In some cases, a physician-patient relationship is created even when the on-call physician does not personally examine or treat the patient. The on-call physician may be “treating” a patient jointly with the ED physician when:
- The physician interprets patient data such as labs, EKGs, or radiographic images
- The physician participates in diagnosing a patient and prescribing a course of treatment
- The ED physician must rely on the on-call physician’s expertise rather than exercising his or her own judgment in treating a patient
- A patient-physician relationship will probably not be found where:
- The on-call physician merely advises the treating physician as to general patient care
- The on-call physician is consulted only for a possible referral of a patient
- The treating physician exercises independent judgment in determining whether to accept or reject a consulting physician’s advice
Because this is such a gray area, the treating physician should communicate clearly what he or she needs or expects from the on-call physician. Unless it is otherwise clear from the circumstances, the on-call physician should presume that the ED physician is relying on his or her opinion. The on-call physician should advise the treating physician as thoughtfully as if the ED patient was his or her own.
When the on-call physician interprets data, makes a diagnosis, advises a specific course of treatment, and agrees to see the patient in follow-up as part of the treatment plan, he or she should document the conversation and any medical decision-making. If the ED physician has questions of a general nature, the sample language for curbside consults can be used. (See our article, “How to Appropriately Ask For-and Respond to-‘Curbside’ Consultations”.)
