Ethics question

Discussion in 'Off The Beaten Track' started by mikey, Jan 25, 2011.

  1. mikey

    mikey ...an acquired taste

    Joined:
    May 25, 2002
    Messages:
    3,465
    What do you think about a dentist writing a prescription for a Z-pack for a friend with upper respiratory symptoms?
     
    Last edited: Jan 25, 2011
  2. agalisgv

    agalisgv Well-Known Member

    Joined:
    Jan 29, 2005
    Messages:
    24,018
    Why didn't the friend just get a script from their regular doctor?
     
  3. Kasey

    Kasey Loving on babies!

    Joined:
    Aug 21, 2004
    Messages:
    12,249
    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.
     
  4. mikey

    mikey ...an acquired taste

    Joined:
    May 25, 2002
    Messages:
    3,465
    convenient and free
     
  5. mikey

    mikey ...an acquired taste

    Joined:
    May 25, 2002
    Messages:
    3,465
    that's my understanding too
     
  6. ryanbfan

    ryanbfan Active Member

    Joined:
    Jul 9, 2009
    Messages:
    807
    Z-packs suck and do not work for me.

    I went to the doctor the other day and unfortunately had to see someone I do not always see, she tried to give me one and I told her they do not make me feel any better and usually I feel no different after taking them. She got frustrated with me. Whatevs.
     
  7. BigB08822

    BigB08822 Well-Known Member

    Joined:
    Mar 16, 2003
    Messages:
    20,788
    I see absolutely no problem with it. It's a Z Pack for crying out loud, not a month supply of narcotics. Is it supposed to be done that way, no, but come on. I don't think anyone will be getting hurt. I am sure the dentist asked the proper questions to make sure they aren't taking other medications that may interfere, allergies, etc.
     
  8. Prancer

    Prancer Dysteleological Staff Member

    Joined:
    Apr 16, 2001
    Messages:
    38,831
    Then it is unethical--which is not the same thing as illegal or immoral

    I would call it unethical because the friend isn't a patient. I have had doctors give me scripts without seeing me--often for Z-packs--but only those doctors who have been treating me a long time and know me well as a patient.
     
  9. taf2002

    taf2002 flower lady

    Joined:
    Feb 16, 2003
    Messages:
    14,415
    Dentists give antibiotics for abcesses so it's not like they are completely untrained to do so. The problem is that the patient may have something other than an upper respiratory problem & may need to see a doctor.
     
  10. BigB08822

    BigB08822 Well-Known Member

    Joined:
    Mar 16, 2003
    Messages:
    20,788
    Well then there is no point in this thread as we all know it is unethical (by definition) but the OP asked our opinion and I gave mine. ;)
     
  11. Prancer

    Prancer Dysteleological Staff Member

    Joined:
    Apr 16, 2001
    Messages:
    38,831
    I don't know if that's actually true, though. For example, I know a doctor who writes scrips for his daughter. I had always thought that was unethical, but he insists that it isn't.
     
  12. vesperholly

    vesperholly Well-Known Member

    Joined:
    May 5, 2003
    Messages:
    7,657
    What a coincidence. I have been sicky lately and I was just thinking about how I could get my doctor to prescribe a z-pack ($15 copay that I can use my flex spending on) without first paying the $40 out-of-pocket cost for an office visit.

    I promise I didn't ask my dentist for it, though :)
     
  13. numbers123

    numbers123 Well-Known Member

    Joined:
    Dec 4, 2005
    Messages:
    30,765
    mikey - I happen to believe that it is unethical. If he had been seeing the friend as a client then it be appropriate.

    But if the friend called the dentist friend and said - hey I have a sinus problem, Z-pak has worked in the past and my regular doctor is out of town or unavailable, then that is not appropriate.

    Not only unethical, but dangerous. If you don't have all the information/assessment of the client and you do prescribe the wrong thing..And as a dentist, he should not be treating anything other than tooth abcesses, etc.
     
  14. Michalle

    Michalle New Member

    Joined:
    Mar 24, 2002
    Messages:
    923
    What is a Z-pack?
     
  15. vesperholly

    vesperholly Well-Known Member

    Joined:
    May 5, 2003
    Messages:
    7,657
    A commonly-prescribed 5-day regimen of Azithromycin, marketed in the US as Zithromax.
     
