Convenience is a powerful, invisible force in our daily life. We take the elevator because it’s quicker or more accessible than the stairs. We grab fast food for lunch because it’s easier than meal prep the night before. These easy way out examples of day-to-day life may seem inconsequential, but convenience has the power to influence important decisions, especially when it comes to health care and insurance.
For busy physicians, the ease of self-prescribing or having a coworker or physician spouse prescribe medication is far more efficient than the hassle of scheduling a proper doctor’s appointment. When we are sick, we often know the problem, and we know the appropriate treatments. Because of this, it’s easy to cut corners in the name of getting back to our important work. The faster we get better, the faster we can serve our patients.
Several studies have analyzed the number of physicians who self-prescribe and treat non-patients – people treated outside a formal office relationship often without documentation. Between 52 percent and 84 percent have actively participated in these activities.
Dealing with a sick parent and can’t sleep? Ask a coworker for an Ambien prescription to get you through the night. Contracted a severe case of poison ivy while camping with the family? Your physician spouse can call in some prednisone. Has residency been challenging? Trade SSRI scripts with your coresident. Forgot to schedule your follow-up, and your Lexapro is about to run out? Call in your own refill. Most physicians think, “How bad can it be? It’s not a narcotic.” Well, I thought the same thing when I was practicing.
Other studies have supported these speculations, reporting that the most commonly used medications in these contexts have been antibiotics, antihistamines, and contraceptives.
Most of these medications seem harmless enough. We are all so busy; who has the time to schedule an appointment, find a backup, or worse, cancel patients? Then what happens to our Press Ganeys?
When it comes to obtaining disability and life insurance, convenient actions in the present can cause inconvenient roadblocks in the future.
Insurance carriers will check your pharmacy history for the last five to seven years, and the medications they find will spark medical record searches. Prescriptions without a paper trail, especially antidepressants, anxiolytics, sleep agents, narcotics, weight-loss medication, steroids, and infertility medication, can cause many difficulties during the underwriting process. If you’re ultimately declined personal life insurance, there is no stopgap. However, there is a chance you may still have access to group life insurance as part of your employer benefits, so be sure to review your policy.
Self-prescribing often leads to automatic declinations with traditional carriers. Carriers often view acts such as self-prescribing or having scripts with no paper trail as you not receiving proper care, follow-up, or that you are trying to hide something.
If you are declined disability insurance coverage with a traditional carrier, you will have to attempt to get coverage with the non-traditional ones as a stop-gap. These policies are inferior in several essential areas. The most important in this scenario is that they have limited terms and benefit periods.
If you incur an illness or injury that disables you during the policy term, the carrier is only responsible for paying out a limited benefit period, often three to five years. The traditional carriers often mandate at least two years of good behavior before they entertain your file again. You will need to establish care with a physician, have regular visits, and take no medications without documentation.
There are some gray areas as to what’s acceptable and what’s not at the legal level. With that, research has shown that most American physicians aren’t aware of ethical guidelines for non-patients. One section of the AMA Code of Medical Ethics states that “physicians generally shouldn’t treat themselves or members of their immediate families” because “professional objectivity may be compromised.” This is what happens when personal feelings get in the way of their professional judgment which, in turn, could interfere with the integrity of the care provided.
However, there are exceptions. The only acceptable reason, as explained by the Journal of Ethics, to bend that rule is in the case of “short-term, minor problems” or in “emergency or isolated settings.”
Depending on where you practice medicine, some states are more strict than others. For instance, North Carolina specifies that the “physician must prepare and keep a proper written record of that treatment.” In Virginia, “records should be maintained of all written prescriptions or administration of any drugs.”
All in all, this shouldn’t be a significant stressor in your life if you continue to make it a priority to stay informed about what’s allowed where you practice.
In any case, the next time you’re feeling under the weather, it might be wise to take the time to schedule an appointment with a medical professional. The next time your colleague asks you to call in a quick script, remember to let them know that it could be a problem later. Although it can feel inconvenient, these small actions can ensure that obtaining disability or life insurance is a seamless experience.
And since we are playing the long game here, commit to making the small decisions that add up to a healthy life over time. The next time you see the stairs, take them, just because it’s better for your health. The next time you crave fast food, pack a few healthy snacks in your bag to eat on the go. In that same breath, the next time you think of asking a friend or spouse to write you a script, schedule an appointment!
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Stephanie Pearson, MD, FACOG
CEO and Insurance Advisor
Stephanie Pearson, MD, FACOG brings the experience of a physician into the disability and life insurance market. Injured in the prime of her career, the Board Certified OB/GYN took an unexpected journey to becoming an advocate and advisor for physician insurance.