How often are we told as doctors? You can’t do this. Don’t do that.
We are sometimes made to feel as if we are two-year-olds.
Now for the good news. An article published by Victor Cotton, MD, JD* pushes the opposite position. Curbside consults. If you follow the basics, you’re on safe ground. A breath of fresh air.
As a neurosurgical resident, we were cautioned to avoid curbside consults. Attending physicians admonished us to get the formal consult. At Ben Taub County Hospital, our service was busy. The internal medicine service was busy. Everyone was busy. The one commodity we did not have was time.
I was forced to use the following strategy to coax an internist to see my patient – one suffering from a head injury, in the Neuro-ICU, with a gazillion lines penetrating his skin and a blood sugar of 450.
“I know you are really busy and I hate to bother you. I have a patient with severe head injury and a blood sugar of 450. Do you give one amp or two amps of insulin?”
“What! Don’t do anything. We’ll see your patient in a matter of moments.”
Mission accomplished. The more stupid I sounded, the easier it was to get a consultant to the patient’s bedside.
That made no sense to me then. It makes no sense to me today.
The article concluded a true curbside consult does not create any actual liability for the consultant. You read that right. And that’s a breath of fresh air. Here’s the article’s definition of a true curbside consult. ALL criteria must be met:
- Is informal;
- Occurs between two physicians (neither of whom is subordinate to the other);
- Involves a consultant who does not have a preexisting doctor-patient relationship with the affected patient and who is not covering for someone who does;
- Does not involve an on-call consultant and the care of a patient who is in the emergency room;
- Does not involve any contact between the consultant and the patient;
- Does not result in the generation of a written report; and,
- For which no payment is received.
By the way, the internists mocked me for weeks for my limited knowledge of blood glucose management. Guess who had the last laugh.
*Cotton VR, Legal Risks of “Curbside” Consults, Am J Cardiol. 2010; 106(1):135-8. Epub 2010 May 13.
Related:
This is good news: two physicians are permitted to discuss care of a patient informally, subject to no fewer than SEVEN conditions? Please!
As unusal, Med. Justice lead by accomplished neurosurg Dr. Segal who is also a lawyer, gets right to the useful service and does more for me in one year, than the 60 years of AMA money sent to them from my medical family and I.
MJ is FOR PHYSICIANS. What an unusual idea in this world in which we are called to give more, do more, document more, be faster, know more and be self-LESS…….. to the point of profound life and emotional pleasure loss.
Good article.
Keep up your REAL defense of physicians.
Ian, seems to me one could summarize Dr. Segal’s advice as that one simply have a hypothetical, informal conversation on the subject.
What are comments upon the following? Radiology is different in that Radiologist does not see patient. When curbside was ony upon an x-ray and there was no written record there were no liability incidents that I recall. But now with complicated CT and MR and viewing of multiple exams, I have to make notes of the dates and findings. Years ago I would merely keep the notes in my private file and not send to dr. or any chart so that there could be no discovery by an atty. if in case there was a lawsuit. In recent years I send informal note to doctor and at the top state “this is a courtesy consultation to the physician and not a report to the patient.” (I also recommend to residents that if they are at a new job and dont want to irritate referring doctors they dont know with added exam recomendations, they can send informal notes to Doctors of their recommendations for follow up which they keep in a private file but not in the record. Then the referring doctor can keep the note and use it for justification, or discard the note and not have it on the record.)
Very useful information. Thanks.