Should you prescribe medications for family and friends?

Dear Dr. Mossman:
On a recent golf outing, my buddy Mike told me about his trouble staying “focused” while studying for his grad school exams. He asked me to write him a prescription for methylphenidate, which he had taken in high school and college. I want to help Mike, but I’m worried about my liability if something goes wrong. What should I do?—Submitted by “Dr. C”

Doctors learn early in their careers that family, friends, or coworkers often seek informal medical advice and ask for prescriptions. Also, doctors commonly diagnose and medicate themselves rather than seek care from other professionals.^1,2

In this article, we use the phrase “casual prescribing” to describe activities related to prescribing drugs for individuals such as Mike, a friend who has sought medication outside Dr. C’s customary practice setting. Despite having good intentions, you’re probably increasing your malpractice liability whenever you casually prescribe medication. Even more serious, if you casually prescribe controlled substances (eg, stimulants), you risk investigation and potential sanction by your state medical licensing agency.

To decide whether, how, and when you may prescribe drugs for yourself, family members, colleagues, or friends, you need to:

• anticipate being asked to casually prescribe
• understand the emotions and forces that drive casual prescribing
• know your state medical board’s rules and regulations
• be prepared with an appropriate response.

After we explore these points, we’ll consider what Dr. C might do.

A common request

People often seek medical advice outside doctors’ offices. Playing a sport together, sitting on an airplane, or sharing other social activities strips away the veneer of formality, lets people relax, makes doctors seem more approachable, and allows medical concerns to come forth more easily.³

Access to medical care is a problem for lay people and doctors alike. In many locales, simply getting an appointment with a primary care physician or psychiatrist is difficult.^4,5 Navigating health insurance rules and referral lists is frustrating. When people find a provider, they may feel guilty about taking a slot from someone else. Job expectations or a tough economy can make employees reluctant to take time off work^6,7 or concerned that they’ll miss productivity goals because of illness.¹

Doctors often self-prescribe to avoid facing the stigma of being ill. Although doctors should know better, many of us don’t want to experience the vulnerability that comes with being sick and needing health care. Some doctors fear colleagues’ scrutiny if their serious mental illness (eg, depression) becomes known, or they would rather treat themselves than seek professional help.¹ The most formidable obstacle physicians face is time—or lack of it. Many doctors work >60 hours per week, and their dedication and altruism causes them to neglect their own health until illness interferes with their professional lives.⁸

Emotional factors

Doctors pride themselves on knowing how to help people, and when loved ones or colleagues ask for our help, it’s gratifying and flattering.³ Such feelings may help explain why the largest numbers of prescriptions written for non-patients are for family members and friends, followed by prescriptions written by residents for fellow house officers.⁹

The circumstances surrounding casual prescribing usually make it difficult to maintain objectivity, avoid substandard care, uphold ethical principles, and handle discomfort. Your professional objectivity and clinical judgment likely are compromised when a close friend, an immediate family member, or you yourself are the patient.¹⁰ Treating loved ones and close friends can make it awkward to ask about sensitive matters (eg, “How much alcohol do you drink?”) or to perform intimate parts of a physical examination. Physicians who want to “go the extra mile” for family members or friends may try to treat problems that are beyond their expertise or training—a setup for failing to meet your legal and medical obligations to conform to the prevailing standard of care.¹¹

State medical board rules

The American Medical Association, British Medical Association, and Canadian Medical Association all discourage physicians from prescribing for themselves or family members.²Table 1^10,12-16 gives examples of states’ comments and guidelines relevant to casual prescribing. Overwhelmingly, state medical boards tell you that casual prescribing is ill-advised. However, in emergencies or in isolated settings where no other qualified physician is readily available, you should provide needed treatment for yourself, family, friends, or colleagues until another physician can assume care. Physicians should not be the primary or regular care providers for their immediate family members, but giving routine care for short-term, minor problems may be acceptable.¹⁴ Although state medical boards use differing language, all agree that casual prescribing requires assessment and documentation similar to what you do for patients seen in your regular practice setting. Table 2 summarizes appropriate casual prescribing practices, but you should also know the boards’ rules in the locales where you work.