered by an emotional attachment to the situation.  Should the medical board control whether or not the physician treats family members?, probably not.

By Kareh Le Hew on Aug 02, 2011 at 9:58pm

What is “your expertise”??  As a Pathologist, I am expected to know what antibiotics are sensitive or resistant to what bacteria.  What bacteria are most comon in most clinical settings and deal with the hospital pharmacist to “educate” the hospital staff of these findings. Am I suitable to prescribe an antibiotic to my daughters eczema breakout to prevent a MRSA? I don’t do that now. My wife brought her to a Derm Clinic at a well known NC Hospital only to hear what I already told her. 250$ later she did get a presription that I could have already prescribed. Good thing someone cancelled an appointment or else my child may have been treated for a much more severe infection due to a delay in treatment. A minor but real example. I’ve got plenty more examples. Please change the rule.  Thanks

By Dr D on Aug 02, 2011 at 11:43pm

Physicians should be allowed to treat family and self within the scope of practice in accordance to the standard of care.  Access to care remains a problem for all and our family’s are not exempt from this issue.

By DR. K on Aug 03, 2011 at 4:08am

I feel simple prescriptions are acceptable. For example, malaria prescriptions for the family who routinely travels to an endemic area, following current CDC guidelines.

By I. Hamrick, MD on Aug 03, 2011 at 7:42am

Avoiding delineated regulation seems to be our consensus here.  Guidelines rather than rules will best address the many variations of scenarios and not entangle someone with good judgment and appropriate action:  a prompt treatment for asthma or infection, the above mentioned travel medications, patches for seasickness, and many topicals.  Even with the controlled substances there are rare instances where the physician can alleviate suffering, do the right thing and practice proper medicine, for instance letting a grieving relative have a few Dalmane after a funeral.  Drs Charles Yoder and Charles Davant should be invited to join the oversight of this issue!

By Anne Walker, MD on Aug 03, 2011 at 2:19pm

I agree with Dr. Hamrick and the overwhelming majority of the above contributors who stated that we are capable and qualified to decide for ourselves if and when self/family treatment is appropriate.  - unless, of course, we’re drug addicts…

By S. Hayes, MD on Aug 03, 2011 at 3:22pm

I agree with the majority opinion. Doctors are trained and pass certification exams to determine qualification. If a physician feels the need to prescribe and care for a family member or friend, they should be allowed. If the friend or relative feels uncomfortable, that person is not being forced to follow the doctor’s advice. Let’s please use common sense and not over legislate. I would not treat any condition where I don’t have a comfort level.

By Samuel Willinger, MD on Aug 03, 2011 at 6:14pm

I am one of those who HAS seen his “name in the back pages of the Forum” as noted above. Thus having been formally warned for prescribing medicine to family members, my ability to provide quality care has been sadly inhibited.
Three years ago I took my mother and father into my home, both of whom had significant dementia, to take care of them. As a board certified family practicioner with thirty years experience, I have treated a good many patients with dementia both in and out of the nursing home environment. Because of a “flagged prescription” an NCMB private investigator approached me.
After that whole unnerving experience, I had to “drag” my parents to a doctor they’d never met, so he could prescribe their meds, even though I had full documentation including complete H&P’s w/ all meds listed.
When my dad developed the UTI that marked the beginning of his demise, I called for help through the channels expected of me, eventually having to demand that a homehealth nurse come out (I gladly did the cath since she was squeamish). I couldn’t even order a U/A w/ C&S on obviously infected urine. We had to WAIT. I personally began Cipro from a sample left over in my closet. The Rx didn’t come until FIVE DAYS LATER!
Being bed-ridden my dad needed strengthening PT. Of course I was not permitted to write the order. I got involved hiring custodial assistance due to my fatigue. But then as my dad was developing severe and PAINFUL contractures, we had to wait A WEEK for his busy doctor JUST TO ORDER PT! By the time the therapist arrived there was little he could provide.

YES I DO believe NCMB needs to rewrite its position statement.

By William H. Harrison III, MD on Aug 03, 2011 at 8:14pm

Physicians should be allowed, without prejudice, to prescribe for themselves and family for minor illnesses etc.  Controlled substances should not be given, except perhaps in truly extraordinary circumstances. As experienced physicians, are we now less qualified than we were as interns to treat otitis media, sinusitis, etc?  To expedite care, we or our family often are seen by providers who may be less qualified than we are -who benefits from that? I have personally encountered several instances where current regulations have delayed, and even compromised, timely delivery of appropriate care.

By sb md on Aug 04, 2011 at 11:48am

I have returned to practice in the small town I grew up in.  It is nice to have a statement on this subject; by looking at the disciplinary report one can see this may be necessary. However, in my case, it is almost impossible to NOT treat family members.  Sometimes, this happens several times a week if I am staffing the ER. Therefore, I do not think one can make a blanket statement about this without considering those of us in very rural areas (that are also our hometowns).  I hate to feel like I am consistently doing something wrong, when I am just serving my community.

By Dr. B on Aug 04, 2011 at 6:53pm

I must admit I have done things like remove a lateral nail plate for an ingrown toenail and (gasp) didn’t do a procedure note. What good is it to have a doctor in the family if you can’t do these types of things?
However, I do have strong feelings about many of these scenarios. Controlled substances just present too much room for abuse and physicians are notorious for thinking we are “above” addiction problems. Although I just can’t see myself writing a note for addressing a minor injury or illness for my family, I am very careful when it comes to people in the office, friends, neighbors etc to document like I would any other patient interaction. In addition, some of the chronic, serious illnesses noted above should really be addressed by a third party with more objectivity.

By HP MD on Aug 04, 2011 at 10:35pm

No one should ever be allowed to prescribe controlled substances for self or family. Beyond that, I certainly agree with the great majority of the comments. I use triamcinolone every winter to control eczema and I see nothing wrong with writing for it. We are responsible for our judgement—as a pediatric oncologist, I would never write anything for ANY adult because I know nothing about internal medicine!

By Allen Chauvenet MD on Aug 07, 2011 at 1:45pm

I think it appropriate to treat minor problems for family members. I would not recommend ordering Scheduled drugs.

By Clive Possinger on Aug 07, 2011 at 10:50pm

In my opinion it is OK to treat minor illness of your family and friends as long as you are qualified to treat and may be good idea to make a note of it. But not comfortable to prescribe controlled substances.

By Orugunta R on Aug 11, 2011 at 11:15pm

I believe that if it is a condition you would treat a nonfamily member patient for that you should be able to treat a family member for this, with one exception. No chronic narcotics or ADD medications to be prescribed, although one week of medications if needed in between routine prescriptions from another provider would be acceptable.

By DC MD on Aug 14, 2011 at 9:48am

thank you Dr Huff for understanding our dilemmas in the exact situation you described with out of town travel and sick kids and i hope that the position of the board gets clarified in these minor instances as well as emergencies. i would draw the line at prescribing narcotics however to avoid any controversies.
thank you.

By naguib on Aug 17, 2011 at 1:45am

As a 63 year old physician, I certainly feel more competent to prescribe for myself or my family than the vast majority of recent graduates.  My experience, with the majority of physicians graduated after 1990, is that they are woefully inexperienced.  My MD brother and I worry who will take care of us in our retirement years!!

By George on Aug 24, 2011 at 8:41pm

Who knows ur family member better other than you?  I trust my judgement and clinical skills more than some random provider…So what’s the problem in treating family members?  I don’t see the issue unless the board is worried about drug abuse/dependence?

By AC on Sep 29, 2011 at 10:32pm