Can NPS write prescriptions for themselves and Family?

PMFB-RN, RN · Oct 15, 2007

Assuming that all criteria for a true provider/patient relationship where met and that a provider would only treat a family member when an alternative provider was not available, the laws absolutely need to allow NPs, PAs, MDs, & DOs to treat their own family members. To prevent them doing so is simply discrimination against those who live in rural areas.

For example how could a provider be induced to take a position in a rural area to serve an undeserved population if it means that their own children would be denied access to health care? Everybody in the area benefits from the providers services but the providers own family members mush travel very long distances for treatment?

Our little town has a single provider clinic. It is the only one for a long way around. We used to have a great old time country doctor who kept regular office hours plus would come in for emergent situations when called. When he retired this town had no health provider for over a year until a FNP took over the same clinic. Not having a health care provider significantly reduced the quality of life for area residents. I doubt that the NP could have been attracted at all if it meant her family would be the only ones in the area who would be forced by law to travel long distances.

ohiobirds99 · Nov 24, 2009

Not legal, not ethical. Its is spelled out very plainly in NPA. Must be established patient with established history etc. I know of some folks that are rougue prescribers, just a matter of time before BON catches up with them.

SandBetweenMyToes, BSN, RN · Nov 25, 2009

In the clinic I am in now (doing clinicals), the NPs and docs write for each other. There is definitely a patient encounter created for each time meds are renewed or tests are ordered (i.e. it shows up on the EMR). But, at least that keeps everything at arm's length. Once you are in practice, I am sure you will have a similar situation, so not to worry. And, I cannot imagine, any of the prescribers in our clinic saying to another practitioner, "No, I disagree. You don't need those tests or that strength of drug"...it seems to be a professional courtesy.

carachel2 · Nov 25, 2009

The very nature of the disease of hypothyroidism is such that often you lack insight into your own symptoms: slowed verbal response, slowed thinking, fatigue, etc. I wouldn't want to treat my own levels! You could easily arrange to have your labs drawn at your own clinic and just fax the results to your treating physician.

Smitty08 · Nov 25, 2009

I heard from someone reputable in my state that the BON, consistent with our NPA does condone prescribing for oneself and family with the priviso (as pointed out by "Jalexhoe" nicely above) that you need to have a provider/patient relationship. Apparently, that can even extend to a Provider/Patient relationship with one's self. Makes sense to me, although I can't see why I would ever do this or when this would makes sense...

PMFB-RN, RN · Nov 27, 2009

I heard from someone reputable in my state that the BON, consistent with our NPA does condone prescribing for oneself and family with the priviso (as pointed out by "Jalexhoe" nicely above) that you need to have a provider/patient relationship. Apparently, that can even extend to a Provider/Patient relationship with one's self. Makes sense to me, although I can't see why I would ever do this or when this would makes sense...

*** Of course providers must be allowed to treat themselves and their family members. Not allowing them to do so is discrimination against those who live in rural areas. I am sure those who live in areas with a variety of health care providers to choose from really can't see why it would make sense. However for those who live in rural areas where there may very well be a single health care provider, as in the little town I live near, denying health care to one family (the family of the provider) is urban vs rural discrimination.

Trauma Columnist · Nov 28, 2009

I too live in a rural area with one provider and no - they don't treat their family members. This is against the BON rules/regs and will land this and any other provider who does this in deep, dark, hot water - not worth losing your license over.

ruralnurs · Dec 1, 2009

I realize this post was old but then renewed so don't know if the OP is still reading it. In Montana one can write/order for themselves as long as a medical record is maintained.

I don't see the problem as "if one can order tests and write for themselves (or family)" but "if you should get health care willy nilly". Most of us in health care are always advising others to have a primary care provider. That it is not good practice to get health care here and there and hit or miss. I see a patient that is a veterinarian. Nice guy and great with animals, but every time he comes to see me he has self prescribed and so far most of the time he was wrong.

And we all get those people that have meds left over from an old script or the meds someone gets from Mexico and things muddy the water. If we as health care providers believe that having a main PCP is the best, then we need to practice what we preach as much possible.

Can you, probably. Should you, probably not.

kanzi monkey · Dec 2, 2009

, "No, I disagree. You don't need those tests or that strength of drug"...it seems to be a professional courtesy.

This seems to be a very good argument for curbing this practice. There's nothing objective in this type of encounter. Asking a friend, colleague, or family member for medical treatment is walking a very fine line. Treating someone because you believe you are being "professionally courteous"--and not because you have addressed the actual symptoms or pt history--seems like throwing your prescription pad around as if it had no more value than a square of post-it notes.

I'm not saying it is 100% bad. If this is done extremely rarely, is acknowledged by those involved as being exceptional, and the illness being treated is not complex or chronic, I can see it maybe working out. But treating a chronic illness without being the PCP for the patient, and without acknowledging that you're assuming the role of the provider, seems reckless and irresponsible. I would not, for example, want to be put in a position where I was asked to write a prescription for a thyroid medication for a colleague that doesn't recognize the value of a TSH. I also wouldn't want to face the burden of having to sort through my own disease process without a PCP to bounce ideas off of.

That being said, I'm sure that if you tell your primary care provider what it is you want, s/he will give it to you--once your history is completely known, an assessment is completed, and studies reviewed.

Dixiecup · Dec 14, 2009

our medical director at the SNF I work no longer has a practice,but stll has a script pad! Since he does have to write a prescription once in a while for a resident.

But he also writes scripts for all the employees in the building. From URI's, to UTI's to scabies to inhalers. whatever they want, he just writes it or tells one of us to call it in usuallly. I keep telling him he's going to get into trouble but he still keeps doing it.

Trauma Columnist · Dec 14, 2009

I'm about keeping my license safe - you are right - he could certainly be in trouble.

BmoreCRNP · Dec 16, 2009

Symptoms are the part that is bunk. If I had a dollar for every patient who came in and told me I'm tired/gained weight etc. my thyroid is off, I would be very rich. The way to regulate thyroid is by normalizing the TSH.
As far as prescribing for yourself there is an old saying in law. Someone who serves as their own lawyer has a fool for a client.
David Carpenter, PA-C

I was going to say the same thing you said. I always go by the TSH. I am in LTC, so my situation is unique in that many of my patients can't tell me when they "feel" hyper/hypothyroid. Even if they could, I doubt I would adjust the dosage based on symptoms alone. That would be kind of risky in my opinion.