What happens when you write Rx’s for relatives

Your mother-in-law is visiting, and a delay in her travel plans means she’s going to run out of blood pressure medication before her flight home. Do you dash off a quick renewal of her prescription?

Many physicians might do so without a second thought—but when it comes to prescribing medications to their own family members, physicians might want to think twice. The issue is more complicated than it first appears, warns Katherine J. Gold, MD, MSW, associate professor, Institute of Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI.

Dr. Gold, who has studied the issue, explained that such informal prescribing is quite common. In surveys, more than four out of every five physicians admit they’ve done it. The most common justifications were “I’m the best person to treat my child” and “This is my right as a physician.”

It even crops up as a plot point in the world of film and literature—often as a cautionary tale.

• In the television show “The West Wing,” the First Lady, a thoracic surgeon, gives her husband doses of Betaseron^® so that he can cover up his multiple sclerosis.
• In the 2004 movie “Garden State,” Zach Braff plays a young man whose controlling father, a psychiatrist, had him on lithium and antidepressants for years.
• In the 1942 noir film “Kings Row,” Claude Rains and Charles Coburn play small-town doctors who prescribe drugs for their daughters, while the 1988 movie “Dead Ringers“ depicts twin gynecologists who supply each other with addictive prescription drugs.

The American Medical Association’s Code of Ethics strongly discourages the practice of self-treatment or the treatment of immediate family members, yet acknowledges that there may be some situations in which the practice is acceptable.

That code states, “In general, physicians should not treat themselves or members of their own families.” After that, however, it quickly introduces some wiggle room: “However, it may be acceptable to do so in limited circumstances.” Those might include “emergency settings or isolated settings where there is no other qualified physician available,” or for “short-term, minor problems.”

To be clear, Dr. Gold explained, “treating” and “prescribing” are the same thing. “There’s no real difference,” she said. “Prescribing is a part of treatment.”

In fact, according to results of a 1994 survey that assessed how frequently Oregon-based physicians treated their family members in 17 categories of care, minor prescribing was the most common category reported among the nearly 1,300 respondents.

Often, however, physicians may not have considered the ways in which the transaction could be questionable, or even unethical.

• The doctor might feel pressured to write the script to save the patient money or inconvenience, even if it seems medically unnecessary or unwise.
• The overall relationship could sour if the medication proves to be ineffective.
• Adolescents in particular may feel uncomfortable being treated by a relative, and may not be forthcoming about things like recreational drug use.
• Relatives might feel bashful about disclosing their full medical history. Is a doctor’s elderly uncle going to tell her he takes Viagra, for example? Will a teenager tell her father that she’s using birth control pills?
• Parents might be incapable of being objective about the medical needs of their own children.
• Physicians could find themselves prescribing outside of their area of expertise, according to Dr. Gold, and might not be up-to-date on changing protocols. For example, should an anesthesiologist be prescribing antibiotics for a toddler’s ear infection, even though antibiotics are no longer recommended as first-line treatment? “Sometimes you don’t know what you don’t know,” she said.

That’s why Dr. Gold urges doctors to avoid getting into the habit of routinely prescribing for relatives—what may seem straightforward can veer into the problematic. In short, simply prescribing medication for your sister-in-law’s urinary tract infection could start you down a slippery slope with unforeseen consequences.

“Most doctors are seeing these things as very small, insignificant events,” she said. “But they need to think through the possibility that things might not go well.”