Medical Ethics of Self-Treatment

[Noah930]

Is it unethical for a doctor to treatment him/herself? How about a family member?

I had a recent conversation with a doctor who got into a little trouble with the state medical board. I'm not entirely sure why either, as I know him well enough to know a lot of the facts of the case, and if you go by the facts he did nothing wrong. But I digress. As part of the agreement with the state medical board, this doctor has to take some remedial-type/re-education courses. He attended one this past weekend (I think on ethics), and was a bit shocked at the stories of some of the other participants. As in, they didn't really seem to do terrible things that would warrant official reprimands and restrictions on their licenses--but those are topics for perhaps another thread.

One issue that came up regarded self-treatment by physicians. Is it wrong for a doctor to treat himself? Or a family member? And should these answers vary state-by-state?

It's certainly not illegal. There's nothing that I know of in any law book that says it's illegal for a licensed doctor to practice medicine on himself/herself. You can't be thrown in jail for trying to make yourself healthy or cure an ailment. I'm talking about making reasonable medical decisions. If I have an infection, can I write myself a prescription for an antibiotic? Can I remove my own suspicious-looking mole? Can I prescribe myself an appropriate anti-hypertensive if I have high blood pressure? It's certainly not illegal. I actually looked that up when I was first licensed in Massachusetts 2 decades ago. Maybe it's not the smartest idea--akin to a lawyer representing himself in court--but there's nothing illegal about it. (Not referring to self-prescribing narcotic or addictive-potential medications.)

What about treating a family member? I can't write my wife or dad a prescription for a Z-pack if they've got a sore throat brewing? Heck, I even looked up the rules when I got my license in MA, and wasn't illegal to write a family member for narcotics (though I think you need a good and documented reason for doing so to avoid getting in trouble with the law). And I clearly remember debating the concept during residency about operating on family members. Again, not illegal, but possibly not the best idea.

But here's the rub: this acquaintance of mine reports that the (CA) state medical board rules that it is unethical to do the above, and thereby punishable by sanctions/loss of licensure. I think that's ridiculous.

If it's not illegal, to a certain extent how does the medical board (which is a government agency) overstep the law of the land? Arguably, I'm not even sure it's unethical. We're not talking gross negligence here. We're talking practicing reasonable medicine.

When my son had a burn on his arm, was I not allowed to do the dressing changes? Was I supposed to have hired a visiting nurse to do so? If I took him to urgent care or the ER, would the doctor there then bounce the kid right back to me because that's actually within my specialty to treat? Where do we draw the line? Because I'm a doctor I can't give my own kids (or myself) Motrin or Tylenol when one of us has the cold or flu?

Am I off base when I make comparisons to attorneys representing themselves? It's certainly not illegal for an attorney to write a strongly worded letter regarding a personal matter, and toss around the fact that they're a lawyer to intimidate the recipient. A mechanic can't wrench on his own car? A plumber can't hook up his own gas stove in his kitchen?

Thoughts? Or am I totally missing something?

[Arizona_928]

Doctors can write for themselves. The trouble they get into is when they start writing controls for themselves. If a pharmacist is worth the paper their degree is on, they'll refuse to fill and report. Does not happen much. Especially with the reprisal from the two major pharmacies.

Go to a med board meeting. You'll hear the trash of the doctors world. No offense to the docs on this board. Not every profession are immune to drug abuse, sexual assault, and especially extreme negligent deaths. I am no way hating on medical doctors at all.

[LEAKYSEALS951]

I did a quick google search "Virginia State Board treating family members" and came up with this for Va:

[SIZE="3"]Regulation 18VAC85-20-25 (effective October 19, 2005) specifies that treating or prescribing must be based on a bona fide practitioner-patient relationship, and prescribing must meet the criteria set forth in §54.1-3303 of the Code of Virginia. Those criteria provide that the practitioner shall:

(i) ensure that a medical or drug history is obtained;

(ii) provide information to the patient about the benefits and risks of the drug being prescribed;

(iii) perform or have performed an appropriate examination of the patient, either physically or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically; except for medical emergencies, the examination of the patient shall have been performed by the practitioner himself, within the group in which he practices, or by a consulting practitioner prior to issuing a prescription; and

(iv) initiate additional interventions and follow-up care, if necessary, especially if a prescribed drug may have serious side effects.
When treating or prescribing for self or family, the practitioner must maintain a patient record documenting compliance with statutory criteria for a bona fide practitioner-patient relationship.

