This topic hits close to home. I am married to a third year resident who is starting his career as a hospitalist in August. Friends and family frequently ask my husband to write them a prescription for various ailments rather than visit their primary care physician. His response? “Sorry, unless you come visit me in my clinic and we establish a physician – patient relationship, the Statutes and Regulations in Nebraska prevent me from writing you a prescription.”
My husband has the benefit of being married to a lawyer who practices in this field; however I often run into young physicians who do not know the legal parameters for the writing of prescription drugs. This post will touch briefly on two legal requirements placed on health care practitioners when prescribing medicines: (1) creating an adequate medical record, and (2) establishing a proper physician-patient relationship. Because this discussion is not meant to be exhaustive, I suggest each health care provider with prescribing privileges read the Regulations posted on the Department of Health and Human Services’ website, found here.
The Nebraska Statutes define the term “unprofessional conduct” as grounds for disciplinary action against a physician. This includes, but is not limited to, the failure to keep and maintain adequate records of treatment of service. According to the Nebraska State Regulations governing the practice of medicine and surgery, an “adequate record” is a record that contains, at a minimum, sufficient information to identify the patient, support the diagnosis, justify the treatment, accurately document the results, indicate advice and cautionary warnings to the patient, and provide sufficient information for another practitioner to assume the continuity of the patient’s care. When investigative or unproven therapies are utilized, the record must also include written informed patient consent.
The phrase “unprofessional conduct” is additionally defined under the State Regulations to include the prescribing of drugs to an individual without first establishing a proper physician – patient relationship. A proper physician-patient relationship requires that the physician make an informed medical judgment upon examination, diagnosis, and formulation of at treatment plan, and that arrangements exist to insure availability of the physician or physician coverage for follow-up patient care.
The short of it is, do not write a prescription unless you have: (1) established a proper physician – patient relationship as outlined above, and (2) created a medical record that documents, in detail, the patient and the prescription. The failure to do so may result in an array of penalties including censure of your medical license.