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Scenario 2:
A friend calls and asks you to prescribe a medication for her. You have this
autonomy, but you do not have your friend’s medical history. You write the prescription
anyway.
Ethical and legal implications for prescriber and patient
Published guidelines recommend against care for one's self or family and friends
other than in exceptional situations, there are no professional organizations that condones
this practice. The very first code of medical ethics drafted by the American Medical
Association (AMA) in 1847 recommends against physicians treating family members or
friends stating that anxiety and concern of the sickness of a friend or family member tend
to obscure judgment, and produce apprehension and indecision in practice (Gold,
Goldman, Kamil, Walton, Burdette, & Moseley, 2014).
The ethical issues that are involved in treating friends and family are numerous
and become increasingly problematic as the closeness of the relationship increases.
Physicians who are also a family member of the patient face numerous conflicts of
interest between their dual roles (Gold, Goldman, Kamil, Walton, Burdette, & Moseley,
2014).
The issues of beneficence (to provide care in the patient's benefit or best interest)
and nonmaleficence (to do no harm) are important in the care of friends and family.
There may be inappropriate use of evaluations, referrals, medications, and testing (with
either overuse or underuse), and practitioners may feel pressure to provide services
outside their scope of practice (Gold, Goldman, Kamil, Walton, Burdette, & Moseley,
2014).
On a practical basis, there are also risks of malpractice or other legal actions,
since writing a prescription, reviewing patient records, or giving an opinion to a patient
can establish a physician-patient relationship. This can open the door to the need for
ongoing care and even legal action in the case of adverse outcomes (Gold, Goldman,
Kamil, Walton, Burdette, & Moseley, 2014).
Legally document all encounters in the same way as for patients who are not
colleagues, VIPs, friends, or family members; even informal consultations can result in
malpractice claims. Be aware that some state medical boards prohibit caring for friends
and family members (Farrell, Ozbolt, Silvia, & George, 2013).
You should respect the patient’s autonomy and confidentiality, avoid deferring
potentially uncomfortable aspects of the history and physical examination, and maintain
appropriate documentation. In other words, you should take the same approach to friends
and relatives who seek clinical advice as you would with any other patient, making sure
to provide them with the same professional expertise and judgment (Farrell, Ozbolt,
Silvia, & George, 2013).
Strategies as an advanced practice nurse, in decision-making.
If a practitioner decides to treat a friend or family member, then it is imperative
that the practitioner should document what took place, even if the treatment was minor
and stay away from prescribing controlled substances. Some insurance providers,
including Medicare and Blue Cross Blue Shield, deny payment for the care that
physicians provide for immediate family members, even in an office setting (Kepper, &
Baum, 2014).
Refer to the state medical board policies regarding the care of friends and family
members. Some states have specific policies that limit or forbid this practice (Farrell,
Ozbolt, Silvia, & George, 2013).
References
Farrell, T. W., Ozbolt, J. A., Silvia, J., & George, P. (2013). Caring for colleagues, VIPs,
friends, and family members.American family physician,87(11), 793-795.
Gold, K. J., Goldman, E. B., Kamil, L. H., Walton, S., Burdette, T. G., & Moseley, K. L.
(2014). No appointment necessary? Ethical challenges in treating friends and
family.New England Journal Of Medicine,371(13), 1254-1258.
doi:10.1056/NEJMsb1402963
Kepper, P., & Baum, N. (2014). Caveats for doctors providing care for themselves,
family, friends, and colleagues.Journal Of Medical Practice Management,29(5),
317-319.
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