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First, though, here are a few of the many reasons that giving out friendly prescriptions is a bad and dangerous medical practice. For me, this includes sleeping aids and almost all controlled substances. Some states require an initial physical exam while others do not stipulate whether that relationship can be established via a telemedicine visit. The patient’s prescription cannot stay there. Here are three things to know before you get started. But don’t forget other “favors” people ask of doctors and nurses. . It is illegal in most states to prescribe controlled substances without a face-to … and risky. Most patients would much rather visit their own doctors — whether those visits occur in-person or online. However, each state requires (with limited exceptions) that they receive medical treatment from a provider who is licensed to practice in that state specifically. They go one step further, with the patient never even having a phone consult with the doctor. Sleep aids? 2. Keep fighting the good fight. Take, for example, the patient who wants a refill of a simple hypertension medication, let’s say lisinopril. As with the prescribing requirements, state legislatures and medical boards often have defined requirements that need to be met prior to a patient being seen at in a virtual care environment, let alone receive an e-prescription. Remote prescribing restrictions can be commonly found in telemedicine-specific statutes or regulations, pharmacy practice acts, medical practice acts, and in controlled substances acts themselves. So you are practicing bad medicine. Even though I know that I probably shouldn’t give out prescription medications in this manner, these are co-workers and friends. The American College of Correctional Physicians is the professional organization for correctional practitioners. They want you to treat their burn or tell them if they have a broken bone. Writing a prescription to treat a mental health disorder is easy, but it may not always be the safest or most effective route for patients, according to some recent studies and a growing chorus of voices concerned about the rapid rise in the prescription of psychotropic drugs. 301 et seq. A patient taking five medications produced by five generic manufacturers, theoretically faces 3,125 possible arrays of tablets for what are, chemically and clinically speaking, the same drugs. Notify me of follow-up comments by email. Most (I guess) turn to other, less stringent, friendly prescribers. You don’t have to charge your co-worker or friend a fee, so if your friend is asking this favor because of a lack of insurance or funds, by all means, don’t charge! . Prescribe only where necessary, and consider benefits versus risks. So here is the obligatory medico-legal horror story that I heard about through Risk Management Monthly. Kenalog shots or other steroids? In fact, that is why the outside doctor insists on seeing the guy once in a while—so she can make sure that the medication is actually doing what it is supposed to do—lowering the blood pressure—as well as checking for those insidious complications that people with hypertension sometimes develop. Semi-structured, in-depth interviews were conducted with clinic staff who had responsibility for managing requests for same-day appointments at 10 GP clinics (seven metropolitan and three regional) around Melbourne, Victoria. In other words, federal policy does not outright forbid medical providers from evaluating their patients using an online technology — but it doesn’t outright allow it, either. ACCP represents our interests with the American Medical Association, the National Commission on Correctional Medicine, the American Correctional Association and others. A. ACCP provides these services: Membership is not expensive. Also, amphetamine driven rapid weight loss is controversial and, at best, requires frequent monitoring. 4. It is illegal in most states to prescribe controlled substances without a face-to-face meeting and examination. That is why the policy then proceeds to specifically exclude a coverage situation (“prescribing for a patient of another physician for whom the prescriber has taken call”) from that restriction. It seems to me a disaster in the making, with deaths, malpractice suits, improper medication mixing etc. As a nurse practitioner, you must know legal obligations when prescribing medications. . But depending on the urgency of their medical situation — and the tool they use to seek telehealth services — they may not always receive the evaluation and prescription from their usual physician. He is the Medical Director of Badger Medical, which provides medical services to several jails and juvenile facilities in Idaho. (All states except AK, CT, ME, WA and DC have a specific law or regulation requiring a veterinarian to have VCPR to treat a patient) Giving them the prescription would be easy for me. Imagine that you are a healthcare provider in a jail medical clinic. Stop providing new prescriptions without a doctor's visit for the highly diverted drug classes: opioids, sedative-hypnotics, stimulants and antibiotics. I’ve been a pharmacist in correctional facilities for the past 18 years, and “friendly prescribing” for me is not so friendly. Not me. How do I say to him “No” without implying “Even though this would be easy for me, I’m going to make you pay the $100.00 to your doctor because, well, I just don’t like you that much?”