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On Call: Issues in Graduate Medical Education
July 17, 2002

Residents' Prescription Writing for Nonpatients

Author Affiliations

Author Affiliations: Department of Medicine, Christiana Care Health System, Wilmington, Del.


On Call Section Editors: Joseph K. Lim, MD, and Stephen J. Lurie, MD, PhD; Editors: Ethan M. Basch, MD, R. Sonia Batra, MD, MPH, Natalie Holt, MD, Alison J. Huang, MPhil, MD, Nina Kim, MD, Vincent Lo Re, MD, Dena E. Rifkin, MD, and Mrugeshkumar K. Shah, MD, MPH.

JAMA. 2002;288(3):381-385. doi:10.1001/jama.288.3.381

Context Writing prescriptions is one of the most tangible new responsibilities that residents acquire after graduating from medical school. During their regular duties, house officers' prescription writing is carefully monitored. Little is known, however, about residents' patterns of prescription writing outside of supervision or about residents' knowledge of the ethical and legal guidelines that regulate prescription writing.

Objective To study what factors influence residents' decision to write prescriptions for nonpatients.

Design, Setting, and Participants Survey distributed in December 1997 to 92 internal medicine and family practice residents at a US community-based teaching hospital. Eighty percent responded.

Main Outcome Measures Self-reported prescribing activities for nonpatients and for individuals in 12 hypothetical vignettes.

Results Eighty-five percent of respondents reported having written prescriptions for nonpatients. Based on their responses to the vignettes, under certain circumstances, up to 95% of residents would write a prescription for an individual who is not their patient (eg, a sibling). Thirteen percent of residents believed that some ethical guidelines on prescription-writing activity existed. Only 4% of residents reported being aware of federal or state laws addressing the appropriateness of physician prescription writing for nonpatients. None of the residents were able to describe the circumstances that make prescription writing for nonpatients illegal or unethical based on legal statutes or ethical guidelines, respectively.

Conclusions In a sample of community-based internal medicine and family practice residents, unsupervised prescription writing by residents for individuals who are not their patients is a common occurrence. Since residency training is a time when practice habits are established, it is important that all residents learn about the ethical, legal, and liability implications of writing prescriptions for nonpatients.