I'd like to bend your ear with a hypothetical situation and see what you think. This one is for the docs, and I'm going to start and end it with a simple question: is it okay to prescribe for a family member? Is it okay to prescribe a psychotropic medication for oneself or a family member?
Before you jump on me, let me tell you that to the best that I am aware, docs have always written prescriptions for themselves and for their family members. An antibiotic, an allergy medication, I think this has been par for the course for straightforward things. When I was an intern, one of the nurses asked me to write for an ulcer medication for her mother ---I said 'no' since I'd never so much as seen the mother, but it was uncomfortable for me. I've heard older and wiser psychiatrists talk about prescribing Valium for themselves, Xanax for a friend afraid to fly, an antidepressant for a parent, and I've certainly had patients who've gotten medications from family members who are docs, including controlled substances.
Somewhere in there, it became taboo to prescribe for family members, particularly psychotropic medications or controlled substances. In our state, the licensing board sanctions people if they learn about prescriptions written for anyone where there is no chart. I think. What's kosher and what's not kosher is a bit of a guessing game, and while obviously it's a problem to prescribe large quantities of Oxy for yourself, I'm not sure if or when it's a problem to refill a spouses' statin when their doc is out of town.
So let me give you an invented scenario, and I'm curious as to what the docs out there think is the right thing to do. If everyone else wants to chime in, that's fine, but please say who you are -- doctor, nurse, social worker, golf pro, whatever, no pure anonymous responders, please.
Lucy has a history of panic disorder and five years ago she was treated with medications: first with Xanax for a couple of weeks, and then with Zoloft. Once the Zoloft kicked in, Lucy was able to stop the Xanax. Lucy said the panic attacks were horrible, and the medications brought her tremendous relief, and she also had psychotherapy. After about a year, Lucy tapered off the medications and she has been free from panic attacks ever since. Until last week. Out of the blue, Lucy was hit with a horrible attack. She lives in another part of the country now, and Shrink Brother, visiting for a few days, took her to the ER, where they ruled out a heart attack, gave her some Ativan, and sent her home with a prescription for ten pills and directions to see a psychiatrist.
Lucy starts working the phone, but her new town is nothing like her old town. She calls ten psychiatrists, most have a wait of 4 to 6 weeks. Shrink Brother also calls around, but he lives in another state-- he's just visiting for the weekend -- and all the shrinks have secretaries that form pretty solid walls. Weeks, if it's an emergency, she should go to the ER, but Lucy's already been to the ER. Lucy wants to start back on Zoloft, because she remembers it took weeks to work. Having moved to town 18 months ago, and being in very good health until now, she never got a primary care doc or a gynecologist, and yes, she's well aware this is all her fault. She makes the soonest appointment she can get with a psychiatrist -- 3 weeks, and is told that the shrink sees new patients for an hour, and after that it's a 4 patient/hour flow. So, she'd like to start on Zoloft, she's still having panic attacks and is due to run out of Ativan, and she also needs to figure out how to get a therapist (plus a primary care doc and a gyn). Brother shrink is worried about prescribing for her -- he's gone home to his own state and no one will be monitoring sister Lucy -- what if she gets suicidal or manic on the Prozac? Does he really want to monitor sister Lucy for sexual side effects? (TMI, he notes) Isn't it a problem for him to write for Ativan, an addictive, controlled substance, for a family member? Lucy goes to an urgent care center, and is sent out with a script with a low starting dose of Zoloft -- enough to last for 10 days, and ten more Ativan tablets, not enough to get her to the appointment. Infuriating given that Lucy had made a point of telling them she couldn't find a psychiatrist to see her for weeks, but when she got to the pharmacy, she realized that the script was too low a dose and too few pills.
At this point, Brother Shrink is totally frustrated. His sister has now been in an ER and an urgent care center, she has an appointment with a psychiatrist, chosen for the soonest appointment, no clue if he's any good. Nothing horrible will happen if Lucy goes without medications, she'll simply suffer longer and it's feeling a bit unnecessary when he could phone in some Zoloft and a few more tablets of Ativan to hold her over. The only other option that either of them can think of is for Lucy to continue to make regular visits to the urgent care center where a doc with no expertise in psychiatry can continue to prescribe, if he feels so inclined. At the same time, Brother Shrink worries that if there is a bad outcome, now or ever with any of his other cases, it will come out that Brother Shrink inappropriately prescribed to sister.
What should he do? Jesse? PsychPractice? Dr. Reidbord?