. I have had large correctional officers screaming in my face because I won’t fill the prescription written by the institutional physician. You are putting your medical license at risk when you give medical advice to someone who is not your patient. Would a simple lisinopril prescription be appropriate in that case? What are you going to say when they ask for another refill 3 months from now? By law, a doctor or nurse must be consulted in order to receive a prescription for a medication. You would say, “I’m happy to, but you need to come see me. . The encapsulates a common encounter perfectly! 1. Note this quote: “A practitioner must examine a patient every time he/she prescribes controlled substances.” So giving out a friendly Ambien prescription is not only bad medicine, it is illegal! Some of them are pretty weak in their therapeutic knowledge and are putting themselves at risk. ACCP needs your expertise! C. Dispensing or prescribing a prescription product requires a VCPR. Summary 1. The prescription of these medications involves the weighing of potential benefit vs. potential harm, and one job of the medical prescriber is to explain this to the patient. This shift work kills me and I need them occasionally.” Or “Can I get some Augmentin? Let’s say you do an exam and document that they look ok and give them a 3-month refill. And there’s the liability issues, as we are mandated only to provide care to inmates, and not staff. I won’t charge you, but you do need to come by.” When you start to do this, you may be surprised how few actually show up. Except when dispensed directly by a practitioner, other than a pharmacist, to an ultimate user, no controlled substance in schedule II, which is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act [ 21 U.S.C. Prescribing medication, particularly psychiatric medication, without a diagnostic workup is a recipe for inadequate treatment and unwanted side effects. On November 1, 2011, the Centers for Disease Control and Prevention (CDC) issued a press release stating that overdoses from prescription … Would it make a difference to you if you actually took the patient’s blood pressure and found that it was 240/130? And since you did not do a history, a physical exam or discuss treatment, your chance of getting it wrong and having a bad outcome has gone way up, which leads us to our next point. For example, if a friend asked you to prescribe phentermine to help with weight loss, would you do it? That means it’s on each individual state to define what constitutes permissible telemedicine practice within its borders. So, what makes a prescription valid? If you don’t believe me, call your insurance company and check! The Board of Medicine in many states, including my home state of Idaho, have also formally condemned the practice of giving out any prescriptions, even those that are not controlled substances, without an examination. Pharmacists, practice nurses and other healthcare professionals … There was no history or exam. prescriber, who would never be in a position to see the patient, you are available to treat in person if required. The way it works is this: a friend calls you up and asks for a friendly prescription. But, the rules governing the manner in which the doctor conducts that evaluation — that is, in person or via telemedicine — differ at the state level. two weeks later, the husband commits suicide. Take the guy who wants a refill of his hypertension meds. . Dr. Barboza provides workshops on stress management and self-care for custody and healthcare staff. That the FDA recently required manufacturers to reduce the dosage recommendations because of this, it is illegal in most states (42 out of 50, to be exact) to prescribe controlled substances without physically examining the patient, New York’s policy on prescribing controlled substances, Correctional Medicine conferences twice a year. You did nothing that would identify them as patients of yours—so if something does go wrong, you are on your own. It probably would be worthwhile to discuss “friendly prescribing” practices at your facility! The practice of “friendly prescribing” without seeing the patient is bad medicine . Well stated, Denise! How about anti-depressants or other psych meds? It is -not- a pain medication, a controlled substance, or anything that could be abused. It is bad medico-legal practice. The physicians would write prescriptions for the nurses or correctional officers, and then they’d expect me to fill them, not only a violation of ethics but also of our policies and procedures. For example our dog had whipworms when he was adopted. Join Here! That wasn’t proper medical practice! drug samples), physicians must continue to meet all of the relevant requirements that apply to prescribing and dispensing drugs generally 21, including those related to patient assessment, documentation, and prescription monitoring. For the majority of drugs, a physician may refill a prescription over the phone without seeing the patient in person. Controlled substances? So the first step on the way to do these prescriptions right is to create a chart and treat the person like a patient. I