A practitioner may prescribe Schedule VI controlled substances (as defined in as defined in §54.1-3455 of the Code of Virginia) for him/her self or a family member. A practitioner cannot prescribe a controlled substance to himself or a family member, other than Schedule VI, unless the prescribing occurs in an emergency situation or in isolated settings where there is no other qualified practitioner available to the patient, or it is for a single episode of an acute illness through one prescribed course of medication.

Does the California board spell it out the same way, or in specifically prohibit self/family member tx. in written form? I'm wondering if something your friend heard was taken/presented out of context?

[Tobra]

That is not what he is talking about, writing controlled substances for themselves. I get the quarterly report from the medical board, I know what goes on at those meetings.

What he is talking about is a bit of a ridiculous situation. For example. Say my brother has a gout attack on a Saturday night, am I not supposed to treat that? Or my kid steps on a broken bottle at the lake, is not stitching that up reasonable? When I was a lad, I woke up in respiratory distress. Mom woke up at 3 in the morning with me standing next to the bed with full on stridor, which is a helluva thing to wake up to. She grabbed me by the wrist, the vein popped out and she hit me with some solumedrol she had in the nightstand. Big whack of steroids did its magic on by throat and the hole went from the eye of a needle back to normal. She took me into their tiny shower room, made a pallet on the floor, turned on the hot water, sat on the commode and kept me under close observation until she went to work. That is an extreme example, but illustrates the ridiculousness of the concept.

The oath says "do no harm" it does not say do nothing. I have done things that are definitely out of my scope of practice at the scene of an accident, or if someone is injured. Grandkid got knocked on his ass playing basketball, and I ran out there and gave him an ice pack and made sure his eyes were tracking and he knew his birthday was next Thursday before he ran over to the bench. Pretty good chance that was illegal

I think Class VI is over the counter, so no antibiotics. Oh, and the whole writing for controlled substances is stupid now in California. I have had to buy prescription pads like 3 times in 4 years. That is totally keeping drugs off the street.

[LEAKYSEALS951]

I get the prescription part vs the medical ethics part, and I'm only practicing dentistry, but help me with my understanding of this. Where do state boards specify such as "bad", for example, I treat my daughter's teeth. Is that illegal? and if such, where is it written? I'm assuming it would be written somewhere as prohibited (like the schedule example I found).

I also treated my father when he was alive, and yes, he would call me when he was having trouble for antibiotics, however, with my daughter (and dad), they were patients of record, and both cases seem legit from the board regulations in Va. (At least from the written schedule IV example perspective). edit- If treating family members was illegal (at least in Va, it seems like that would be reflected in the board regulations- such as "Schedule IV prohibited to be prescribed by family member, because that's illegal because it's illegal to see them in the first place." I'm trying to learn.

[Noah930]

Originally Posted by AZ_porschekid

Go to a med board meeting.

Actually, I tried that once in MA. The Board's website claims the monthly (or biweekly?) meetings are open to the public, but when I tried to attend one I was barred from entry. So to a certain extent, the Board doesn't even have to follow its own rules. But who's going to call them out on that?

[Noah930]

Originally Posted by LEAKYSEALS951

Where do state boards specify such as "bad", for example, I treat my daughter's teeth. Is that illegal? and if such, where is it written? I'm assuming it would be written somewhere as prohibited (like the schedule example I found).

That's my point. I am not aware of any law that states it's illegal for a doctor to treat his own family. But apparently the CA Board has taken the position that it's unethical, and therefore subject to sanction. I find that ridiculous.

[john70t]

Watch 'The Knick' end of season two. (spoiler alert)

[Rusty Heap]

Thank you Docs, for the insight into your complicated ethics and moral codes.


here's my question.


What if a Husband and Wife of 30 years recently get the same local Dr for general care.

What is the Dr's obligations, or restrictions, on sharing ones' personal care info, with the other spouse?

meds, maybe a antibiotics, for a shared common cold?




interesting concept.

[GH85Carrera]

I can understand the restrictions on some treatments of family members. I can't imagine many surgeons would want to be the one doing complex surgery on a loved on. Emotions would make it harder or impossible to do the job right.

But a doctor removing a mole on his leg or someplace easy to get to, or treating an abrasion on his own body sounds reasonable. Writing a prescription for a narcotic, well, no.

Don't most doctors have doctor friends that can treat each other for free or swapping services?

[Tobra]

Depends. STD, doc probably has to report it to the public health department, but is barred from sharing it with the spouse.

