Discretion and Liability

[MiaBlakley]

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I have a medicolegal question. How much discretion does an ER doctor have in discharging a patient? For example if a radiologist strongly recommends an MRI (because a CT scan shows symptoms of Cauda Equina Syndrome) and the ER doctor does not order the MRI, but instead discharges the patient...does the ER doc have the discretion to do that?

 

[Jeff698]

I have a medicolegal question. How much discretion does an ER doctor have in discharging a patient? For example if a radiologist strongly recommends an MRI (because a CT scan shows symptoms of Cauda Equina Syndrome) and the ER doctor does not order the MRI, but instead discharges the patient...does the ER doc have the discretion to do that?

Yes. Treatment of the patient is our responsibility and we have the authority to do it however we feel is appropriate.

We are, however, responsible for doing it wisely. If, for example, we're treating a patient with RLQ pain and get a CT which shows appendicitis, we have the ability to discharge the patient with no further care. It would be a really, really bad idea on many fronts to do so, but from a strictly technical standpoint, we could.

Radiology will frequently recommend follow up studies when dictating reports. Their recommendations are just that. We have no obligation, other than to the patient, to follow them. Many, many of their recommendations don't have anything to do with why the patient is in the ED and therefore can be followed up later.

Take care,
Jeff

 

[yaah]

As a reminder, the SDN forums are not intended for patient consultation or legal advice about medicolegal issues. If that is your purpose for being here, then please do not post further. Consult an attorney. If you are simply a new visitor (who is not a patient) who for some reason happened upon this forum and wants to discuss a relevant ER issue in the context of a highly specific case scenario, then please stay.

 

[skiz knot]

I have a medicolegal question. How much discretion does an ER doctor have in discharging a patient? For example if a radiologist strongly recommends an MRI (because a CT scan shows symptoms of Cauda Equina Syndrome) and the ER doctor does not order the MRI, but instead discharges the patient...does the ER doc have the discretion to do that?

A CT scan can not show symptoms of any disease.

As previously mentioned the ED doc has the discretion to DC any patient at any time. Additionally radiology reports often say a certain test may be warranted based on the clinical situation. Nobody would (should) order a CT scan if there is suspicion of Cauda equina, an MRI is the test of choice. If the patient did not have symptoms/signs of cauda equina (after careful and well documented history and physical) than an MRI is not warranted based on a CT scans findings.