personally won’t, because phentermine is a DEA schedule 2 amphetamine with a high abuse, addiction and side affect profile. Note the patient's age, medical histor… This list is never ending and the more willing you are to “help” the more you will be called on to do. Finally, since you are going to do an exam and generate a chart on these friendly prescription people, the facility where you practice may have an opinion as to how this is to happen. Weight loss meds? You did no physical exam. Recruitment was through the e-mail bulletin of the Victoria… This is the reason these medications are not over-the-counter. Are you going to take them on as a chronic long-term patient? Once a vet has an established relationship with the patient they may prescribe medications that have worked in the past. This requirement (Business and Professions Code section 2242) existed long before the Internet was created and is the cornerstone of why Internet prescribing is illegal when a legitimate physician-patient relationship does not exist. I said I couldn’t give out meds to staff, and probably her symptoms were viral and an antibiotic wouldn’t help anyway. I will discuss that later. The bottom line is that without an exam, you are not sure, really, of the diagnosis, or whether the prescription is the correct one. Jail employees are told to see their own doctors or the established workman’s comp clinic. They would never sue me!” Well, you might think this but you would be wrong. The moral of this story is: No Good Deed Goes Unpunished. The good news? But do generate a chart and in every other way treat them like a real patient. One of the jail nurses comes to you and says “Will you call me in a prescription for my hypertension meds? So you really need to get back in to see your regular doctor.”. A medical journal devoted to topics in Correctional Medicine: Interaction and fellowship with fellow Correctional Medicine practitioners. As for the ethics, yes, it probably is not ethical to write prescriptions for people whom you do not have a doctor-patient relationship, because writing a prescription implies you are assuming such a relationship. There are laws to consider when assessing any prescribing issues which include, but are not limited to: 1) a physician cannot prescribe without an appropriate prior exam and a medical indication for the prescription, and 2) an adequate and accurate medical record relating to the provision of services to the patient and documenting the medical need for the prescription … I am just not sure how it could be legal, when I must see my doctor every 6 months to receive prescriptions and pharmacies cannot sell across state lines. The bad news here is that this practice truly is bad—on several levels that we will review. ACCP needs you! Evaluate and Clearly Define the Patient's Problem. There is one exception in the federal law— physicians may use patient prescriptions in the office when they are registered with DEA to treat opioid addiction The problem I have now is nurses helping themselves to drugs without telling me, as they know I will refuse. Also, all prescription medications have side effects and potential negative effects. As you know, an online visit may not be enough for you to accurately diagnose a patient’s chief complaint, but many common conditions including urinary tract infections, flu, allergies, rashes, sore throats, and respiratory infections are good candidates for telehealth evaluation and prescription. Does he understand that he should never, ever drink and take Ambien because this is quite dangerous (though commonly done to get high)? Your co-worker and friend might say thank you at the time for the freebie, but when they have the stroke because you missed the 240/130 blood pressure or they have the allergic reaction to Augmentin and their skin falls off, they will suddenly remember that, Hey! The widow now sues the ER doc for malpractice, alleging that the ER doc failed in his responsibility to inform her that one well recognized complication of Zoloft is that it may increase suicide risk early on, especially in adolescents and young adults, like her husband. Why not? The practice of “friendly prescribing” without seeing the patient is bad medicine . This was not one of his patients. Give us a call!844-693-8474, How to Get a Prescription Without going to a Doctor. When your patients are sick, the last thing they want to do is go anywhere. One small study of practices in Scotland showed that a clinical pharmacist based in a GP practice can free up to five hours of GP time a week, just by taking on prescribing work.. The “Friendly” part is that you will not charge them for this. That way, they skip the drive, the wait, and possibly exposing other patients to infection. It has happened in urgent care clinics. There are a couple of other things you should consider in the matter of friendly prescriptions. And refusing it would seem to be an insult. I have no more refills and my doctor charges $100.00 for a visit just to get more!” Or perhaps it is a detention deputy who asks, “Can I get a few Ambien from you? Many doctors do this automatically but this article will provide you with some pointers and reminders to bear in mind when prescribing. Are you going to explain this to him during the “friendly prescription” request encounter? For