A physician is approached by a longtime friend who requests a prescription for dextroamphetamine. The physician has known this individual since childhood and is aware that he has attention-deficit hyperactivity disorder, for which he received stimulant medications throughout high school. The physician sees her friend socially several times a year, and the friend has been supportive during some difficult times in her own life. The friend explains that he is under a lot of pressure at work and wants to resume taking stimulants briefly to help him stay focused and meet his deadlines. Which of the following is the most appropriate response?

Question

A physician is approached by a longtime friend who requests a prescription for dextroamphetamine.  The physician has known this individual since childhood and is aware that he has attention-deficit hyperactivity disorder, for which he received stimulant medications throughout high school.  The physician sees her friend socially several times a year, and the friend has been supportive during some difficult times in her own life.  The friend explains that he is under a lot of pressure at work and wants to resume taking stimulants briefly to help him stay focused and meet his deadlines.  Which of the following is the most appropriate response?

Quizplus · Accepted Answer

Explanation: This physician is faced with the dilemma of wanting to help a longtime friend while also wanting to adhere to professional ethical standards. The physician may therefore feel conflicted and pressured to fulfill the request for a stimulant prescription. Physicians are commonly approached by friends for informal medical care ranging from prescription medications to treatment for injuries or more complex medical problems. Physicians must be aware of the ethical issues involved in providing medical care to friends. These include failure to perform an adequate assessment of sensitive issues, the possibility that the patient will not be forthcoming due to the nature of the relationship, being pressured into treating conditions beyond the physician's expertise, and lack of appropriate follow-up and documentation. All professional ethics guidelines recommend that treatment of friends should be restricted to limited care in emergency situations when no other physician is available. In this case, the physician may feel uncomfortable asking her friend about substance use and other medical issues relevant to the prescription of stimulants. Likewise, the friend may be reluctant to disclose these issues. From a medico-legal perspective, writing a prescription establishes a physician-patient relationship and may be problematic in the event of an adverse outcome or review of the physician's controlled substance prescribing practices. The most appropriate response is for the physician to explain that she is uncomfortable with the request and assist her friend in obtaining appropriate care elsewhere. (Choices A, B, and E) The physician may be well intentioned in asking her friend additional questions to determine whether prescribing a stimulant is appropriate. However, this does not solve the ethical dilemma of treating a friend when the nature of the relationship could interfere with obtaining accurate history and appropriate follow-up. (Choice D) Treating friends is generally discouraged from an ethical standpoint but may be justified in exceptional or emergency circumstances when no other physician is available. Educational objective: Physicians must consider ethical issues when asked to provide informal treatment for friends. Treating friends should generally be limited to emergency situations when no other care is available. References: No appointment necessary? Ethical challenges in treating friends and family. (http://www.ncbi.nlm.nih.gov/pubmed/25251620)

A Physician Is Approached by a Longtime Friend Who Requests