Problematic Self-Prescribing Beyond Scope of Practice

June 16, 2015

Physicians have been prescribing medications for themselves and family members forever.

Physicians have been prescribing medications for themselves and family members forever. This doesn’t get a second look from any medical board.

But then there are prescribers such as dentists and podiatrists who play medical doctor and write prescriptions beyond their scope of practice. I do not tolerate this situation whatsoever.

When prescribers act as their own primary care providers, it takes a fair amount of diagnosis impartiality out of the equation. If a doctor feels a lump in his neck, does he get it examined by a specialist or just say, “It’s nothing,” and move on, subjecting himself to something more dangerous? I also doubt that a male physician over the age of 45 is giving himself a “complete” physical.

When I was doing my professional rotations, the hospital outpatient pharmacy didn’t charge medical residents for prescriptions. This led to the unconscionable practice of male prescribers writing oral contraceptives for themselves and giving them to their wives and girlfriends. I viewed this as completely unethical, but since I was an intern and had no say in the matter, I begrudgingly went along with it.

One thing I never allow is a physician prescribing controlled substances either for family members or their own personal use. This is where ethics override the law, in my opinion. In either case, it is an accident waiting to happen.

Scope of practice is something I hold near and dear to my heart. While it is difficult to prove when a dentist is prescribing antibiotics for family members, it is given a lot of benefit of the doubt. When dentists self-prescribe pain medications, however, I put a quick halt to it, because I doubt they are performing their own root canals.

Thinking about my pharmacy career, 2 related incidents readily come to mind. One involved a retired dentist who was self-prescribing procainamide, a once oft-used and dangerous antiarrhythmic. When he said “other pharmacies” would fill the script, I told him to go to them instead.

The second involved a podiatrist who tried to prescribe a sleep medication to a pediatrician friend of his. When I found out, I immediately called and asked if he was trying to make someone’s foot fall asleep. I told him that if he wanted to keep doing this, I would gladly report him and then hang his license next to all of my running medals.

As long as I’ve been a pharmacist, prescribers have done a lousy job of policing themselves. I fear this will only get worse.

Jay Sochoka, RPh, fears for medicine in general.