example, does the patient who asked for Ambien know that Ambien is a controlled substance (DEA schedule IV, the same as benzodiazepines)? When providing drugs to patients without a formal prescription 20 (e.g. This has happened in every ER I ever worked. This is not just a phenomenon in corrections. For example, the administration at one of my jails, after considering the medico-legal risk, the hassle of how and where to store charts and the strain of deciding what could be prescribed and what could not, decided in the end that they did not want the jail employees seeking friendly prescriptions at the jail medical clinic—at all. . Take the co-worker who asks for a refill of hypertension meds. And are you really going to take the time to explain all of this to him while you are standing in a public hallway? 2. Opioids are a class of drugs that are derived from the opium poppy (or, in the case of pharmaceuticals, made synthetically) and bind to nerve cells, inhibiting pain signals. Have any questions? And you probably will not fulfill your responsibilities as a prescriber to explain diagnosis, treatment and potential complications of therapy. They may be able to obtain a prescription without leaving the comfort of their home — and it will take less time and be less stressful. Now I have ammunition to handle more appropriately! That is just good medicine. But if they need a prescription medication they have no choice but to drag themselves into your office, right? 4 A to the practitioner /1/2017 Prescribing after 30 days A practitioner who prescribes a CS to treat pain for more than 30 days must, not later than 30 days after issuing the initial prescription, enter into a Prescription Medication Agreement with the patient. The ER doc was on his own. “[A] physician shall not prescribe, dispense, or otherwise provide, or cause to be provided, any controlled substance to a person who the physician has never personally physically examined and diagnosed.” Providing treatment, rendering a diagnosis, or prescribing medications based solely on a patient-supplied history that a physician licensed in this state received by telephone, facsimile, or electronic format. Malpractice insurance will not cover you for “friendly prescribing.” 3. You did no history. You might think, “I’m OK! A patient may bring you their prescription so that you may administer it immediately, but the pharmacy cannot send . Psych meds? Many people look for a prescription to fix their illness, despite the same treatment often being available over the counter more cheaply. 3. I don’t know about you, but when this happens, I feel like I am on the spot. It is a good idea to decide before hand what “Friendly Prescriptions” you will not give under any circumstances. You generated no medical chart. Save my name, email, and website in this browser for the next time I comment. Here is the single most important thing that you need to know about the medico-legal risk of friendly prescriptions: Your malpractice insurance policy does not cover them! If you have not done a formal history and physical exam, you are prescribing blind—you do not know for sure whether the patient really has the condition they are telling you about. How do you handle “Friendly Prescribing” at your facility? In the vast majority of cases, for a prescription to be considered valid, the practitioner issuing it must perform at least one medical evaluation of the patient. Or whether instead they have wheezing and would benefit more from albuterol instead? That the FDA recently required manufacturers to reduce the dosage recommendations because of this? Malpractice insurance will not cover you for “friendly prescribing.” Your email address will not be published. Needless to say, the ER doc’s malpractice company refused to cover this event. Specify the Therapeutic Objective. “If this topic is not discussed, patients discovering that their medication contains animal products may stop taking it, with potentially life-threatening consequences,” practitioners said in “Ethical and Practical Considerations in Prescribing Animal-Derived Medication” published in BMJ. Arizona ARS 32.1401(27)(ss) and (ww), ARS 32-1854(48) Yes 27. How to Get an Online Prescription with Telemedicine - GoodRx For example, states that allow prescriptive authority in some form include Florida, Utah and Pennsylvania. Enter your email address to subscribe to this blog and receive notifications of new posts by email. Or consider the patient who asked for a specific antibiotic (Augmentin) for “bronchitis.” How do you know without an examination whether this friend really has a viral chest cold and the antibiotic could not possibly help? The veterinarian-client-patient relationship (VCPR) is the basis for interaction among veterinarians, their clients, and their patients. Are you willing to commit to all of that? ], may be dispensed without the written prescription of a practitioner, except that in emergency … 5. They often want free medical advice or a diagnosis for themselves or family members. The first is exactly which prescriptions you are willing to prescribe in a friendly fashion and which you are not. Most patients would much rather visit their own doctors — whether those visits occur in-person or online.
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