J Oral Maxillofac
Surg
49:111,1991
Dealing With Drugs sulting need to explain the flood of narcotic orders suddenly appearing at various pharmacies. This situation can become even worse when presigned prescription pads are stolen and there is the need to explain how a legal signature appeared on an illegal prescription. It is important to be efficient in the office, but not to the point of taking such a foolish risk. There are also certain precautions to take when writing legitimate prescriptions for patients. Oral and maxillofacial surgeons are particularly vulnerable in this respect because they often see patients for only one or two visits and, thus, do not become thoroughly familiar with them. Prescriptions must always be written in such a way that they cannot be altered. It is mandatory that prescriptions for narcotics be written in ink or indelible pencil. It is also advisable to write the number of tablets or capsules, as well as the number of refills, in such a way that it cannot be changed. As a further precaution, either a copy of the prescription or a written description of what was prescribed should be placed in the patient’s record. Providing verbal orders to the pharmacist should also be done with caution, and all such orders must be recorded. It is generally inappropriate to reorder old medications or prescribe new medications without first seeing the patient again. Prescribing for a condition diagnosed over the telephone is risky for the doctor as well as for the patient. Even more dangerous is prescribing for a patient that one has never seen. There have been too many reports of addicts using tales of woe over the telephone to coax prescriptions for narcotics from sympathetic practitioners. The rule of never treating a stranger certainly applies in this situation. It is important that each of us becomes thoroughly familiar with the rules and regulations that apply to prescribing medications in our practice. Ignorance of these restrictions is no excuse when a violation occurs. We assume enough risk and responsibility in the practice of oral and maxillofacial surgery as it is, without the need to allow foolish, preventable errors in prescribing drugs to further complicate our professional lives.
One of the privileges granted to us by our license to practice dentistry is that of prescribing drugs. As with any other privilege granted by a regulatory body, however, it is subject to certain rules and regulations. Violation of these rules and regulations can result in disciplinary actions that can be punitive as well as humiliating to the practitioner. Fortunately, these occurrences can be avoided simply by being familiar with the various restrictions that apply to prescribing medications in the practice of dentistry. Although these may vary somewhat from state to state, most of the rules have general applicability . Probably the most frequent mistake made by the practitioner is to prescribe for oneself. This is a particularly serious violation when the medication prescribed is for a dentally unrelated condition. The same holds true when prescribing for family and friends. It is only permissible to prescribe for such persons when the medication directly relates to dental treatment, there is a bona tide dentist-patient relationship with the person, and the treatment and medication prescribed are documented in a patient record. Because the oral and maxillofacial surgeon is so frequently involved in the management of patients with associated medical problems, one becomes very accustomed to prescribing for such conditions. This raises the issue of where the practice of dentistry ends and the practice of medicine begins. Most dental practice acts define the use of drugs rather nebulously by restricting the dentist to those drugs directly related to clinical practice. Because such a definition is open to varying interpretations, it is probably best to always err on the side of conservatism. Moreover, although this definition still permits the prescribing of a wide variety of drugs, it is also sound practice to use only those with which one is thoroughly familiar and that are directly applicable to one’s scope of clinical competence. Although not directly related to the rules and regulations governing the use of drugs, there are a number of other precautions one should take in prescribing medications that can help prevent embarrassing situations as well as avoid possible medicolegal implications. One frequently hears stories about dentists carelessly leaving prescription pads in places readily accessible to patients and the re-
DANIEL M. LASKIN
111
Surg
49:111,1991
Dealing With Drugs sulting need to explain the flood of narcotic orders suddenly appearing at various pharmacies. This situation can become even worse when presigned prescription pads are stolen and there is the need to explain how a legal signature appeared on an illegal prescription. It is important to be efficient in the office, but not to the point of taking such a foolish risk. There are also certain precautions to take when writing legitimate prescriptions for patients. Oral and maxillofacial surgeons are particularly vulnerable in this respect because they often see patients for only one or two visits and, thus, do not become thoroughly familiar with them. Prescriptions must always be written in such a way that they cannot be altered. It is mandatory that prescriptions for narcotics be written in ink or indelible pencil. It is also advisable to write the number of tablets or capsules, as well as the number of refills, in such a way that it cannot be changed. As a further precaution, either a copy of the prescription or a written description of what was prescribed should be placed in the patient’s record. Providing verbal orders to the pharmacist should also be done with caution, and all such orders must be recorded. It is generally inappropriate to reorder old medications or prescribe new medications without first seeing the patient again. Prescribing for a condition diagnosed over the telephone is risky for the doctor as well as for the patient. Even more dangerous is prescribing for a patient that one has never seen. There have been too many reports of addicts using tales of woe over the telephone to coax prescriptions for narcotics from sympathetic practitioners. The rule of never treating a stranger certainly applies in this situation. It is important that each of us becomes thoroughly familiar with the rules and regulations that apply to prescribing medications in our practice. Ignorance of these restrictions is no excuse when a violation occurs. We assume enough risk and responsibility in the practice of oral and maxillofacial surgery as it is, without the need to allow foolish, preventable errors in prescribing drugs to further complicate our professional lives.
One of the privileges granted to us by our license to practice dentistry is that of prescribing drugs. As with any other privilege granted by a regulatory body, however, it is subject to certain rules and regulations. Violation of these rules and regulations can result in disciplinary actions that can be punitive as well as humiliating to the practitioner. Fortunately, these occurrences can be avoided simply by being familiar with the various restrictions that apply to prescribing medications in the practice of dentistry. Although these may vary somewhat from state to state, most of the rules have general applicability . Probably the most frequent mistake made by the practitioner is to prescribe for oneself. This is a particularly serious violation when the medication prescribed is for a dentally unrelated condition. The same holds true when prescribing for family and friends. It is only permissible to prescribe for such persons when the medication directly relates to dental treatment, there is a bona tide dentist-patient relationship with the person, and the treatment and medication prescribed are documented in a patient record. Because the oral and maxillofacial surgeon is so frequently involved in the management of patients with associated medical problems, one becomes very accustomed to prescribing for such conditions. This raises the issue of where the practice of dentistry ends and the practice of medicine begins. Most dental practice acts define the use of drugs rather nebulously by restricting the dentist to those drugs directly related to clinical practice. Because such a definition is open to varying interpretations, it is probably best to always err on the side of conservatism. Moreover, although this definition still permits the prescribing of a wide variety of drugs, it is also sound practice to use only those with which one is thoroughly familiar and that are directly applicable to one’s scope of clinical competence. Although not directly related to the rules and regulations governing the use of drugs, there are a number of other precautions one should take in prescribing medications that can help prevent embarrassing situations as well as avoid possible medicolegal implications. One frequently hears stories about dentists carelessly leaving prescription pads in places readily accessible to patients and the re-
DANIEL M. LASKIN
111
