A physician is approached by a friend who requests a prescription for antidepressant medication. The physician has been friends with this individual since college and is aware that she has been treated for depression in the past. The friend explains that she is only "a little depressed" due to work stress and relationship issues and would like to resume sertraline, which she has taken previously. She has a physician but wants to avoid seeing the provider due to difficulty getting an appointment and her own busy schedule. Which of the following is the most appropriate response?

Question

A physician is approached by a friend who requests a prescription for antidepressant medication.  The physician has been friends with this individual since college and is aware that she has been treated for depression in the past.  The friend explains that she is only "a little depressed" due to work stress and relationship issues and would like to resume sertraline, which she has taken previously.  She has a physician but wants to avoid seeing the provider due to difficulty getting an appointment and her own busy schedule.  Which of the following is the most appropriate response?

Quizplus · Accepted Answer

Physicians are commonly approached by friends and family for informal medical care ranging from prescriptions for antibiotics to treatment of complex medical issues. However, the wish to be helpful must be balanced with ethical considerations related to the risks of compromising objectivity and clinical judgment when treating a friend. Potential problems that could result in patient harm (maleficence) include failure to perform an adequate assessment of sensitive issues related to depression (eg, suicide risk), the possibility that the patient will not be completely forthcoming due to the friendship, treating conditions that may be outside of the physician's expertise, and lack of appropriate documentation and follow-up. In addition, from a medico-legal perspective, writing a prescription establishes a physician-patient relationship and may be problematic in the event of an adverse outcome. Professional medical organizations with published ethics guidelines consistently recommend that treatment of friends and family be limited to emergency situations when no other physician is available. The most appropriate response is for the physician to decline to write the prescription, explaining that the nature of their relationship prevents objective treatment. (Choice A) Physicians may feel pressured to accommodate requests from friends, but offering a limited supply of medication is not indicated in this nonemergency situation. The physician should encourage the friend to schedule an appointment with her provider. (Choice B) Describing the friend's psychiatric history as complex may be viewed as judgmental and is not the fundamental reason for declining the request for medication. It is preferable to explain how the nature of their friendship compromises the physician's ability to treat her objectively. (Choice C) Although it is well intentioned, scheduling a full evaluation to determine whether antidepressants are indicated does not solve the ethical problem of treating a friend in a nonemergency situation. (Choice E) This option makes the unfounded assumption that another physician would be willing to prescribe medication without reevaluating the patient in person. Educational objective: Providing informal treatment to friends and family is ethically problematic due to lack of objectivity that can negatively impact clinical judgment. It should generally be limited to emergency situations in which no other physician is available.

A Physician Is Approached by a Friend Who Requests a Prescription