The AAP Committee on Medical Liability and Risk Management understands and supports the benefits of tobacco use cessation. We were asked, however, by an AAP Fellow specifically about potential medicolegal risks of a pediatrician prescribing nicotine replacement therapy (NRT) to parents and provided an answer in a Pediatricians and the Law article (http://www.aappublications.org/news/2016/03/25/Law031016).
While Susanne E. Tanski, M.D., M.P.H., FAAP, notes in her letter to the editor (http://www.aappublications.org/news/2016/04/21/LTE042116) in response to the article that serious adverse effects are rare, side effects are actually quite common.
Prescribing a medication creates a physician-patient relationship and a consequent legal duty toward the patient. This would include appropriate screening, informed consent and documentation. Additionally, a patient may reasonably expect that he or she could call the prescribing physician about side effects, which may be outside the scope of practice for a pediatrician and therefore not covered by malpractice insurance. The fact that a medication is available over-the-counter makes no difference from a liability perspective.
We agree that tobacco use by a pediatric patient is within our scope to treat and prevent. While we also support encouraging parents to quit using tobacco products, pediatricians need to be aware of the medicolegal implications in order to manage those risks.
Member of AAP Committee on Medical Liability and Risk Management
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