visit our booking page to schedule a consultation – or use the tool shared below.
“Can Medical Justice solve my problem?” Click here to review recent consultations…
all. Here’s a sample of typical recent consultation discussions…
- Former employee stole patient list. Now a competitor…
- Patient suing doctor in small claims court…
- Just received board complaint…
- Allegations of sexual harassment by employee…
- Patient filed police complaint doctor inappropriately touched her…
- DEA showed up to my office…
- Patient “extorting” me. “Pay me or I’ll slam you online.”
- My carrier wants me to settle. My case is fully defensible…
- My patient is demanding an unwarranted refund…
- How do I safely terminate doctor-patient relationship?
- How to avoid reporting to Data Bank…
- I want my day in court. But don’t want to risk my nest egg…
- Hospital wants to fire me…
- Sham peer review inappropriately limiting privileges…
- Can I safely use stem cells in my practice?
- Patient’s results are not what was expected…
- Just received request for medical records from an attorney…
- Just received notice of intent to sue…
- Just received summons for meritless case…
- Safely responding to negative online reviews…
We challenge you to supply us with a medico-legal obstacle we haven’t seen before. Know you are in good hands. Schedule your consultation below – or click here to visit our booking page.
We open with some brief background: Our companion piece discussed the risks and best practices specific to curbside consultations – informal conversations with a colleague regarding a patient’s care. This piece will address risks specific to the curbside consultation’s “partner in crime” – casual care.
What is casual care? Broadly, casual care refers to informally consulting with an individual who is not your patient. A neighbor, a family member, a co-worker, etc.
If you have been dragooned into frivolous litigation due to a casual care experience, schedule a consultation with our Founder and CEO, Jeff Segal, MD, JD. Medical Justice is equipped to help you address a bevy of medico-legal threats, including sham peer review, medical board complaints, defamatory online reviews, and more. With that said, onto the main event.
Casual care is risky because it manifests in environments where doctors typically have their guards down. Consider the following examples of casual care:
Your child’s elementary school teacher asks you to comment on her chronic stomachache.
A neighbor thinks he’s twisted his ankle and wants to know whether he should head to the ER.
A family member wants you to comment on the efficacy of a certain prescription she just filled.
Several other examples certainly pop into mind, which is why casual care is so risky. Opportunities to engage are everywhere. And some doctors are hesitant to refuse these requests because they don’t want to deal with the social consequences. Refusing a stranger’s request is one thing, but family members (extended or otherwise) may take the rejection personally. The practices outlined in this piece will teach you how to extend a helping hand while limiting the risk to your own neck.
We’ve condensed our best practices into six key points, which we’ll touch on shortly. We open with the following suggestion: To reduce the risk you’ll get bitten by casual care, act as their doctor, not as their pal.
You know the protocols – just keep to them. Don’t write prescriptions blindly. Don’t speculate if the questions drift outside your realm of expertise. And if the question would be better (and more safely) answered in your office, invite the individual into your practice.
We recognize that’s easier said than done. The best practices outlined below (supplemented by examples) will shed some light.
Legally, there is no such thing as “casual care.” There is only care – and the standards that define it.
If there’s a bad outcome, and the patient believed you were acting as his doctor, that’s usually enough to turn the tide against you. The severity of the patient’s inquiry also plays a role. If your neighbor asked you to interpret data specific to a serious health issue, your willingness to do so may signal to the court that you acted as your neighbor’s physician. For example, if, you, as an endocrinologist agree to help your neighbor interpret reports specific to his blood sugar, expect the courts to tether you to this individual.
We’ll repeat this next point several times before the piece concludes, and you’ll read it here first: Do not prescribe in the casual care setting. Doing so tethers you to the individual for whom you’ve written the prescription. There will be no excuses in the event of a bad outcome – if you write an individual a prescription, he/she is now your patient.
Protect your neck by “re-routing” a risky, informal conversation to a more formal setting – such as your office. If not your office, treat the visit with the same formality as if it were your office. Treat the individual as a patient and memorialize all details of the visit.
Don’t let a “change of scenery” throttle (compromise) your judgment.
Doctors are more approachable at a house of worship, a grocery store, or a parent-teacher conference than they are in a professional setting. People (who are not your patients) feel empowered to approach you in these settings – after all, as far as they are concerned, you are “off the clock.”
