When a Curbside Consult Is a Liability Risk

Neil Chesanow

Disclosures

October 04, 2017

In This Article

Do's and Don'ts for Curbside Consults

To reduce the liability risk of participating in curbside consults, this advice is worth considering, if you are not already following it.

If you're a primary doctor who seeks information from a specialist, keep your questions simple, general, and brief. Michael Lin, MD, is a gastroenterologist at Baylor College of Medicine in Houston, Texas. A legitimate curbside consult question for him, he says, is, "What does quadruple therapy consist of?"[6] Or, "How many days should a patient be on a clear liquid diet before colonoscopy?"

"These questions can be answered without having the specialist elicit a detailed history, review laboratory results, or consider multiple confounding issues," Dr Lin explains.[6]

An example of an inappropriate question for a curbside consult would be, "What medication should I start for this patient with ulcerative colitis?"[6] Or, "Would you scope an 80-year-old woman?"

"These are questions that require far more details to provide a response and should not be addressed through a curbside consultation," Dr Lin says.[6]

"Frame responses in very general terms," advises Kim Baker, the trial lawyer.[2] She says that it is also wise to "suggest several possible answers, noting that all are dependent on the specific circumstances of a particular case."

Baker would go even further, including "disclaimer statements to emphasize that there is no formal consulting relationship."[2] For example, "As you describe it, I believe..., but without a more in-depth evaluation, I can't be sure."

She also warns against "evaluating test results of any kind and rendering a specific diagnosis."[2]

Some patient situations are inappropriate for curbside consults. The risk managers at Experix offer this advice: Do not ask for or give curbside consultations for patients in active labor, patients who are critically ill, or patients whose conditions are rapidly deteriorating.[4]

What about conducting a curbside consult by email, rather than face-to-face or over the phone?

"It doesn't matter whether the consultation is electronic or face-to-face," say Susan Shepard, RN, director of patient safety education, and Carol Murray, patient safety risk manager at The Doctors Company, a physician-owned malpractice insurer in Napa, California.[7] "The physician's duty to the patient is the same. However, the fact that email allows physicians who are miles—or states—apart to communicate can also lead to other issues, such as privileging, credentialing, and physician licensure in the state where the patient resides."

"Special concerns are posed by email, not the least of which is that a record of the communication is created, and distribution cannot be restricted," warns attorney Ray Kreichelt, JD, and colleagues.[8] Kreichelt is litigation claims manager at the Nemours Foundation in Jacksonville, Florida. "Email may mention the patient's name or attach portions of the patient's chart, including studies, which imply greater connection to the patient than would be warranted if the communication occurred in the hallway or by phone," he says.

"If communicating to an inquiry by email, physicians should be advised to take time to review what they are saying before they hit the 'send' button," urges Kreichelt.[8] Consultants, he adds, "should not suggest a greater degree of involvement with the patient than what is intended. A standard disclaimer paragraph can help make it clear that the writer is not giving advice regarding any particular patient, but rather is responding informally to a general inquiry and would be happy to see the patient formally in consultation."

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