Informal physician consults are known by a variety of different names, including curbside, hall and elevator consults. Physicians consult one another through face to face conversations, phone calls, emails or text messages. Informal consults are a generally accepted practice in the medical profession regardless of the communication method. Physicians often use consults to get a quick answer to a question or ask a colleague’s advice about a patient treatment plan. On the surface, informal physician consults look innocent, but there is an element of risk for both participating physicians.
An informal consult is defined as a conversation regarding patient care in which the consulting physician does not examine the patient, directly communicate with the patient or review the patient’s medical records. The consulting physician also receives no payment for the service and gives an opinion solely to the treating physician. The treating physician remains in control of the patient’s care.
Radiologists, pathologists, and cardiologists who interpret films, specimens, or other studies are not considered informal consultants. Any supervisor of the treating physician – such as in a teaching hospital environment – cannot serve as a consulting physician because supervisors have authority over the treating doctor.
Informal consults should not be conducted with any physician who has a pre-existing relationship with the patient or is actively covering for a physician who does have such a relationship. Although a doctor may never see or examine a patient while on call, a doctor-patient relationship is still established through the on call agreement. On call physicians caring for patients in the Emergency Department also fall into this category as established by the Emergency Medical Treatment and Labor Act (EMTALA).
A physician participating in an informal consult can be named in a malpractice proceeding, regardless of whether or not there is an established doctor-patient relationship. The consulted physician could be held liable if the patient in question has complications, unanticipated outcomes or is harmed based on the given advice.
However, the amount of exposure would likely be determined by the amount of control the consulting physician has over the patient’s treatment. In an informal consult, the physician seeking help remains free to use their own judgment in accepting or rejecting the consultant’s advice. The consulting physician is providing a service to his colleague, not directly to the patient. This limits the consulting physician’s exposure during malpractice litigation.
Physicians can reduce the liability risks of informal consults by keeping questions and answers simple, general and brief. If the discussion becomes too complex or requires documentation, stop the conversation and suggest a formal consult. Should litigation occur later, there could be disagreement regarding what was said and the advice given if there is no documentation of the conversation.
Use these recommended criteria to determine if an informal consultation is appropriate or a formal consultation is needed:
- Questions are for the general education/training of the requesting physician.
- Questions are not patient-specific.
- There is not a request to determine or confirm a diagnosis.
- The patient’s medical record is not reviewed and there is no request to review the patient’s medical record.
- There are no questions about ordering or conducting specific diagnostic testing.
- There are no questions about ordering, prescribing or administering specific medications/ treatments.
- Questions are generalized, straightforward and require only simple answers with non-specific advice.
- If any of the informal consultation questions go beyond the recommendations above, then a formal consultation should be requested instead.
Healthcare providers have learned that poor communication is one of the leading causes of bad outcomes and informal consultations are a major risk to patient safety. Effective communication of the patient’s complete clinical picture is critical in order to provide good clinical advice. When the consulting physician responds during an informal consultation without having all of the important details, they may provide medical advice that is not in the best interest of the patient.
Informal consults are very tempting in today’s busy world due to convenience and speed, but these factors should not trump patient safety. While informal physician consults are an accepted practice in most healthcare facilities, the truth is that the formal consultation process better protects both patients and physicians from adverse outcomes and litigation risks.
If you have any questions related to this newsletter, please contact: