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Question

Difficulty: MediumPatient-Physician Relationship and Boundaries

A 34-year-old medical assistant working in a busy outpatient internal medicine clinic approaches the clinic physician at the end of the workday. She tearfully reports feeling increasingly depressed, fatigued, and anxious over the past three months due to severe marital difficulties. She explains that she has not established care with a primary care provider because of her demanding work schedule. The assistant asks the physician for a temporary prescription for sertraline to help her cope, stating, "I am familiar with the side effects of this medication, and I am legally competent to make this choice for myself." Which of the following is the most appropriate action for the physician to take?

  1. A
    Assess her clinical decision-making capacity and provide the prescription if she is determined to be competent
  2. B
    Review her medical history for pharmacologic contraindications and prescribe the medication if none are identified
  3. Politely decline the request to prescribe the medication and assist her in identifying an appropriate external providerAnswer
  4. D
    Provide a one-month prescription but document the encounter in a private, offline file to maintain her workplace confidentiality
  5. E
    Refuse the prescription and immediately notify the state licensing board regarding her inappropriate request

Answer

Politely decline the request to prescribe the medication and assist her in identifying an appropriate external provider.
According to the American Medical Association (AMA) ethical guidelines, physicians should generally avoid treating themselves, immediate family members, and clinic staff. Treating an employee creates a dual relationship that severely compromises medical objectivity. Furthermore, prescribing psychotropic medications, such as sertraline, to colleagues or employees is strongly discouraged due to the potential for coercion, the lack of a comprehensive psychiatric evaluation, and the blurring of personal and professional boundaries. The most professional action is to clearly but compassionately refuse the prescription while ensuring the employee is directed toward appropriate, independent medical care.

Step-by-Step Solution

1
Identify the ethical dilemma presented in the clinical scenario.
The physician is asked to provide psychiatric care to an employee (the medical assistant).
Recognizing the dual relationship (employer/colleague and physician/patient) is the essential first step in boundary management.
2
Evaluate the appropriateness of the requested medical intervention.
Prescribing psychotropic medication to staff violates ethical guidelines regarding dual relationships and medical objectivity.
Personal or professional closeness compromises objective medical judgment and introduces the potential for unintended coercion.
3
Determine the most professional and supportive course of action.
Decline the prescription request but offer guidance in finding appropriate care.
The physician must strictly maintain the professional boundary while still acting compassionately by directing the staff member to an independent healthcare provider.

Key Concept

Patient-Physician Relationship and Boundaries: Avoiding Dual Relationships
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Topics

Patient-Physician Relationship and Boundaries

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