© Gary Inglese
Dental Defense - Illinois Department of Financial and Professional Regulations Defense - Dental-Legal Issues - Dental Risk Management - Dental Contracts and Business Issues - Dental Office Transitions
“You are a physician, doctor. You would promise life to a corpse if it could swallow pills.”
-- Napoleon (1769 – 1821)
We hear about friends and classmates that get into trouble with their licenses and we never think it can happen to us. Although we are always careful, sometimes trouble finds us. Prescriptions and prescription privileges are two of the areas where dentists need to exercise extreme caution.
Our general dentist license gives us the ability to write prescriptions for antibiotics, dental chemotherapeutic agents, etc. We need both a state and federal controlled substances license to write prescriptions for prescription pain killers. The dentist needs a state license in order to apply for a federal license. Prescriptions for controlled substances cannot be written without current state and federal licenses. However, too many well-meaning dentists invite trouble and break the law by doing favors for friends and writing prescriptions for medications beyond dentistry’s realm.
Although overworked and underappreciated, the pharmacist is a friendly, knowledgeable professional. Use the pharmacist as a resource whenever possible. They know more about medications, dosages and drug interactions than dentists can ever hope to know.
Because pharmacists are more knowledgeable about the laws governing you and your prescription privileges, you might receive a call questioning the appropriateness of a prescription you wrote. Rather than becoming hostile or defensive, consider that pharmacists are only doing their job. Pharmacists are required to question prescriptions and will refuse to dispense the medications if they believe you have gone beyond the scope of your dental license. All you have to do is explain your rationale for writing the prescription. As newspaper reports show, authorities enjoy catching professionals and making public examples of them.
Here are some common sense prescription guidelines that will save you from taking the perp walk:
Only prescribe medications for patients of record and only for therapeutic purposes. Resist the temptation to help family and friends by writing prescriptions for birth control pills. The standard of care requires that you first examine the patient and have an appropriate dental record for the patient. The prescription must have a legitimate dental therapeutic purpose. For example, smoking cessation medications are acceptable.
All prescribed medications must be noted on the patient’s record. Be sure to include the purpose, dosage, amount, number of refills and usage instructions – for both written prescriptions and those called into a pharmacy.
No self-prescribing or favors for friends. Most, if not all, pharmacies are computerized and can easily run patient and prescriber profiles. Pharmacy practices are closely regulated by and the pharmacist must cooperate with both the Illinois Department of Financial and Professional Regulation (IDFPR) and Drug Enforcement Administrations (DEA).
Self-prescribing is a violation. If you are ill, your physician will treat and prescribe medication for you. Don’t order the prescription from a wholesaler. Many pharmacies offer professional discounts and even if they don’t, the purchase price is much cheaper than the costs incurred defending yourself in court.
Friends don’t ask friends to prescribe for them. Make no exceptions.
Don’t write prescriptions beyond the scope of your license. Unless you hold another professional license, you can only prescribe medications for rational dental therapeutic purposes. IDFPR has disciplined dentist who wrote prescriptions for their personal livestock and pets. If you are not a veterinarian, you cannot write a prescription for Fido.
Do not dispense medications from your office. You work in a dental office, not a pharmacy. You may be contacted by drug companies offering to stock your office pharmacy. Their literature promotes dispensing medications as a profit center without noting the increased cost of your liability insurance.
There are strict rules and statutes governing pharmacy practice, including areas such as inventory control, security and labeling. Office dispensing eliminates one of the checks and balances of the system and makes the dentist solely responsible for issues such as checking for drug interactions and allergic reactions. Does the patient return to you for a refill? Who is responsible for identifying medications – you or your staff?
The only justification for office dispensing is to provide patients with a starter dose before they fill a prescription or if they have forgotten to take pre-treatment medication. Again, all medications dispensed must be noted in the patient’s chart.
Beware of drug seeking patients. Drug seekers typically will come late at night or on a weekend, frequently presenting themselves as an emergency. They want to be your patient, but cannot remember who referred them to you or they picked your name out of a phone book or they are from out of town. Sometimes all they want is “just enough” medication to get them through until they can see their own dentist. They talk about severe pain and will provide many reasons why the cause of their discomfort remains untreated. Also, they will know more about pharmacology than you – naming the medication that has worked well in the past, assuring you that no other medication will do the trick.
Help these patients and you will be dubbed as an easy mark – and you will get calls from their abuser pals.
Avoid telephone prescriptions. Do not give prescriptions without proper patient identification.
When treating patients, make certain that their condition warrants the painkiller. For example, establishing drainage may treat an exposed pulp and large draining lesion, antibiotics and a nonprescription pain reliever will work as well as controlled substances.
Call their “regular” dentist and hear what he has to say. If you are suspicious, call your local police department and pharmacy to see if they have a patient profile.
Do not write a prescription for someone who is not a patient of record and to whom you have only spoken by telephone. Recommend a non-prescription alternative until the patient can have a conventional appointment.
Establish an office policy stating that patients will not be given prescriptions unless they have been examined. Direct those who claim they are in severe pain to the local emergency room.
Article written by Michael Vold originally published in CDS Review, July/August 2004
A prescription for your well being