Ethical Question

[JDJones89, BSN]

Curious to some people's input on something.  What are your thoughts on someone giving their medical recommendation for a patient they have never evaluated or treated when that recommendation goes against what a physician diagnosed and prescribed that has properly evaluated and screened a patient?

Additional details

Pediatric patient, 11 yo, screened for and diagnosed with combined type ADHD by his board certified pediatrician and started on methylphenidate.  

Patient's mother, who was not present at appointment and did not participate in completing a screening form, disagreed with both the diagnosis and medication prescribed after the fact.  She then went to a friend who is apparently a PA (I know this is the nursing board, but PAs and NPs have similar scopes and I am looking more for thoughts on ethicality) to ask their opinion.  The PA is a pain clinic provider with no pediatric or psychiatric background.  The PA then recommended that the patient not take the methylphenidate and instead recommended Strattera (did not prescribe it though).  

So I am curious people's thoughts on where this falls on the ethics/professionalism spectrum.  My thought process was that the physician was able to use the tools of screening forms to accurately diagnose and treat a disorder.  Discussions were had between the physician and father of the child to make a correct choice of medication that fit the child's needs and situation.  The PA knew very little about the child, his background, or his social situation and made a blind recommendation.  That recommendation really could result in poor efficacy as well as reactions due to the child's medication compliance because of his social situation in his home life. 

So I am just on the line of being unsure if the PA crossed the ethical line of making an uninformed recommendation or if it is more just unprofessional or poor judgement that they did so? Or maybe neither if you think so?  Really would love any thoughts you all have!!

[Nurse Alexa, MSN, RN]

Hi JDJones89, BSN

These ethical dilemmas do happen. The first thing that jumps out at me is why exactly did the mother not want her child to be the first prescribed medication? (Was it because of side effects she's heard of this medication,? Or is the mother in denial that her child has a disorder at all?)

I think it is very common for patients to ask friends and family medical advice. As healthcare professionals, we have the knowledge-base to guide them in the right direction and they also trust us as family.

The PA who suggested another medication was giving her honest opinion. However, you are right to the fact that she might not know the child's history like the physician. 

At this point because her friend recommended a different medicine, it does cause distrust of the physician who prescribed the previous medication. 

I think instead of the PA just flat out recommending something - she should have asked to potentially speak with the physician to go over the choice of medication in this situation. 

This child's medication choice should not be based on someone's experience and knowledge, but based on the best medication for his condition.

Hope this helps ?

 

[londonflo]

JDJones89 said:

Patient's mother, who was not present at appointment and did not participate in completing a screening form,

JDJones89 said:

Discussions were had between the physician and father of the child

Have to wonder if the parents are both on the same page.

[traumaRUs, MSN, APRN]

I don't think it was unethical. I'm thinking this is discussion between friends ie PA and RN?  

Moral of the story - don't give out free advice. I will say as someone who is raising a child with ADHD there are so many shortages of meds at the moment that perhaps that was a factor?

[FolksBtrippin, BSN, RN]

 

Parents should talk to each other and work it out, rather than use providers to fight each other about what's best for their kid. Whether the PA should give an opinion that  differs from the MD is not the actual problem in this situation. Parents who don't get along and recruit professionals to take their side in disagreements with each other do real damage to children that often outweighs either decision. 

[offlabel]

And you are involved, why?

[JKL33]

OP hasn't been here since shortly after  making the post over a year ago.

[offlabel]

JKL33 said:

OP hasn't been here since shortly after  making the post over a year ago.

And you care because? Has she been checking in with you about reading AN?

[JKL33]

offlabel said:

And you care because? Has she been checking in with you about reading AN?

Well as I'm sure you know, despite your sarcasm, no one needs to check in with anyone. You, too, can easily see when someone last visited the site.

But to answer your question, it was meant to be courtesy post regarding the fact that the poster above you had bumped an inactive year-old thread so you might not get a reply from the OP.

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