The provision of a prescription to a patient is a medical act. It is the result of a clinical decision made by a physician subsequent to an evaluation of the patient by the physician. This evaluation should be based on a face-to-face encounter, subject to certain permissible exceptions which are set out in detail below. In the view of the College of Physicians & Surgeons of Newfoundland and Labrador, an appropriate medical assessment should normally include documentation of an appropriate history and physical examination; reaching a diagnosis; and deciding upon appropriate investigations and therapy. Patient records should clearly reflect that the pertinent elements of the patient evaluation have been completed.
When a medication is prescribed, physicians have a responsibility to advise the patient about such matters as the medication’s therapeutic effects, contraindications, precautions, adverse effects, possible drug interactions and any other information pertinent to the patient’s use of the medication. There is also an obligation for the prescribing physician to arrange appropriate follow-up.
In the view of the College prescribing for a patient solely on the basis of mailed or faxed information, or an electronic questionnaire, or countersigning a prescription issued by another physician, without direct patient contact, is not an acceptable standard of medical practice. The only exceptions would be generally accepted hospital and on-call group practices as described below.
The College would acknowledge that the prescribing or countersigning of a prescription by a medical practitioner, for a patient in the province, without that medical practitioner proceeding through all of the steps of a medical assessment outlined above, may be appropriate in the following circumstances:
(Note: All references to a "medical practitioner" in this paragraph and below should be read as a "medical practitioner licensed by the College and engaging in the practice of medicine within the province")
- In an emergency situation to protect the health or well being of a patient;
- In consultation with another medical practitioner, where that other medical practitioner has a continuing physician/patient relationship with the patient and agrees to supervise the patient's ongoing treatment, including the use of the prescribed medications;
- When providing on-call or cross coverage for the patient of another medical practitioner, where the patient has been medically assessed by that other medical practitioner, and where the on-call/cross coverage medical practitioner has access to the record of the patient for whom the prescription is issued;
- When providing on-call or cross coverage for the patient of another medical practitioner, where the patient has been medically assessed by that other medical practitioner, and where the on-call/cross coverage medical practitioner is able, on the basis of a telephone discussion with the patient or a representative of the patient, to reach an appropriate diagnosis that is consistent with good medical practice; or
- In the circumstance where a medical practitioner, on the basis of a telephone call with a person with whom the medical practitioner has a bona fide physician/patient relationship or a representative of that patient, is able to reach an appropriate diagnosis that is consistent with good medical practice.
Even in the above situations, a medical practitioner must be able to arrive at the opinion that, in the circumstances of that patient, the medical practitioner can safely issue or countersign the prescription.
See also “Policy regarding Prescribing Practices/Signing or Countersigning Extra-Provincial Prescriptions” and “Notice to Non-Resident Physicians concerning Prescribing for Patients outside of Newfoundland and Labrador”.