Ethics question

[milanessa]

I always had the idea that it was unethical for doctors to treat immediate family, but I don't know if that's true.

When I had some hardware replaced in my ankle the orthopaedic surgeon had an unusual name. When the nurse came to give me some drugs I noticed the same name on her name tag and asked if they were related. He turned out to be her husband and she said he had operated on her leg.

[Aceon6]

I always had the idea that it was unethical for doctors to treat immediate family, but I don't know if that's true.

Most of the doctors I know don't treat immediate family, not because of ethics, but because they feel they would be too emotionally involved and that would impact their effectiveness.

[KikiSashaFan]

It sounds a bit iffy, but on the other hand, I have a few prescriptions and I usually see my own doctor whenever I need more of anything, but sometimes when she's too booked and I'm running low I've gone to a walk in clinic and shown them my last prescription and they've written up a new one (usually for a smaller amount than I'd get from my doc) no questions asked and without actually treating me.

[rfisher]

What do you think about a dentist writing a prescription for a Z-pack for a friend with upper respiratory symptoms?

I thought technically, if the doctor/dentist in question hasn't been seeng the person as a patient (i.e., having an established file on them), it's a no-go. Which is why we can't just ask the hospitalist or ER doc for an antibiotic script without officially being seen.

That's the rule of practice where I work. We can't even do an x-ray of a friend any more without an order.

[agalisgv]

Just curious, but what are the rationales for making certain antibiotics OTC? I know some countries do this, and am wondering why they feel it's appropriately safe to do so while the US doesn't.

[bardtoob]

Just curious, but what are the rationales for making certain antibiotics OTC? I know some countries do this, and am wondering why they feel it's appropriately safe to do so while the US doesn't.

Because in other countries, the cost of medication is enough of a deterant to keep people from over medicating themselves. They will not pay from something they do not absolutely need.

In the US, medication is relatively inexpensive in comparison to the average income.

[numbers123]

Just curious, but what are the rationales for making certain antibiotics OTC? I know some countries do this, and am wondering why they feel it's appropriately safe to do so while the US doesn't.

Some of the rationale is the emergence of super bugs like MRSA or CD. And that viruses are not treatable by antibiotics. Many people go to the doctor's office to treat a virus with antibiotics, when it is not appropriate.

In the US, medication is relatively inexpensive in comparison to the average income.

Uh, yeah. That's why 2 of my recent prescriptions were $600.20 and $618.40
We no longer have group insurance due to work lay-offs and the private insurance that we had to chose for me with a chronic illness and high deductible does not pay for these drugs until I meet the deductible.

[IceAlisa]

Some of the rationale is the emergence of super bugs like MRSA or CD. And that viruses are not treatable by antibiotics. Many people go to the doctor's office to treat a virus with antibiotics, when it is not appropriate.

That's true. I remember several years ago a paper came out of Finland (IIRC) where they had a public education campaign about viral diseases not responding to antibiotics and their resistant strains reduced significantly after that campaign.

Sometimes patients insist on getting antibiotics for a cold and the practitioner gives in. I can only imagine the superbugs if we had antibiotics OTC. They would eat the penicillins for breakfast. Also, some antibiotics interact and interfere with hormonal contraceptives. A can of worms, really.

[mkats]

Also, some antibiotics interact and interfere with hormonal contraceptives. A can of worms, really.

And coumadin, which is something you REALLY do not want to mess with

We had a patient at our practice who would occasionally have infections (trying to keep this vague, of course) and would get antibiotics. No problem. But then she wouldn't finish the course, and she would save the rest of the pills - then randomly use them herself whenever she thought she had a similar infection instead of actually getting it looked at. We'd get calls saying "Well, I had symptoms x y and z starting last week, so I took 3 Levaquin I had left over from last time, but it's been three more days and that didn't help, so now I need something else." Her doctor tried over and over again to explain that she should NOT do this - to no avail. The last time she had a UTI, they did a culture and her bugs were resistant to almost every antibiotic the lab tried.

[IceAlisa]

Is someone suggesting that coumadin be available OTC????

[mkats]

Oh no, no, no, thank goodness. I was just pointing out that antibiotics can interfere with coumadin, as well. (or maybe that isn't really the right smiley )

[Prancer]

Some of the rationale is the emergence of super bugs like MRSA or CD. And that viruses are not treatable by antibiotics. Many people go to the doctor's office to treat a virus with antibiotics, when it is not appropriate.

I can't speak for her, but I think agalisgv was actually asking what the rationale was for making antibiotics OTC in some places, not asking for the rationale for why we don't in the US .

The same problems would exist elsewhere, after all.

[agalisgv]

^^^Yes, thank you

[Twilight1]

I think in this case, I find it unethical for a friend to prescribe meds.

Small towns it is unavoidable to have a friend/ family member etc be a prescribing doctor but in this case, that is not the issue.

[mikey]

This particular situation is both unethical (because it occurred outside of an established doctor-patient relationship, and I am sure there is not documentation in the patient's chart regarding the patient encounter) AND illegal (because it is a violation of the Texas Dental Practice Act, which states that a dentist can only prescribe medications that directly pertain to dental practice- upper respiratory infections and/or pneumonia do not qualify).

However, I am equally at fault because I haven't done anything about it. The people involved are a friend's boss and her dentist friend. My friend asked that I drop the issue because it could affect his job and because I shouldn't know about the situation in the first place. What I should do is report the case to the state dental board- there would likely be a fine involved, as well as a mandate for the dentist to complete extra ethics training under supervision.

[danceronice]

Honestly, it depends on the drug. My friend, who is an OB/GYN with extensive familiarity with a particular autoimmune condition I have (it can create a very high-risk pregnancy, which hasn't been an issue for me yet as I've never been pregnant, but she's treated several patients with it) would probably write, say, a birth-control refill or prednisone scrip for me--she knows my history, she knows what I would have either for (no, the BC in my case isn't necessarily for the primary reason you'd think!) OTOH, if I asked for Cipro or Vicodin or some such, she'd say no and want to know what the heck I was doing. (Not that I would ask for either--I have to be practically browbeaten or in total agony to take an Advil, and I have actually been on Cipro once and it gives me headaches. I'd have to be exposed to anthrax before I'd take it again.)

[Twilight1]

There is no depends if the action is illegal.

Also, ethics in anyone's respective field is IMHO, non negiotiable. I also think their is no grey area (except in the small town scenario that I gave). If someone can go to a walk in clinic or personal GP for a rx then they should. Why compromise the integrity of a friend for something like this? (even if the general view is it is no big deal??)

[IceAlisa]

I can't speak for her, but I think agalisgv was actually asking what the rationale was for making antibiotics OTC in some places, not asking for the rationale for why we don't in the US .

The same problems would exist elsewhere, after all.

I remember penicillin being available OTC in the old country. Not sure if it's still the case. I can't say about the presence or absence of superbugs there as such data would have been suppressed if it existed. As to rationale, again I am not sure there was any rationale behind this (as in strong scientific evidence). A lot of things in medicine are based on tradition. It is a mistake to assume that every single aspect of medical practice is based on solid research.