A 32-year-old physician approaches a colleague and asks if he would write him a prescription for an antidepressant. He has known this colleague since medical school and they work closely in the same hospital department. The physician says he has been under a great deal of stress lately. His mother was recently diagnosed with cancer and his spouse has complained about his long work hours and disinterest in the relationship. The physician says, "I'm trying so hard to be everything to everybody, but some days it's just too much. I would really appreciate if you could help me out. I don't want this in my medical record. I don't think I'm clinically depressed; I just think I could feel better."
Which of the following is the most appropriate response?

Question

A 32-year-old physician approaches a colleague and asks if he would write him a prescription for an antidepressant.  He has known this colleague since medical school and they work closely in the same hospital department.  The physician says he has been under a great deal of stress lately.  His mother was recently diagnosed with cancer and his spouse has complained about his long work hours and disinterest in the relationship.  The physician says, "I'm trying so hard to be everything to everybody, but some days it's just too much.  I would really appreciate if you could help me out.  I don't want this in my medical record.  I don't think I'm clinically depressed; I just think I could feel better."
Which of the following is the most appropriate response?

Quizplus · Accepted Answer

This physician is faced with the difficult situation of being asked to prescribe medication for a colleague. Although it is understandable to want to help, physicians must consider the ethical implications of this decision. Due to the nature of the social and professional relationship, the treating physician may not feel comfortable asking sensitive and potentially critical questions regarding suicidal ideation, severity of depression, past psychiatric history, and substance use. As a result, the treating physician would be assuming medico-legal responsibility for treatment decisions that may be based on an inadequate assessment. In addition, the treating physician may feel pressured to agree to the patient's suggestions, as the patient is also a physician and a colleague. In the event of an adverse outcome, the treating physician would likely feel guilty and remorseful. Other potential problems include lack of timely and appropriate follow-up, inadequate documentation, practicing outside one's area of expertise, and lack of communication with the patient's primary physician. Physicians must always be guided by the ethical principles of beneficence (patient's best interest) and nonmaleficence (do no harm). Expressing empathy but explaining that it is best not to prescribe for a colleague would be the most appropriate response. (Choices A, B, and C) Although adequate documentation and specific follow-up plans would be preferable, prescribing medication for a colleague is ethically problematic. (Choice E) Psychotherapy is a treatment option for mild to moderate depression that could be discussed with the patient. However, treatment recommendations should be based on a thorough, independent assessment. Educational objective: Physicians may feel pressured to provide informal or undocumented care to colleagues and should be aware of the ethical implications. Referral to an independent clinician who can perform a comprehensive assessment is in the patient's best interest. __________ References: No appointment necessary? Ethical challenges in treating friends and family. (http://www.ncbi.nlm.nih.gov/pubmed/25251620)

A 32-Year-Old Physician Approaches a Colleague and Asks If He