I remember when I was a kid, asked about the solumedrol in the nightstand. Mom kept it for my older brother, who had asthma, she was surprised she ending up using it on me. Think about your 6 year old kid waking you up in the middle of the night, choking to death. Would freak me out more than somewhat. She turned on the light, blinked her eyes, sized up what was happening, grabbed that stuff and gave me a shot so quick I did not even notice her drawing it up. Dad slept through the entire thing.

Implacable in the face of catastrophe. My wife is like that too. Just the sort of person you want to have around when someone is trying to up and die on you.

[Noah930]

Originally Posted by GH85Carrera

Don't most doctors have doctor friends that can treat each other for free or swapping services?

Not legal per medical board, either. Cannot offer for barter your professional services. Cannot bill someone less than your standard rate.

[flatbutt]

This may be a tangent but may help illustrate how times have changed. When I was a kid we had a pharmacist we called Doc John. He ran what is now called a compounding pharmacy except my memory of it is that is was more like Merlins lab. I clearly remember going to him with various minor-ish ailments and he'd treat me right there. Including the time that a branch whacked me in the eye while riding my bike in the park. It scratched my eye and hurt like heck. Doc John looked at it , smeared some salve into my eye, patched it and told me to come back the next day. Well it was all good within 3 days.

[GH85Carrera]

Originally Posted by Noah930

Not legal per medical board, either. Cannot offer for barter your professional services. Cannot bill someone less than your standard rate.

OK, now that is really stupid.

[Tobra]

Exactly.

I have heard there are guys that do professional courtesy, and won't cash a check from a nurse, a cop or a fireman for example.

That would be illegal though.

[gacook]

Don't think it's an issue here in Arizona...my best friend uses his brother as his PCP, so does his wife. Wife also works in the office...all the siblings use him as their doc.

[RWebb]

informed consent for self-tmt should be pretty obvious

for a relative...

more fun if a DVM treats someone - if an emergency that helps

I will bet that the state medical board has this pretty well worked out

[masraum]

Originally Posted by GH85Carrera

OK, now that is really stupid.

Until you think about the Dr "working out a deal" with the hot young thing or whatever. Or you're a pain in the rear grumpy old bastard with BO, so the Doc charges you 50% extra for having to deal with your sheisse. There are cases where things could be abused in a bad way, and that reg is probably there to combat that.

[LEAKYSEALS951]

Originally Posted by Rusty Heap

Thank you Docs, for the insight into your complicated ethics and moral codes.


here's my question.


What if a Husband and Wife of 30 years recently get the same local Dr for general care.

What is the Dr's obligations, or restrictions, on sharing ones' personal care info, with the other spouse?

.

My understanding is this falls under HIPAA confidentiality. Unless the family member consents to sharing the info with the spouse and names the spouse in a written release, then the treating Dr. is technically not allowed to share any information until a release is signed.

It works both ways in real life. For example, often, husband and wife come in together, and you know darn well they know what is happening to the other, but on the other hand, you'd be surprised how many times a husband and wife get divorced, yet still come into the same Doctor, sometimes even on the same day, and the Doctor darn well better not say anything about the ex to the other ex.

[LEAKYSEALS951]

Oh yeah- interesting topic. Tonight, my daughter and I decided to ride our bikes to a local restaurant. She is 7. She dropped a wheel off the side of a sidewalk and dumped herself on her face at about 13mph. She had on a helmet, but not full face. Chewed up her face pretty bad. Lots of abrasion. Hematoma under nose. I got her off the street, and checked for the worst. Passer-by's stopped to offer assistance. No broken bones. Suborbital bones ok. lower jaw ok. No broken maxilla/mandible. No loose/broken teeth. Lacerations on the inner lip where the teeth hit, but no sutures needed. Abrasion on her shoulder. ROM wnl. No problems with her teeth, no mobility, tenderness to percussion. No change in orientation/awareness/ signs of concussion. She's eating dinner and watching spongebob. Mom's a little upset we might have just botched summer family pics. Had her teeth fallen out, we would have been in the office in milliseconds. She is now upset that she can't find remote! While she got the brunt of the physical trauma, I got the brunt of the emotional trauma watching it happen.

In short, Every single dentist I know treats family. I wouldn't even know how to define family, offspring, spouse, father in law? Send me to jail now!!

edit- I showed this post to my wife- she stated (and I quote)- "If you had to choose between jail and treat your father and law, you'd better choose jail, because my dad would be really pissed!" (He's not someone you want on your bad side. Help me please lol!!!! )