The risk of writing informal prescriptions

If clinicians write informal prescriptions for friends or family, their supervising physicians may also suffer the consequences.
If clinicians write informal prescriptions for friends or family, their supervising physicians may also suffer the consequences.

As medical professionals, we often find ourselves in difficult situations. One of the situations I hate the most is when I am asked to write a prescription for a close family member, friend, or coworker. It's often considered a professional courtesy to write a prescription for someone else who thinks they may need an antibiotic, a cream, or some other prescription.

It can become difficult when that close acquaintance asks you to write a prescription for their family member; many times this is a person that you've never met. Other than what you're told upfront, you don't really know anything about that person or anything about their medical history. Therefore, we can only hope that the prescription will take care of the problem. This practice puts us in a very dangerous position – if there are any issues with the medication that is prescribed, the person could have a serious complication, and as a clinician you'll have some serious explaining to do. Furthermore, we aren't the only ones that are being put into a dangerous situation, as we are now bringing our supervising physicians into the problem as well.

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Although we have the ability to prescribe medications as physician assistants (PAs) and nurse practitioners (NPs), this power comes with a caveat: our prescriptions are written under the assumption that we have a supervising physician available to discuss these patients' cases with. By writing a prescription for someone we haven't officially evaluated, we're saying that the supervising physician was agreeable to this plan as well. This can have serious legal consequences for both the prescriber and the supervising physician should an issue arise with the prescription.

Unlike a PA or NP, physicians who write prescriptions for patients they haven't evaluated aren't bringing anyone else into their decision. Although not a good idea to write prescriptions in this manner, their actions are not affecting unwilling participants.

Writing prescriptions for people can also create a tense office dynamic. I never like being put into this position, because by saying no I'm suddenly on the defensive, and I'm left to explain why I don't want to. Although I would much rather explain myself at this point rather than have to explain my actions down the line, I still don't like having to do it. In addition, if you say yes to someone, then you may get stuck in a situation where it becomes expected that you will say yes each additional time. And if this person tells someone else that you've done it for them, then other people may expect you to do the same for them.

As clinicians, our job titles come with certain powers – but with these powers come the potential for serious consequences. We always have to keep in mind that our actions continually affect others and when we agree to do something that could get us into trouble, we are subjecting our supervising physician to the consequences of our actions as well. When it comes to these situations, it's best to say no in advance. This will hopefully set a precedent that will prevent others from continually asking for prescriptions, and it will keep both you and your supervising physician out of hot water.

Jillian Knowles, MMS, PA-C, is an emergency medicine physician assistant in the Philadelphia area.

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