Question & Answer
Writing Prescriptions for Family Members
Q: Leslie, a family practice PA, is hosting her 19-year-old niece Alyssa for a weekend visit. Leslie and Alyssa had planned many fun activities, but Alyssa is experiencing the uncomfortable symptoms of a urinary tract infection. Alyssa doesn't want to go through the hassle of calling her physician and asking him to phone in a prescription, so she asks Leslie if she would write the prescription. Leslie is certain that Alyssa has a UTI--her niece gets them relatively frequently, and Alyssa's symptoms are classic. But Leslie doesn't know if it would be illegal or unethical to write the prescription, or if the practice of writing prescriptions for family members is discouraged. Should Leslie go ahead and write the prescription?
A: Although Leslie might feel extremely comfortable prescribing the antibiotic for her niece, it would seem most appropriate to me that she refrain from doing so. There are a couple of important issues to consider. First, without a clear record of the interaction between the patient and the health care provider, Leslie would be placing herself in a precarious situation by providing the medication. Second, the practice of providing medications for family members has always been considered unethical due to a mismatch in the provider-patient relationship. Family members are seen as patients who may not consider some aspects of treatment--aspects that probably would not be missed if the provider-patient relationship did not involve close relatives. According to most understood laws governing dispensing medications, providers are not given the right to prescribe medications to family members.
But there is a more important issue at hand in this scenario: that Leslie might not be privy to all of the historical information contained in the medical record at Alyssa's physician's office. An account of the previous UTIs is most likely recorded in such a record. Without such information, Leslie may put her niece at risk for other problems should something be missed that the primary care provider has planned to do were Alyssa to develop another UTI.
Providers probably write prescriptions for family members from time to time, but the practice should be limited as much as possible. People often reveal information to the provider that they would not reveal to a family member. That the patient-provider relationship is held to the highest standard of care is of paramount issue here, and it's not just that Leslie is considering putting her signature to the prescription form.
--Mark E. Abell, BS, PA-C
A: I don't see any reason why Leslie shouldn't treat her niece. Alyssa is a young adult and is certainly legally capable of requesting treatment. She is also capable of understanding instructions on the use of prescription medications.
I don't recall seeing anything in the regulations or rules for PAs governing the treatment of family members. Ethically, however, there could be problems in the event that something should go wrong (e.g., an allergy to the prescribed drug). Each individual PA knows his limits based on the relationship with his own supervising physician, and Leslie should know whether she believes her prescription would be covered or not in this case. Under the circumstances, I'd like to think that most of our physicians would have no problem with this at all. And I'd make sure I wrote the prescription out, retaining a copy, to make sure I have brought the issue to the attention of my physician, and I'd forward a copy for her records back home.
UTIs are pretty cut and dried, and so are the medications used to treat them. As long as Leslie makes sure she knows what Alyssa's allergies are (if any) and uses well-known, common medications, she's fine. This would be a much different scenario, however, if it involved scheduled drugs. That would be a definite no-no that could cost Leslie both a license and national certification quicker than she could approve a refill.
--Tony V. Bevill, PA-C
A: The issue of writing prescriptions for family members is controversial. As PAs, our actions reflect on the supervising physician as well as on our own legal and ethical perspectives. Any time that a prescription is written, there should be a chart for the patient to document the encounter. Because we are PAs, that chart must be co-signed within the time limits specified by state law. Therefore, Leslie should not merely write out the prescription unless she is prepared to bring her niece to the office, establish a chart and follow through with the countersignature from her supervising physician.
Ethically, writing prescriptions for family members is also wrong. A good practitioner establishes a relationship with her patient that is different than the relationship with family. The practitioner/patient relationship is based on mutual respect and trust and is not entangled with the emotional stresses that can confuse intimate relationships. The practitioner must act objectively while remaining empathetic. Prescriptive authority is a heavy responsibility. A good PA would not sacrifice his or her professional standards in the name of convenience for any patient, including family members.
--Claire Babcock O'Connell, MPH, PA-C
this month's Q&A panel
Mark E. Abell practices in Ocala, Fla., and is a freelance medical writer.
Tony V. Bevill practices at Southeast Healthcare Associates in Swainsboro, Ga., and is on the ADVANCE editorial advisory board.
Claire Babcock O'Connell is clinical coordinator of the PA program at RutgersUniversity/University of Medicine and Dentistry of New Jersey in Piscataway, N.J.