JADA 143(2) http://jada.ada.org February 2012 109

Certainly, the prescribing ofpsychoactive drugs or othermedications “not in the scope ofpractice” or without proper his-tory or examination is incor-rect, unethical and possiblyillegal. Electronic monitoring ofprescription writing habits mayeven be beneficial to publicsafety.

However, when the AmericanMedical Association1 offers anopinion that goes further to say,“Physicians generally shouldnot treat themselves or mem-bers of their immediate fami-lies,” and the Montana Board ofMedical Examiners2 states thatprescribing for one’s family oroneself ‘ “[a]rguably … does notmeet the general acceptedstandards of practice’ ” and this“may subject the physician tolicense discipline,” thensomeone has drawn a line inthe sand.

If Dr. Donaldson or anyoneelse feels he or she cannot pro-vide correct and complete diag-nosis and treatment for afamily member, then, as alicensed professional using hisor her best judgment, he or sheshould make the decision torefer that patient.

Who better to treat myfamily than me? Dr. Donaldsonmakes good points, but it isabsurd even to suggest thattreating my own family isimproper.Frank M. Bonno, RPH, DDS

Santa Fe, Texas 1. American Medical Association. AMA code

of medical ethics: opinion 8.19—self-treatmentor treatment of immediate family members.“www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion819.page?”.Accessed Jan. 11, 2012.

2. Montana Board of Medical Examiners.Statement of physician prescribing orordering diagnostic studies for self or mem-bers of the physician’s immediate family.“http://bsd.dli.mt.gov/license/bsd_boards/med_board/pdf/prescribing_self.pdf”.Accessed Dec. 6, 2011.

Author’s response: I wishto thank Dr. Bonno for his com-ments concerning my guest edi-

torial. He raises excellentpoints that this editorial inten-tionally tried to highlight: thatwe each may be practitionerswith abilities beyond our initialtraining in school, and thatthese additional skills andexperiences should position usto be the best providers forthose closest to us. In otherwords, “Who better to treat myfamily than me?” However, thisis exactly the predicament pre-scribers often find themselvesin when the bigger picture isnot considered. In other words,“What is the harm?”

As parents, we may see ourchildren with a headache andsuggest that they take theappropriate dose of acetamino-phen rather than considering atrip to urgent care or the emer-gency room. As prescribers, wemay extend our “power” a littlefurther to write an antibioticprescription for a relative (suchas a sibling with acute sinusitisor our own child with acuteotitis media) rather than con-sidering a trip to urgent care orthe emergency room. However,the American Medical Associa-tion,1 the Montana Board ofMedical Examiners,2 other statemedical and dental boards andThe Spider-Man Principle3 areall clear on this topic: “Withgreat power there must alsocome—great responsibility!”

What if that simpleheadache was misdiagnosedhypertensive crisis or a braintumor? What if that antibioticyou prescribed results in a Type 1 immunoglobulinE–mediated anaphylactoidreaction because a completephysical examination of thepatient, as required by NewYork state law4 and others, wasnot performed? Remember, as aminimum requirement of pre-scription writing, or as theMedical Board of California’sguidelines5 put it, “a good-faithexamination and documenta-

tion that justifies the prescrip-tion” must be completed.

Those of us who work insmall towns or independentpractices often find ourselves asthe resident expert to whommany people refer, whether ornot their ailment is specific toour training. Most of us wentinto medicine because we wantto help people and, tradition-ally, we are compelled to dowhat we feel is best for thepatient—even if it is outsideour scope of practice—but thisis a slippery slope. In the exam-ples above, while we may feelwe are doing what is best forthe patient, if there is an unto-ward outcome, could it havebeen avoided? What is the legaland ethical jeopardy we exposeourselves to when we practiceoutside our scope?

Regarding the provision ofdentistry to family members orclose friends, it is important tounderstand the special circum-stances of “treatment.” In thecase of medical care by physi-cians, “treatment” in toto mayconsist of prescribing medica-tions for a suspected ailment orcondition. For dentists, “treat-ment” may consist of definitivecare (for example, operativetreatment, oral surgery, hy -giene procedures) and pre-scribing. Providing definitivedental care to family members(providing they have receivedthe same examination anddiagnosis as any other patient)is not prohibited and was notthe topic of the editorial;avoiding inappropriate pre-scribing when the suspectedcondition may not be within thescope of dentistry was theintended message.

After all, how easy is it for adentist to simply call in a pre-scription for a family membercomplaining of a sinus infec-tion? A recent article6 high-lights the benefits and risks ofthis type of practice. The bene-

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110 JADA 143(2) http://jada.ada.org February 2012

fits may include increasedaccess to medication and symp-tomatic relief. However, therisks are substantial andarguably more severe: incorrectself-diagnosis, delays inseeking medical advice whenneeded, infrequent but severeadverse reactions, dangerousdrug interactions, incorrectdosage, incorrect choice oftherapy, masking of a severedisease and risk of dependenceand abuse.

Just because dentists havethe power to order any avail-able medication does not meanthat it is ethically and legally

responsible to do so.7 Mythanks again to Dr. Bonno forhis comments.

Mark Donaldson,BSc(Pharm), RPh, PharmD,

FASHP, FACHEDirector of Pharmacy Services

Kalispell Regional Medical CenterKalispell, Mont.

1. American Medical Association. AMA codeof medical ethics: opinion 8.19—self-treatment or treatment of immediate familymembers. “www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion819.page?”.Accessed Jan. 11, 2012.

2. Montana Board of Medical Examiners.Statement of physician prescribing orordering diagnostic studies for self or mem-bers of the physician’s immediate family.

“http://bsd.dli.mt.gov/license/bsd_boards/med_board/pdf/prescribing_self.pdf”.Accessed Dec. 15, 2011.

3. Lieber SM. Introducing Spider-Man.Amazing Fantasy 1962;1(15):1-13.

4. 10 NYCRR part 80.71(a) (Feb. 25, 2009).“http://w3.health.state.ny.us/dbspace/NYCRR10.nsf/11fb5c7998a73bcc852565a1004e9f87/8525652c00680c3e8525652c006f1294?Open-Document”. Accessed Dec. 15, 2011.

5. Medical Board of California, Departmentof Consumer Affairs. General office prac-tices/protocols: frequently asked questions.“www.medbd.ca.gov/consumer/complaint_info_questions_practice.html#13”. Accessed Dec.15, 2011.

6. Ruiz ME. Risks of self-medication prac-tices. Curr Drug Saf 2010;5(4):315-323.

7. Sketris IS, Langille Ingram EM, LummisHL. Strategic opportunities for effectiveoptimal prescribing and medication manage-ment. Can J Clin Pharmacol 2009;16(1):e103-e125.

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