Medical ethics is woven into the Whistleblower blog. I have presented vignettes exposing ethical controversies in the medical profession. I have pointed out scenarios when patients test the steeliness of our ethical scaffolding. I have admitted when my own ethics can be fairly challenged. Indeed, this blog does not take a ‘holier than thou’ posture, though at times I have been accused of this. I have directed as much criticism at myself as I do elsewhere.
Recently, I received a request to assist someone whom I was told was in dire need of a physician’s assistance. While I am a physician who has taken an oath to heal and comfort, in this case I turned away from a person in need. I present the anecdote not because it will stimulate a discussion of the competing ethical angles of the case. Indeed, the case has no angles and no reader will challenge my decision. I present it as an example of an outrageous and improper request that was made to a doctor. Indeed, while I have received numerous improper requests from patients over the past two decades, which I routinely declined, this request was the ‘mother of all ethical outrages’.
Valtrex Structural Formula
This case poses no ethical quandary for any physician.
The woman who called me is a wonderful and caring person. I wanted to offer some counsel beyond a rebuke of her request, and I did so.
I am interested in what advice readers would have offered, as well as potential explanations for the niece’s anxiety. Once a discussion has hopefully developed, I will share the advice I rendered, and will look forward to readers’ response to it. I always welcome criticism because I am holier than no one.
This is surprisingly not uncommon. There are so many reasons patients (or non-patient friends) will ask us to fill prescriptions for others. The stories are elaborate and seem to make total sense to the requester.
ReplyDeleteOf course the answer in this case has to be no. The request was built on a faulty premise...that a diagnosis of herpes is something to be hidden. If I had the time, I would educate the woman on herpes infection and the latent properties of the virus. I would advise her to always have a supply of Valtrex on hand and if her own personal physician will not refill this essential medication, she needs to find a new doctor.
Filling prescriptions for non-patients is illegal and the risk goes as far as loosing our license to practice medicine. Added to that is the knowledge that this RX would be handed over to yet another person. Huge red flags, which of course, you recognized and dealt with.
This dilemma brings up the "do no harm" ideology, which is paramount to our profession. As we know, millions of Americans and not-yet-official Americans are without health insurance that will cover prescriptions and medical visits. Would it be ethical to advise a non-patient to spend $120 for a clinic visit in order to obtain a $4 antibiotic?
ReplyDeleteImplications of patient prescriptions also must be considered. An associated diagnosis of asthma, anxiety, migraine headaches, etc. may bar an otherwise-healthy individual from joining the armed forces, obtaining better, non-governmental health insurance, or organ donation.
As a physician, I've balked at the suggestion of writing a prescription under these circumstances. However, I have considered it as a daughter, granddaughter, friend.
Ethical issues are never cut-and-dry, and never static. We do the best we can.
Agree that ethics are not purely black and white, as you suggest, but there needs to be some bright lines that we don't cross. Clearly, the slippery slope risk of even minor ethical erosion is there and we need to be vigilant.
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