The other day while I was running errands in town, an acquaintance approached me and asked if I would write him a prescription for Quaaludes (methaqualone). My answer was “absolutely not,” and I immediately walked away.

Unfortunately, I receive many requests from acquaintances to write prescriptions for controlled substances. Although I’m no longer surprised by this, my answer is always no.

I’m not willing to fuel someone’s addiction—or lose my medical license.

 

When is it appropriate?

I have occasionally filled prescription requests from trusted loved ones—to treat a sinus infection, to refill a friend’s birth control, or to manage acute, treatable symptoms.

But I know my limitations, and I always practice in an ethical manner in such cases. There are certain times when this can be appropriate, but most often, it’s not wise to write prescriptions for friends and family.

A study published by Western Journal of Medicine showed that 99% of doctors had gotten requests from family members for therapy or medical advice.

Korenman SG, Bramstedt KA. Your spouse/partner gets a skin infection and needs antibiotics: is it ethical for you to prescribe for them? Yes: it is ethical to treat short-term, minor problems. West J Med. 2000;173(6):364.

 

 

Code of ethics

According to the American Medical Association (AMA) Code of Medical Ethics, there are only certain circumstances where a physician may treat loved ones:

AMA Code of Medical Ethics’ opinion on physicians treating family members. Virtual Mentor. 2012;14(5):396–397.

 

• In isolated or emergency situations when no other qualified physician is available

• When routine care is needed for minor or short-term problems, such as prescribing steroids for a superficial skin infection, refilling a long-term medication, or removing stitches

Furthermore, as stated in the AMA report, it’s never appropriate (except in cases of emergencies) for physicians to write prescriptions for controlled substances for anyone—including themselves.

 

Why is it unethical?

These rules and ethics may seem like nuances to many people.

You may be thinking, "What if a family member can’t afford to seek medical attention? Aren’t we just doing them a simple favor?"

Maybe—but maybe not. You must consider the scenarios that could result from prescribing medications to family and friends:

• What if the medication or treatment is ineffective—or worse? What if your loved one starts to experience unwanted side effects?

• Relatives (especially adolescents) may not want to disclose their medical history or current list of medications out of embarrassment. For example, your daughter may not want to disclose she’s on birth control, or your grandfather may not want to tell you he takes Viagra. This is important when prescribing medications due to the many possible drug interactions.

• You may be treating and prescribing outside your area of expertise.

• Once you provide care to a family member or friend, it may be challenging to deny it in future situations.

Other complicating factors:

• Typically you'd give your patients a complete physical exam, but this is often inappropriate with a family member.

• You may not have an objective view of the severity of their condition, which could cloud your judgment.

• What about the family member who repeatedly requests a specific medication for their ailment? This can often turn into drug-seeking behavior (which can be a hallmark of addiction).

Remember, as the prescribing physician, you’re responsible for these medications and their side effects, especially if a medical history, current medication list, and physical exam are left out.

You should apply the same level of care and standards you would for a patient who came into your office.

Besides potentially harming your loved ones, prescribing medications to family and friends could even damage your career. You might reap consequences from your state medical board, especially if you informally prescribe a controlled substance.

 

Saying no

If a friend or family member approaches you about a treatment or prescription medication, and it’s not a minor issue or emergency, you are well within your rights to say no.

When refusing their request, be kind and empathetic, explain the reasoning behind your answer, and offer alternative treatment such as referral to a trusted physician.

As stated in an article published by the American Academy of Family Physicians’ Family Practice Management, “The bottom line for ethical and legal guidelines: Don’t treat non-patients except in cases of minor problems or emergencies. Document what you do. Stay away from prescribing controlled substances.”

Latessa, R. Ray L. Should You treat yourself, family or friends? Fam Pract Manag. 2005;12(3):41-44.