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.