  16. bardtoob

    bardtoob Well-Known Member

    Joined:
    Feb 25, 2005
    Messages:
    8,140
    I know a doctor who wrote a prescription for birth control for someone he was not seeing as a patient.
     
  17. Japanfan

    Japanfan Well-Known Member

    Joined:
    Mar 1, 2002
    Messages:
    12,941
    It's a slippery slope issue. If the daughter is her father's patient, writing her scrips would not be unethical unless treating family members/friends was against the code of medical ethics - and I don't think it is?

    But prescribing even the most simple of medications without examining a patient is unethical, period. Ultimately, it involves the temptation to abuse power.

    We can't even get antibiotics from our vet without having our pets examined, even if we are sure that antibiotics are what is needed. For example, our cat had a lingering cold and we would have preferred to try out a course of antibiotics before we paid for any tests. But the vet was concerned that she might have a blockage of some sort in her nose and wanted to rule that out first. Perhaps we could have argued with him, but in the end we just paid the bill and had the test done.
     
  18. FigureSpins

    FigureSpins New Member

    Joined:
    Jun 18, 2004
    Messages:
    2,062
    Did the dentist's office in the original post actually do a dental exam/cleaning/treatment/check up on the patient? If so, then I can see it being justified because of the infection risk involved. There have been reported cases where a person's heart is attacked by infections contracted during dental work.

    My brother, who has major health issues as the result of a heart attack and transplant, has to take antibiotics before dental appointments. Even if it's just a cleaning/checkup, he takes a round of antibiotics to prevent the germs from getting into his bloodstream and causing further damage to his immune system or his organs.

    If it was just a wink-wink arrangement and the buddy never even went to the dentist's office, then it is unethical imo. The fact that the buddy would brag about it means that the dentist has put himself at risk of being caught because the buddy has a big mouth.

    I was just talking to a doctor friend about this and she said that fewer and fewer doctors are writing prescriptions for their family members because the prescriptions are being tracked more closely now and patterns are being recognized, such as "didn't have an appointment, but a prescription was phone in." It's to cut down on prescription fraud and drug abuse.
     
  19. Aceon6

    Aceon6 Get off my lawn

    Joined:
    Dec 22, 2005
    Messages:
    6,488
    I agree FigureSpins, dentists in my area frequently prescribe prophylactic or post-procedure antibiotics for anyone in a risk category, anyone with heart valve issues, or anyone who is immuno-compromised in any way. The presence of an URI may suggest to the dentist that the antibiotics are in order, not because of the URI, but because a patient already fighting off a viral infection may be more susceptible to a bacterial one.
     
  20. Prancer

    Prancer Dysteleological Staff Member

    Joined:
    Apr 16, 2001
    Messages:
    38,831
    I always had the idea that it was unethical for doctors to treat immediate family, but I don't know if that's true.
     
  21. milanessa

    milanessa engaged to dupa

    Joined:
    Jun 8, 2002
    Messages:
    18,917
    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.
     
  22. Aceon6

    Aceon6 Get off my lawn

    Joined:
    Dec 22, 2005
    Messages:
    6,488
    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.
     
  23. KikiSashaFan

    KikiSashaFan Well-Known Member

    Joined:
    Apr 26, 2003
    Messages:
    2,830
    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.
     
  24. rfisher

    rfisher Satisfied skating fan

    Joined:
    Oct 20, 2005
    Messages:
    41,444
    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.
     
  25. agalisgv

    agalisgv Well-Known Member

    Joined:
    Jan 29, 2005
    Messages:
    24,018
    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.
     
  26. bardtoob

    bardtoob Well-Known Member

    Joined:
    Feb 25, 2005
    Messages:
    8,140
    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.
     
  27. numbers123

    numbers123 Well-Known Member

    Joined:
    Dec 4, 2005
    Messages:
    30,765
    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.

    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.
     
  28. IceAlisa

    IceAlisa Épaulement!!!

    Joined:
    Mar 24, 2002
    Messages:
    30,980
    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.
     
  29. mkats

    mkats New Member

    Joined:
    Dec 22, 2004
    Messages:
    2,804
    And coumadin, which is something you REALLY do not want to mess with :eek:

    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. :scream:
     
  30. IceAlisa

    IceAlisa Épaulement!!!

    Joined:
    Mar 24, 2002
    Messages:
    30,980
    Is someone suggesting that coumadin be available OTC???? :scream: