Treating family for minor illness

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RuralEDDoc

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On another thread, someone mentioned that they won’t (or shouldn’t) treat their own kid for any illness that requires more than ibuprofen. That definitely took me by surprise. A huge benefit of being an emergency physician from my standpoint is the ability to confidently treat family members for minor illnesses. I’d be happy to treat my daughters ear infection, for example, if that got her faster treatment and saved a trip to the pediatrician (just an example - not starting a debate here on antibiotics for AOM).
What’s your take on this? Do you treat family members? Is this somehow unethical? Opinions please!

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Far more ethical than they way most health systems behave and force us to practice when working inside them.
 
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On another thread, someone mentioned that they won’t (or shouldn’t) treat their own kid for any illness that requires more than ibuprofen. That definitely took me by surprise. A huge benefit of being an emergency physician from my standpoint is the ability to confidently treat family members for minor illnesses. I’d be happy to treat my daughters ear infection, for example, if that got her faster treatment and saved a trip to the pediatrician (just an example - not starting a debate here on antibiotics for AOM).
What’s your take on this? Do you treat family members? Is this somehow unethical? Opinions please!
Not per se unethical, but your biases, conscious and unconscious, will affect your decision making. Whereas, in your shop, these are chip shots, at home, you will either over or undertreat. You are too close to the situation to be effective. It's a bad idea, in general.
 
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On another thread, someone mentioned that they won’t (or shouldn’t) treat their own kid for any illness that requires more than ibuprofen. That definitely took me by surprise. A huge benefit of being an emergency physician from my standpoint is the ability to confidently treat family members for minor illnesses. I’d be happy to treat my daughters ear infection, for example, if that got her faster treatment and saved a trip to the pediatrician (just an example - not starting a debate here on antibiotics for AOM).
What’s your take on this? Do you treat family members? Is this somehow unethical? Opinions please!
That someone was me. I am completely unobjective when it comes to my kids. That's why if I'm at all concerned I take them to another doctor.

I don't personally find it to be unethical, barring controlled substances obviously, just that it's not always a good idea for various reasons.
 
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On another thread, someone mentioned that they won’t (or shouldn’t) treat their own kid for any illness that requires more than ibuprofen. That definitely took me by surprise. A huge benefit of being an emergency physician from my standpoint is the ability to confidently treat family members for minor illnesses. I’d be happy to treat my daughters ear infection, for example, if that got her faster treatment and saved a trip to the pediatrician (just an example - not starting a debate here on antibiotics for AOM).
What’s your take on this? Do you treat family members? Is this somehow unethical? Opinions please!

I do...I've written for prednisone, albuterol, antibiotics.

In reality...most of the time my spouse is more worried about something than I am. I often refuse to treat, or suggest waiting a few weeks to treat.
 
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On another thread, someone mentioned that they won’t (or shouldn’t) treat their own kid for any illness that requires more than ibuprofen. That definitely took me by surprise. A huge benefit of being an emergency physician from my standpoint is the ability to confidently treat family members for minor illnesses. I’d be happy to treat my daughters ear infection, for example, if that got her faster treatment and saved a trip to the pediatrician (just an example - not starting a debate here on antibiotics for AOM).
What’s your take on this? Do you treat family members? Is this somehow unethical? Opinions please!
Most state medical boards will have some language discouraging treating of family members. It tends not to be an issue when it's an after hours minor illness (like your otitis media, example) and which is commonly done. But when it goes bad, it can go real bad.

Example: A very competent and otherwise well respected Pediatrician I know was treating his adult wife (see any problem?) for chronic pain with opiates (see any problem?) and showing up in the ER to try to coerce the ER physicians into giving her IV opiates for things that normally wouldn't need opiates (see a problem?). Better yet, she was a nurse with a history of opiate abuse and was fired from that same ER for stealing narcotics and he didn't find any indication to point out that this is a problem to her (see a problem?) And he wasn't keeping any records, why, because, "Duh, it's my wife after all!"

He never would have done any of that, if it wasn't a family member. In every other instance he was a very good doc. But when he was providing disastrously bad care for his closest family member, and he seemed to have no idea how bad the care was. He was "helping her" and providing "the compassion all other providers lacked," and after all, "no one knew her better than him."

He ultimately had action taken against him by the state medical board and one of the grounds was, "Treatment of a family member."

So, it's not a big deal, until it is.
 
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I do...I've written for prednisone, albuterol, antibiotics.

In reality...most of the time my spouse is more worried about something than I am. I often refuse to treat, or suggest waiting a few weeks to treat.

Same same.
Except I don't wait long.
I know the pathophysiology better than the Jenny McJennyson that the family member would be relegated to seeing in the acute care setting.

Option #1: Spend too much money and roll the dice on Jenny doing the medicine close to correctly, or:
Option #2: Do it right the first time, for no money.
 
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Most state medical boards will have some language discouraging treating of family members. It tends not to be an issue when it's an after hours minor illness (like your otitis media, example) and which is commonly done. But when it goes bad, it can go real bad.

Example: A very competent and otherwise well respected Pediatrician I know was treating his adult wife (see any problem?) for chronic pain with opiates (see any problem?) and showing up in the ER to try to coerce the ER physicians into giving her IV opiates for things that normally wouldn't need opiates (see a problem?). Better yet, she was a nurse with a history of opiate abuse and was fired from that same ER for stealing narcotics and he didn't find any indication to point out that this is a problem to her (see a problem?) And he wasn't keeping any records, why, because, "Duh, it's my wife after all!"

He never would have done any of that, if it wasn't a family member. In every other instance he was a very good doc. But when he was providing disastrously bad care for his closest family member, and he seemed to have no idea how bad the care was. He was "helping her" and providing "the compassion all other providers lacked," and after all, "no one knew her better than him."

He ultimately had action taken against him by the state medical board and one of the grounds was, "Treatment of a family member."

So, it's not a big deal, until it is.
That whole scenario seems generally unadvisable. Yikes.
 
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Most state medical boards will have some language discouraging treating of family members. It tends not to be an issue when it's an after hours minor illness (like your otitis media, example) and which is commonly done. But when it goes bad, it can go real bad.

Example: A very competent and otherwise well respected Pediatrician I know was treating his adult wife (see any problem?) for chronic pain with opiates (see any problem?) and showing up in the ER to try to coerce the ER physicians into giving her IV opiates for things that normally wouldn't need opiates (see a problem?). Better yet, she was a nurse with a history of opiate abuse and was fired from that same ER for stealing narcotics and he didn't find any indication to point out that this is a problem to her (see a problem?) And he wasn't keeping any records, why, because, "Duh, it's my wife after all!"

He never would have done any of that, if it wasn't a family member. In every other instance he was a very good doc. But when he was providing disastrously bad care for his closest family member, and he seemed to have no idea how bad the care was. He was "helping her" and providing "the compassion all other providers lacked," and after all, "no one knew her better than him."

He ultimately had action taken against him by the state medical board and one of the grounds was, "Treatment of a family member."

So, it's not a big deal, until it is.
Come on man. That is completely different than what the OP is referring to. It's akin to a response of, "Of course I don't treat my son's neuroblastoma, that's not my field and I don't trust myself to be impartial or to know the most updated chemo protocols".
 
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1. Controlled substances never under any circumstances.

2. Back when Allegra was a prescription medicine, I prescribed it for my family. Similar basic prescription medicines should not be an issue.

3. If it requires anything in addition to your unaided senses to make a diagnosis, make an appointment with a physician. An otoscope may be the exception. Ordering lab tests or imaging opens a whole can of worms.

4. The independent small town pharmacy chain will not bat an eye at #2. Walgreens or CVS might.

5. Like a lot of things, what was common in the 70's and 80's will get you in trouble today.
 
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Treating minor, self-limited illnesses or occasionally refilling a chronic medication for family and friends is fine as long as you are independently licensed, keeping a record somewhere, and not prescribing scheduled medications. I keep a notebook at home that I write a quick SOAP note into for these situations. There are probably some free/cheap EMR's you could use if you prefer. Your malpractice insurance likely isn't covering you so keep that in mind before you tie yourself to malpractice risk with a friend or distant family member. Hopefully your wife or kid aren't waiting to throw you under the bus with a lawsuit.

People get in trouble for blatantly terrible decisions like the case above but failing to keep records and residents who prescribe outside of supervision while practicing with a training license are pitfalls to be aware of.
 
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People get in trouble for blatantly terrible decisions like the case above but failing to keep records and residents who prescribe outside of supervision while practicing with a training license are pitfalls to be aware of.
This but it’s just not worth any risk as far as prescribing goes. A complaint to the state board just isn’t worth it. I think there are exceptions if you are truly rural like the only doc in your county but that’s basically none of us these days. I suppose I wouldn’t mind stitching up a neighbor or something but nothing that requires a script.
 
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Come on man. That is completely different than what the OP is referring to. It's akin to a response of, "Of course I don't treat my son's neuroblastoma, that's not my field and I don't trust myself to be impartial or to know the most updated chemo protocols".
I differentiated between minor conditions and major ones. It’s spelled out right in the first paragraph of my post.
 
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It's not unethical, but it is unwise when there's any diagnostic uncertainty.

Want to superglue a clean, straight laceration at home? Have at it.
Assessing your kiddo for appendicitis? Bad idea. Not because it's unethical, but because if you're wrong about your own kid it's a miss that you may never forgive yourself for.
 
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1) I'd treat a family member for UTI, strep, simple lac.
2) Won't treat for anything that requires bloodwork, certainly not imaging.
3)No controlled meds under any circumstances. This is where people get into trouble with the medical boards.
4)I don't treat friends. Ever. Not even best friends. I refer them to pcp.



What is actually common from my experience is curbside consult from my ER nursing staff for scripts. "Hey doc, can you write me a script for antibiotics for my uti, strep, rash etc ".

I 100% tell them no. Now they go to my NP who gladly writes scripts for them.
 
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If your family member really NEEDS antibiotics for their viral infection, refer them to the NP at the urgent care down the street.

There is literally no emergent need for me to ever write any family a prescription. Ever. In fact, it pisses me off when people assume that because I'm their friend or family that I can just take on the liability, issues with the medical board, etc.

Being a physician and dealing with a loved one with a medical complaint is not even in the same arena as being a plumber and dealing with a family member with plumbing issues in their house. Although now that I think about it, both of them can probably get you in deep s***.

Uncomplicated lac repairs/glue are allowed.

Side note: I had a close friend who REALLY did not want to go to the hospital. Burning epigastric pain, worse after meals, worse when laying flat. Fairly young, healthy, no medical issues. I refused to tell him what he wanted to hear which is "it's probably just GERD, take an antacid and don't worry about it". Went to ED very begrudgingly and somewhat pissed at me for not giving him my blessing, he ended up in the cath lab an hour later.
 
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Side note: I had a close friend who REALLY did not want to go to the hospital. Burning epigastric pain, worse after meals, worse when laying flat. Fairly young, healthy, no medical issues. I refused to tell him what he wanted to hear which is "it's probably just GERD, take an antacid and don't worry about it". Went to ED very begrudgingly and somewhat pissed at me for not giving him my blessing, he ended up in the cath lab an hour later.
About 5 years ago, my sister. No hx heart, very well controlled IDDM x 30 years, states she's having epigastric pain that doesn't feel like her reflux, and there was no change with Tums. Calls me and asks me what I think. I say, "I think you need the ED right now!" Believe it or not, we go back and forth for about 5 minutes on this. Finally, she says "OK".

However, my coda is different. She got worked up every way to Sunday (except for cath lab), and was clean (from ED to obs status - that's how much they did for dx). They ended up calling her reflux.
 
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I’d have no problem with treating a family member, but can’t really see many situations where I’d do so. I’m a minimalist when it comes to medical care that I’m willing to receive, and I also perceive my family to have similar ‘goals of care.’ Myself and family prefer to just wait out or ‘walk-off’ most mild illnesses or injuries. I bring that bias to the table.

I think the ethical consideration of treating a mild illness in a family member is a little antiquated. The real ethical debate relates to providing actual emergent care in the ED for a family member given EM is our cup of tea. I’d personally want to be heavily involved in their care, but wouldn’t want to be the primary EP taking care of them. I also wouldn’t want to be the one doing any invasive procedures, and I’d bet my family wouldn’t want me to either (assuming they’d be agreeable with a procedure in the first place). I think that would probably only be appropriate in a rural environment where you are the only option.

Also agree with broad sentiment by everyone regarding controlled substances. I rarely prescribe controlled substances anyways. If they ‘need’ opioid pain medication for ‘severe’ pain, then they need an evaluation in the ED.
 
AMA Code of Ethics

"Treating Self or Family Code of Medical Ethics Opinion 1.2.1

Treating oneself or a member of one’s own family poses several challenges for physicians, including concerns about professional objectivity, patient autonomy, and informed consent.

When the patient is an immediate family member, the physician’s personal feelings may unduly influence his or her professional medical judgment. Or the physician may fail to probe sensitive areas when taking the medical history or to perform intimate parts of the physical examination. Physicians may feel obligated to provide care for family members despite feeling uncomfortable doing so. They may also be inclined to treat problems that are beyond their expertise or training.

Similarly, patients may feel uncomfortable receiving care from a family member. A patient may be reluctant to disclose sensitive information or undergo an intimate examination when the physician is an immediate family member. This discomfort may particularly be the case when the patient is a minor child, who may not feel free to refuse care from a parent.

In general, physicians should not treat themselves or members of their own families. However, it may be acceptable to do so in limited circumstances:

(a) In emergency settings or isolated settings where there is no other qualified physician available. In such situations, physicians should not hesitate to treat themselves or family members until another physician becomes available.

(b) For short-term, minor problems. When treating self or family members, physicians have a further responsibility to:

(c) Document treatment or care provided and convey relevant information to the patient’s primary care physician.

(d) Recognize that if tensions develop in the professional relationship with a family member, perhaps as a result of a negative medical outcome, such difficulties may be carried over into the family member’s personal relationship with the physician.

(e) Avoid providing sensitive or intimate care especially for a minor patient who is uncomfortable being treated by a family member.

(f) Recognize that family members may be reluctant to state their preference for another physician or decline a recommendation for fear of offending the physician."
 
I don't mind writing non controlled stuff for family members within reason barring it's not a chronic prescription (i.e. course of abx, steroids, etc..) I try not to write it for friends, not necessarily for ethical reasons but because I don't want to be perceived as their doctor and I don't want to start getting requests for Rx on a regular basis. I recently called in a Rx for steroids for a colleague but I don't really mind that kind of stuff and most of my colleagues are not abusing the request.

Early in my career, I used to call in abx for myself with regularity and had a pharmacist refuse to fill it after I'd done it several times. It really pissed me off at the time but after researching the ethics, I totally get it. I typically don't call in stuff for myself anymore but I seem to remember you are able to treat yourself and family if it's an emergency? I could be wrong about that but I seem to recall reading something like that on the pharmacy board website for my state.
 
I don't mind writing non controlled stuff for family members within reason barring it's not a chronic prescription (i.e. course of abx, steroids, etc..) I try not to write it for friends, not necessarily for ethical reasons but because I don't want to be perceived as their doctor and I don't want to start getting requests for Rx on a regular basis. I recently called in a Rx for steroids for a colleague but I don't really mind that kind of stuff and most of my colleagues are not abusing the request.

Early in my career, I used to call in abx for myself with regularity and had a pharmacist refuse to fill it after I'd done it several times. It really pissed me off at the time but after researching the ethics, I totally get it. I typically don't call in stuff for myself anymore but I seem to remember you are able to treat yourself and family if it's an emergency? I could be wrong about that but I seem to recall reading something like that on the pharmacy board website for my state.
Yep, it varies state to state. Also matters if you have an institutional or personal DEA. What is pretty consistent across the US is that:

1 - You can prescribe yourself controlled substances
2 - If you have an institutional DEA, you can't write any Rx for visits not affiliated with that institution (e.g.: Your daughter who wasn't seen in your hospital)
 
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I caught some respiratory bug earlier this year, which wasn't covid (got the PCR) and in retrospect was probably RSV as it was going around, but since I work with very fragile patients, I ended up actually calling the medical director and *gasp* calling out sick. He was supposed to call me in an inhaler and forgot.

I generally only wheeze if it's bad, or I've done something stupid like ascend to 14K on foot in a day. (ahem, Barr Trail.) Well, I got to the drive thru at Walgreens and it wasn't there. Between coughs and wheezes I asked if I could just "call it in for myself," flashed my work badge, the pharmacist passed me a notepad and I scrawled my script to me with my DEA so they could look me up and it was ready 20 minutes later. They can find prescribers with NPI as well, but I don't bother to remember that number.

But it was just albuterol. And it was a Friday and I laid around and got better. And this culture of toughing it out when you're sick is just stupid and I'm glad it's going away. (The only other time I've ever "called out" I was in the OR getting my appendix out.)
 
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I have ulcerative colitis.
I have written for my own Lialda (5-ASA) for years.
Beats the pharmacy having to call people for prior auth, then have to wait for a callback, then have to wait for... whatever.

Our healthcare system wastes more money trying to "verify the medical necessity" of things than they would save if they just went ahead and got them done.
 
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Our healthcare system wastes more money trying to "verify the medical necessity" of things than they would save if they just went ahead and got them done.

Oh man, don’t get me started on that garbage.

The one that really ticks me off is the lidoderm patches that I try to prescribe for back pain, that im now about to give up on because ‘prior authorization’, which gets denied by insurance companies all the time.

So, you’d rather I give the patient narcotics? No insurance company requires prior authorization for those…
 
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Oh man, don’t get me started on that garbage.

The one that really ticks me off is the lidoderm patches that I try to prescribe for back pain, that im now about to give up on because ‘prior authorization’, which gets denied by insurance companies all the time.

So, you’d rather I give the patient narcotics? No insurance company requires prior authorization for those…
How do you even know whether something requires prior auth or not? I'm not sure how I would ever even hear about that, just assume the patient doesn't fill it.

Actually, come to think of it--one place I worked at the unit clerk would try to transfer a pharmacist calling about that, it was always a weird conversation:
Me: "Yeah, this is an ER. We don't do that"
Pharm: "But, but..."
Me: "Yeah, we don't even have fax machine"
Pharm: "But how are they going to get their prescription?"
Me: "Yeah, I don't know. Maybe they should call their PCP"
Pharm: "They tried! But they couldn't get through to them and they said it's an Emergency"
Me: "..."
Pharm: "So can you submit the prior auth?"
Me: click
 
What does "prior" mean in prior authorization mean anyway
Like you were authorized to take a medicine in the past?
 
"Prior to this medication being dispensed, it is authorized as medically necessary."
 
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Oh man, don’t get me started on that garbage.

The one that really ticks me off is the lidoderm patches that I try to prescribe for back pain, that im now about to give up on because ‘prior authorization’, which gets denied by insurance companies all the time.

So, you’d rather I give the patient narcotics? No insurance company requires prior authorization for those…
Just Rx the 4% strength. Works just as well as the 5% and rarely has the same PA problems.

That, of course, does not address the bigger issue.
 
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Oh man, don’t get me started on that garbage.

The one that really ticks me off is the lidoderm patches that I try to prescribe for back pain, that im now about to give up on because ‘prior authorization’, which gets denied by insurance companies all the time.

So, you’d rather I give the patient narcotics? No insurance company requires prior authorization for those…
I literally have a lidoderm macro. I don't have my macro program running at the moment but it basically says:
"You have been prescribed 5% lidocaine patches. Sometimes insurance does not cover these and they can be VERY EXPENSIVE. If your insurance does not cover them, you can generally buy 4% lidocaine patches over the counter which are much cheaper. Ask your pharmacist."

I add that to my DC instructions for anyone I'm Rxing lidoderm for.
 
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