Curbside consults

[deathmerchant]

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I have a question for attendings or if someone has had similar issues.

I’ve been getting called, for curbside consults, by our ER docs who do shifts at other hospitals ( from outside ERs); where I don’t work.
Assuming that I don’t mind helping someone out if they have a question- are there any negatives to doing it. Especially medico-legal.

Like, if a bad outcome happens, can I be liable ? I know theoretically it sounds like I could be, but I want to hear something realistic or if someone has personal experience.
Thanks

 

[Merely]

Someone from a different hospital is calling you to ask about a pt? That seems like a horrible idea

 

[Naruhodo]

A doctor I know kindly offers to do this for trainees who take jobs at other institutions. She has 3 rules about her free consults, 2 of which I'm currently forgetting but the 3rd one is "Never put my name in a patient's chart". I imagine that has to do with the medico-legal aspects.

I think she realizes she's a rare specialist in a small field who could never possibly see all the patients that might benefit from her knowledge, but she is also experienced enough to know the ultimate responsibility for a patient is with the person seeking the consult and deciding the plan.

 

[GuillainMollaret]

I personally wouldn't risk it. If there's a bad outcome then there's a good chance you'll be blamed. You don't even work at those hospitals which also opens up a huge can of medicolegal worms.

 

[deathmerchant]

A doctor I know kindly offers to do this for trainees who take jobs at other institutions. She has 3 rules about her free consults, 2 of which I'm currently forgetting but the 3rd one is "Never put my name in a patient's chart". I imagine that has to do with the medico-legal aspects.

I think she realizes she's a rare specialist in a small field who could never possibly see all the patients that might benefit from her knowledge, but she is also experienced enough to know the ultimate responsibility for a patient is with the person seeking the consult and deciding the plan.

That is what I have been thinking about. If I tell them something like “this is just curbside advice and not a consult; don’t mention my name or that you consulted me And add a disclaimer that refer to your neurologist on call or transfer to a place with one” may be it’s ok?
And I think you are right that ultimate responsibility is with the person seeing the patient, but knowing the medico-legal system they try to suck in as many people as they can.

 

[Algor]

I have a question for attendings or if someone has had similar issues.

I’ve been getting called, for curbside consults, by our ER docs who do shifts at other hospitals ( from outside ERs); where I don’t work.
Assuming that I don’t mind helping someone out if they have a question- are there any negatives to doing it. Especially medico-legal.

Like, if a bad outcome happens, can I be liable ? I know theoretically it sounds like I could be, but I want to hear something realistic or if someone has personal experience.
Thanks

I would not give any sort of advise to any ER docs unless I am on-call for that particular hospital. It is a good chance that you name will be placed in the chart. In the best case scenario, I would not give any advise at all without official consultation and seeing the patient, however, it is not always realistic. Particularly, I never give a clearance to discharge without seeing the patient. Actually, this is ER doctor's job to determine who can be discharged and who needs to be admitted for further work up. I usually say: "Since I do not have all details of the case, I suggest an official neurology consultation". If this is a case within tPA/endovascular window, then you need to be EXTRA cautious. But I would not give ANY advises to any doctors who calls me from the hospital I am not currently covering. This may not be covered by your malpractice insurance as well. Saying: "don't put my name on the chart" sound a little bit defensive, like you are trying to hide something, and you still have no control if they follow your instructions.
Imaging this situation when plaintiff's lawyer talking to the jury: "Look at this negligent neurologist who told to discharge the patient without even examining and seeing the patient and the patient died next day from stroke/GBS/myasthenic crisis/seizure and has 9 kids left". Not good, hah?
And yes, I know people who got in trouble for being too nice.
Just my 2c.
And disclaimer: this is not a legal advise and I am not a lawyer lol
Good luck

 

[deathmerchant]

I would not give any sort of advise to any ER docs unless I am on-call for that particular hospital. It is a good chance that you name will be placed in the chart. In the best case scenario, I would not give any advise at all without official consultation and seeing the patient, however, it is not always realistic. Particularly, I never give a clearance to discharge without seeing the patient. Actually, this is ER doctor's job to determine who can be discharged and who needs to be admitted for further work up. I usually say: "Since I do not have all details of the case, I suggest an official neurology consultation". If this is a case within tPA/endovascular window, then you need to be EXTRA cautious. But I would not give ANY advises to any doctors who calls me from the hospital I am not currently covering. This may not be covered by your malpractice insurance as well. Saying: "don't put my name on the chart" sound a little bit defensive, like you are trying to hide something, and you still have no control if they follow your instructions.
Imaging this situation when plaintiff lawyer talking to the jury: "Look at this negligent neurologist who told to discharge the patient without even examining and seeing the patient and patient died next day from stroke/GBS/myasthenic crisis/seizure". Not good, hah?
Just my 2c.

Thanks for the input. I agree with what you say; but that is ideal case scenario. For the hospital i cover, Im on call 24/7. I don't think its possible for me to Not give advice without seeing the patient. Ill have to go to ER every night! Majority of hospitals in the country don't have 24/7 neuro coverage. You have to trust ER and IM docs and know what questions to ask. I try to figure out which doc is reliable and who is not.

My main question is ;For outside hospitals, lets assume, they are reliable and lets assume they don't write my name and it is indeed a curbside consult- can I get in trouble despite that??

 

[Algor]

It is hard for me to answer because I do not trust neurological exam done by even the best ER or IM doctors. But in my opinion, you potentially can get in trouble. Even if your name is not in the chart, it can be discovered during deposition or pre-trial investigation.

 

[Telamir]

I personally would not provide ANY curbside advice to anyone who is in another hospital that I do not hold privileges with, let alone if it crosses state lines.