Anticipate how your own judgment and internalized protocols will be affected by the change of scenery. Your brick-and-mortar practice and lab coat don’t make you a doctor – the sum of your training, education, and real-world experiences make you a doctor. There’s no reason why the protocol should change because the “patient” stumbled upon you outside of your traditional work environment.
If you aren’t confident you can render professional-level care outside of the office, don’t be shy about it. Tell the person their care is a serious matter. Therefore, it makes sense to move the conversation to a more serious setting – your practice. And if you cannot be impartial (because of blood or familial ties), set this expectation upfront.
Treating family or friends can compromise your judgment. Know your state’s regulations. Follow your state’s regulations.
While strangers/neighbors request casual care all the time, we’ve found that the care of friends and family creates the most risk for doctors. Why? It is among these individuals that your ability to make impartial, clinically driven decisions is most affected.
Ask yourself: Could you operate on your mother? We understand you are likely (hopefully) not operating on anyone in a casual care setting, but the same principle applies.
Remember: Blood may be thicker than water, but plaintiff’s attorneys are attracted to the smell of blood.
visit our booking page to schedule a consultation – or use the tool shared below. With that said, we return to the piece.
“Can Medical Justice solve my problem?” Click here to review recent consultations…
all. Here’s a sample of typical recent consultation discussions…
- Former employee stole patient list. Now a competitor…
- Patient suing doctor in small claims court…
- Just received board complaint…
- Allegations of sexual harassment by employee…
- Patient filed police complaint doctor inappropriately touched her…
- DEA showed up to my office…
- Patient “extorting” me. “Pay me or I’ll slam you online.”
- My carrier wants me to settle. My case is fully defensible…
- My patient is demanding an unwarranted refund…
- How do I safely terminate doctor-patient relationship?
- How to avoid reporting to Data Bank…
- I want my day in court. But don’t want to risk my nest egg…
- Hospital wants to fire me…
- Sham peer review inappropriately limiting privileges…
- Can I safely use stem cells in my practice?
- Patient’s results are not what was expected…
- Just received request for medical records from an attorney…
- Just received notice of intent to sue…
- Just received summons for meritless case…
- Safely responding to negative online reviews…
We challenge you to supply us with a medico-legal obstacle we haven’t seen before. Know you are in good hands. Schedule your consultation below – or click here to visit our booking page.
No state categorically forbids doctors from treating family and friends – but most discourage it. Why? The precedent for medical errors is great. And prescribing is particularly onerous. To cite a specific example: the state of Montana notes that prescribing for family members is held to “arguably…not meet the general accepted standards of practice, and is therefore unprofessional conduct [that] may subject the physician to license discipline.” The idea is that treating friends and family creates too much risk. Your judgement is most likely to be compromised by your complex relationships with these individuals, which makes it harder for you meet/exceed the standard of care.
While language is rarely exact across all states, what does exist is uniform. Therefore, keep your own protocols uniform, regardless of your relationship with the patient. Take medical and drug specific histories. Review treatment benefits and prescription side-effects. And incorporate a complete exam.
Certainly, there are times when treating a family member makes sense. A refill if the patient is under the care of another doctor and is not timely responding. Or the matter is urgent, and time is of the essence – and your care is the best near-term option. Treat the matter formally.
We echo ourselves to the hundredth power: Do not cut corners.
Keep to your expertise.
Put another way: Stay in your lane. You should expect instances of casual care to challenge you. They are informal by nature and unrehearsed. The “patients” encountered in casual care settings may not know the details of your specialty. They likely won’t care. They just want help (and perhaps a free lunch). Resist the temptation to speculate, even at the risk of being perceived as ignorant. In casual care, it’s better to appear thoughtful but ignorant than to speculate and create your own undoing.
And here’s yet another reason to avoid speculation. If answering your neighbor’s question requires stepping outside of your area of expertise, the efficacy of your answer will be held to the same standards of care that would be applied to an expert in that field.
For example – if your cousin asks you (a dermatologist) to interpret a report that really ought to be discussed alongside a neurosurgeon (and you do so anyway), you’ll be held to the same standards as a neurosurgeon. Unless you want to risk a very uncomfortable walk in your colleague’s shoes, eliminate the guesswork.
Do not prescribe in “casual care” settings – unless you want to accept the recipient as your patient. This applies to controlled substances and more benign prescription medication.
As we stated earlier, prescribing in the casual care setting is almost guaranteed to tether you to the recipient. If you don’t intend to treat that individual as your patient, do not write them a prescription.
Treat anything revealed in the “casual care” setting as confidential and subject to HIPAA.
This harkens back to a separate point we’ve repeated throughout this piece: Don’t deviate from established protocols. This logic applies to HIPAA and patient confidentiality just as much as it does the standards of care. To reduce the risk of a bad outcome, treat the “casual encounter” no different than a formal encounter with a patient in your office setting. Document everything. Keep the matter private. If you do elect to write a prescription, document it alongside any recommendations, referrals, or follow-up statements. Treat the matter as confidential. And if you cannot recommend retaining the patient, document this as well. In the event of a bad outcome, detailed record-keeping can cut you out of a net cast by a plaintiff’s attorney.
The ultimate irony: The only way to do casual care “right” is to treat the individual without becoming his or her doctor. But in order to do your job “right” (and minimize potential risk), you must invoke the doctor-patient relationship.
Our advice? Avoid casual care where you can. And when/where you cannot avoid it, reroute the discussions to your office.
If you have been dragooned into frivolous litigation due to a casual care experience, schedule a consultation with our Founder and CEO, Jeff Segal, MD, JD. Medical Justice is equipped to help you address a bevy of medico-legal threats, including sham peer review, medical board complaints, defamatory online reviews, and more. What are your experiences with casual care? Let us know in the comments below.
visit our booking page to schedule a consultation – or use the tool shared below.
“Can Medical Justice solve my problem?” Click here to review recent consultations…
all. Here’s a sample of typical recent consultation discussions…
- Former employee stole patient list. Now a competitor…
- Patient suing doctor in small claims court…
- Just received board complaint…
- Allegations of sexual harassment by employee…
- Patient filed police complaint doctor inappropriately touched her…
- DEA showed up to my office…
- Patient “extorting” me. “Pay me or I’ll slam you online.”
- My carrier wants me to settle. My case is fully defensible…
- My patient is demanding an unwarranted refund…
- How do I safely terminate doctor-patient relationship?
- How to avoid reporting to Data Bank…
- I want my day in court. But don’t want to risk my nest egg…
- Hospital wants to fire me…
- Sham peer review inappropriately limiting privileges…
- Can I safely use stem cells in my practice?
- Patient’s results are not what was expected…
- Just received request for medical records from an attorney…
- Just received notice of intent to sue…
- Just received summons for meritless case…
- Safely responding to negative online reviews…
We challenge you to supply us with a medico-legal obstacle we haven’t seen before. Know you are in good hands. Schedule your consultation below – or click here to visit our booking page.
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Jeffrey Segal, MD, JD
Chief Executive Officer and Founder
Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.
Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.
Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.
In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.
Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. With decades of combined experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.
If only I had one penny for every instance where a free consult aka casual care has been asked of me ….
It is a great pity that we live in such a litigious society. Consulting for friends and family is a time honored tradition that goes back centuries.
In today’s environment one must be extremely cautious about prescribing for friends and family and one is advised not to do it at all, especially for controlled substances. A friend of mine, now retired, prescribed a controlled substance, on a one time script for a daughter in law, and the state authorities stepped in because the last names were the same.
If one must prescribe at all, it should only be for immediate family, ie spouse, children, for a one time prescription, and one better have the appropriate documentation to back it up.
Arguably one is going to take better care of one’s immediate family than just about anyone else, within one’s area of expertise, due to the relationship. But some physicians take things very casually so that is why the legal and state authorities got involved– because of substandard care from the casualness of the setting. If one orders an Xray or other diagnostic test then again, one must have some type of office record to demonstrate the need for such a test. This is all due the scrutiny physicians are under these days.
Given that much care today is provided by mid level practitioners, the level of care provided by a physician relative is higher, just because of the higher level of education and training. My daughter in law goes to an urgent care facility for a cold, mild, with no wheezing, and gets a Zpack, steroids, and an inhaler. This happens over and over again. It should be considered malpractice because there is no indication for any of the treatment. But it passes as acceptable care because a nurse practitioner prescribes it. Do I want to jump in. Yes. Do I do so. No. I’ll answer general questions, but I hate to be in the position of contravening a “nursing professional”. One could be accused of slander if one says that the care was “substandard”. Better just to be silent to the extent that one can with great restraint, to the dumming down of medicine.
How is it Chiropractors can misdiagnose and mistreat things constantly and not get sued? Are they under a different standard?