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“But it’s just a script”: prescribing requests from family and friends

Dr Patrick Clancy, MBBS, FRACGP, MHlth&MedLaw, Senior Medical Adviser, Advocacy, Education and Research, Avant

Saturday, 30 September 2023

prescribing requests from family and friends

As a doctor, it is inevitable that a friend or family member will ask you for a prescription. They see you as a convenient resource.

A junior doctor called Avant’s Medico-legal Advice Service (MLAS) for advice wondering if she could prescribe a contraceptive pill for a friend who needed a new script and couldn’t get in to see her normal GP.

These requests usually occur in situations outside the typical consultation. You may be asked for repeat prescriptions, or for new medications.

Every prescription you write comes with clinical, ethical, and legal responsibilities. Specific medications, like drugs of dependence, carry important additional legal responsibilities. For more information, read our factsheet ‘Prescribing drugs of dependence’.

What does the code of conduct say?

Doctors have a duty to act in accordance with professional standards. The Medical Board’s Good medical practice: a code of conduct for doctors in Australia (the Code) outlines the conduct expected from doctors. The Code assists the Medical Board’s function of protecting the public. A doctor will be expected to explain and justify their conduct should they deviate significantly from that standard.

The Code states:

"Whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends, those you work with and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the patient and doctor.”

“In some cases, providing care to those close to you is unavoidable, for example in an emergency. Whenever this is the case, good medical practice requires recognition and careful management of these issues."

The Code also requires you to assess your patients, and to maintain adequate records.

Critical factors to consider

While prescribing for friends and family is not strictly prohibited, doctors should judge each situation on its own merits. If you are asked to prescribe a medication that they are already taking, you should consider:

  1. What are the effects, side-effects, indications, contraindications, and drug interactions with this medication?
  2. Do you need to take a full medical history?
  3. Is there potential for harm?
  4. Should you only prescribe a minimal amount until the patient can see their usual doctor?
  5. Should you communicate this prescription to the usual doctor?
  6. What medico-legal risks are posed?
  7. With reference to the Code, how would you be judged in this situation?

Requests for new medications

Requests for a new medication from a family member or friend raise additional complex issues. Your duty of care is arguably greater, extra care is required, and you need to ask yourself:

  • Would you be entering into or encouraging a long-term doctor-patient relationship?
  • Would you be interfering with an existing doctor-patient relationship?
  • Would a reasonable standard of care dictate that you take a full history, perform an examination, and order any tests or investigations?
  • Can you really make an objective clinical judgement on the person who asked you for the prescription or are you too close to them?
  • How would you be judged in relation to the Code?

There is no right or wrong answer. However, if a family member or friend asks you to prescribe a medication the below advice can help you to make the appropriate decision:

  • Whenever you write a prescription, you are entering into doctor-patient relationship.
  • Unless the risk of harm of not writing the prescription outweighs the risk of harm of writing it, you should avoid doing so.
  • Prepare an explanation as to why you can’t assist. For example: “I would love to help, but the Medical Board doesn't allow prescriptions to be written for friends and family. Perhaps I can help you get an appointment to see another doctor”.
  • Do not enter a continuing doctor-patient relationship with a family member or friend. This also applies to anyone with whom you have a business or working relationship.
  • Keep an appropriate record of any prescription you write, including the circumstances surrounding the request.
  • Never prescribe Schedule 8 and other drugs of dependence (such as benzodiazepines).
  • Consider whether it may be prudent to consult the family member or friend in your practice, so that you can take a full history and perform an appropriate examination with a well-defined doctor-patient boundary.

It is never easy to say “no” to friends and family. However, you need to remember that if something goes wrong, in addition to adversely affecting your relationship with your family or friend, you may be asked to justify your decision to the Medical Board, court or tribunal.

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Disclaimers

The case discussed in this article is based on a real case. Certain information has been de-identified to preserve privacy and confidentiality.

IMPORTANT: This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is only current at the date initially published.

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