Should Providers Treat Their Friends and Family?

I'm sure you as a nurse practitioner have a similar dilemma - do you prescribe medications or provide medical treatment to your friends and family?  I have found that providers vary in their approach to this problem.  Some treat and prescribe without hesitation, others hold to strict no friends and family guidelines.  What should you do?  What is legal?

I admit, I occasionally write prescriptions for family and friends.  Last winter my husband and I were in Colorado on a ski vacation when he developed a tooth abscess...ouch.  I called in a Amoxicillin to the local drug store to get him started on antibiotics since we wouldn't arrive home until the next day.  I did not, however prescribe him any pain medication- although warranted for his condition, the family connection was too risky.

Often at work, coworkers will ask for prescriptions to treat various ailments.  I don't like this.  Although I trust my husband won't sue me if something goes wrong with the antibiotics I have prescribed for his dental abscess, the coworker connection is a bit shaky.  Prescribing to coworkers is a grey area for me- I have done it but don't like to, it's awkward for both of us (please keep your yeast infection to yourself at the office). 

How Many Providers Write Prescriptions for Friends and Family?

Self-prescribing as well as treating friends and family is widespread among medical providers.  Self-treatment has been reported in 52 to 84 percent of physicians and nearly 100 percent of physicians report treating non-patients. 

Is It Legal to Prescribe to Friends and Family?

The legal implications of treating friends and family vary by state.  In most states, however the laws are nebulous and still leave providers in a gray area.  In South Carolina for example, prescribing controlled substances for family members is considered outside the scope of "good medical practice" except in an emergency situation.  "Emergency situation" however is not defined.  In California, "Evaluating, diagnosing, treating or prescribing to family members, coworkers or friends is discouraged and requires the same practice/ protocol as any patient for which medications are prescribed including a good faith exam and documentation that justifies the prescription".

In most states it is technically legal but not encouraged to treat and prescribe for friends and family.  However many states have caveats to this treatment.  For example, in some states providers can prescribe to these individuals only in emergency situations.  In others a written record of an exam and treatment is required.  Federal law requires that to prescribe controlled substances, there must be a bona fide provider-patient relationship including a written record.  Once a provider-patient connection has been established, whether formally in the clinic or informally, you are legally responsible for that interaction and it's consequences.  This is very important to remember and take into consideration when determining who you will treat.

Although not a legal consideration, nurse practitioners must also take into account that some insurance providers such as Medicare and Blue Cross Blue Shield prohibit payments for care provided to immediate family members even if this care is provided in the office setting.

Given This Information Should You Prescribe to Friends and Family?

Treating and prescribing for friends and family is a major gray area even after reviewing the legal implications.  First, you must review the laws governing this practice in your state and make sure to follow them appropriately.  Secondly, never prescribe controlled medications to friends, family or coworkers.  I don't think self-treating or treating immediate family members consititutes the bona fide provider-patient relationship required to prescribe controlled medications.  You are asking for trouble if you prescribe controlled substances to anyone but your actual patients in the clinic or hospital setting.  

As long as you are abiding by your state's laws, treating friends and family is acceptable for minor problems.  I recommend making some guidelines for your personal out-of-office practices so friends, family and co-workers do not abuse your prescribing power. For example, as a general rule I don't treat coworkers.  I don't like it and I don't feel comfortable with it.  I can't pinpoint the reason, but when a coworker asks for a prescription I politely decline stating I don't prescribe medications for anyone I work with.  Friends and family don't seem to take advantage of my prescribing abilities.  I treat them only for minor, acute problems and never prescribe controlled substances.  Not even "that really good cough syrup that always helps me get better".