Quality Matters Newsletter

Pearls and Pitfalls (Winter 2012)


In this Quality Matters’ newsletter, we will discuss pearls and potential pitfalls with regard to medication/treatment of self and family members/colleagues.  Pearls are office strategies that work well, promote continuity and minimize risk. Pitfalls are processes that increase risk and are not easily recognized as problematic. Listed here are some considerations. We would like to hear from you. Let us know if you have specific topic or an office process that works well.Your questions or office process could be featured in an upcoming newsletter.
 
 

Pearl

Potential Pitfall

Reference

Treatment of non-patients (family, friends, colleagues)

·   Recommendation: Refer the family member, friend or colleague to their PCP/specialist or facilitate care by another physician.

 

Before you treat, ask yourself:

·   Are you trained to treat the person’s condition?

·   Will the family member colleague confide in you?

·   Can you be objective?

·   Will medical involvement provoke or intensify intra-familial conflict?

·   Will the family member/colleague follow your treatment advice?

·   Can you step back and allow another physician to guide treatment?

·   Are you willing to be accountable and liable if complications arise?

 

Once you treat a patient, the physician-patient relationship is established and you are responsible for care.

Treatment of family and friends is widespread among physicians with antibiotics, antihistamines and contraceptives being the most common medications prescribed. Treatment of non-patients, outside the office setting, is reported as nearing 100%.

 

If you provide treatment, the familiarity with the patient can compromise care, and the result may be an inability to obtain a complete medical history or physical exam, make a diagnosis or assure follow-up. There can be awkwardness with sensitive issues or evaluation such as questions regarding sexual history, drug use, and personal issues or in performing a thorough physical or mental exam. If testing is needed, objectivity can be blurred resulting in too many or too few tests.  There can be distress with interpretation of results.

 

Chart documentation may be absent in treatment of family, friends or colleagues because care is often rendered in settings outside the physician’s office. 

 

The AMA Code of Medical Ethics-Ethical Policy E-8-19 states that physicians generally should not treat themselves or members of their immediate family because their medical objectivity may be compromised in these situations. The policy notes that there are some situations when routine care is acceptable for short-term minor problems. It also states that, except in emergencies, it is not appropriate for the physician to write prescriptions for controlled substances for themselves or immediate family members. 

See: AMA Code of Medical Ethics

 

Medicare bars payment for items/services rendered by physicians to immediate relatives of the physician, to the physician’s partner or to members of their household. See: Medicare Benefits Policy Manual

 

Payers and Malpractice Carriers:

Check regarding their stance on treatment of non-patients.

Self-Treatment:

Recommendation: Refrain from self-treating and self-medicating

 

·      Know one’s limits, issues of drug/alcohol dependency, depression, or fatigue all affect motivation and judgment

·      Assure objectivity: Obtaining a physician’s opinion other than self

·      Physical evaluation: Consider that self performance of certain procedures is difficult (PAP, prostate exam)

·      Seek out a personal physician: This assures that care is documented, monitoring and follow-up occurs and you have an advocate to help navigate the healthcare system.

Self-treatment has been reported as high as 52%-90%., and is widespread among physicians with antibiotics, antihistamines/allergy medications, contraceptives and hypnotics being the most common medications self-prescribed.

Literature indicates that if you self-treat:

·      You lose objectivity

·      You bypass the medical work-up, and follow-up and may miss a diagnosis

·      In treating depression, you deprive yourself of the benefits of consultation and psychotherapy which could obviate the need for medication

·      If treating pain, you risk developing drug dependence.

See AMA Ethical Policy E 8-19 (above)

Federal Law and Controlled Substances: The scope of federal law for written prescriptions is limited to controlled substances. It states that a prescriber must have a bona fide patient-physician relationship, including a written record of the care. 

See: Office of Diversion Control

 

State Medical Board of Ohio (OSMB): Refrain from medicating oneself or family for pain: The OSMB states that physicians are prohibited from self-prescribing or self-administering controlled substances. Physicians are permitted to prescribe controlled substances to family members only in a medical emergency

See: Utilizing controlled substances for self and family members

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