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Ethics
When physicians forego the doctor–patient relationship, should they elect to self-prescribe or curbside? An empirical and ethical analysis
  1. J K Walter1,
  2. C W Lang2,
  3. L F Ross3
  1. 1
    University of Chicago, Chicago, IL, USA
  2. 2
    Department of Paediatrics, University of Chicago, Chicago, IL, USA
  3. 3
    Clinical Ethics at the University of Chicago, Chicago, IL, USA
  1. Correspondence to Dr L F Ross, Department of Paediatrics, University of Chicago, 5841 S Maryland Ave, MC 6082, Chicago, IL60637, USA; lross{at}uchicago.edu

Abstract

Background: The American Medical Association, the British Medical Association and the Canadian Medical Association have guidelines that specifically discourage physicians from self-prescribing or prescribing to family members, but only the BMA addresses informal prescription requests between colleagues.

Objective: To examine the practices of paediatric providers regarding self-prescribing, curbsiding colleagues, and prescribing and refusing to prescribe to friends and family.

Methods: 1086 paediatricians listed from the American Academy of Paediatrics 2007 web-based directory were surveyed.

Results: 44% (430/982) of eligible survey respondents returned usable surveys. Almost half (198/407) of respondents had prescribed for themselves. An equal number (198/411) had informally requested a prescription from a colleague. Three-quarters (325/429) stated they had been asked to prescribe a prescription drug for a first-degree or second-degree relative, and 51% (186/363) had been asked by their spouse. Eighty-six per cent (343/397) stated that they had refused to write a prescription on at least one occasion for a friend or family member. The following reasons “strongly influenced” their decision to refuse a prescription request: (1) outside of provider’s expertise (88%); (2) patient’s need for his or her own physician (70%); (3) not medically indicated (69%); (4) need for a physical examination (65%).

Conclusion: These data confirm that most physicians have engaged in self-prescribing or curbside requests for prescriptions. It can be argued that curbsiding is more morally problematic than self-prescribing because it implicates a third party, and should be discouraged regardless of whether the requester is a colleague, family member or friend.

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Footnotes

  • Funding JKW is a 3rd year paediatric resident at the University of Chicago, Chicago, IL. She carried out this work as part of her residency research project. She received funding from the University of Chicago Department of Paediatrics Resident Research Fund. CWL is a graduate of the University of Notre Dame in biology and anthropology. She is a research assistant at the University of Chicago Department of Paediatrics, Chicago, IL. LFR is the Carolyn and Matthew Bucksbaum Professor of Clinical Ethics at the University of Chicago. She is a professor in the departments of paediatrics, medicine and surgery. She is an associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago, Chicago, IL.

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

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