Public Health Law Map - Beta 5 - Medical and Public Health Law Site

c) Informal Consultations
One of the banes of physicians is the curbside consult. These are best handled in the
same way as a telephone call. A nonpatient who needs care should be referred in a
manner appropriate to the urgency of the presenting condition. If the physician
consults with a patient, appropriate records should be kept. With one caveat,
informal consultations should be documented in the same manner as telephone
calls. When a person telephones a physician, that person has demonstrated a much
greater level of concern than someone who just makes conversation with a
physician at a party. All telephone calls should be documented, but it is not
necessary to record every social conversation that turns to a person’s medical
condition. The physician should record substantive discussions with existing
patients in the patient’s medical record and any consultations in which he or she
recommended treatment or referred the patient for evaluation of an emergent
condition.
3. Financial Considerations
The most common reason for refusing to accept a patient is the patient’s potential
inability to pay for the necessary medical services. Patients should be given some
indication of the financial requirements when they make an appointment for
treatment to prevent them from delaying making other arrangements for care while
waiting for an appointment at which they will receive no treatment. A defensible
decision not to accept a patient for financial reasons can appear questionable in
retrospect if the person was injured by the subsequent delay in receiving medical
care.
Some physicians will not treat certain individuals or classes of patients. Perhaps the
most common restriction is refusing to treat patients involved in accidents that will
lead to litigation. Some physicians refuse to treat attorneys. Many obstetricians
refuse to treat a pregnant woman who first seeks care after the sixth month of
pregnancy. These decisions are shortsighted in a competitive market and ethically
questionable in a market where they may make it difficult for the affected persons to
obtain care; but they are not illegal.
4. Assisting at Accidents
A physician has no duty to help an injured or sick individual unless there is a
preexisting physician–patient relationship or other statutory or contractual
relationship. Although morally reprehensible, it is not illegal for a physician to drive
past the scene of an accident where his or her services could be lifesaving or to
refuse to provide cardiopulmonary resuscitation to a fellow diner at a restaurant. If
the physician does choose to help, there is one central rule for volunteers: do not
make the victim worse off.
The classic legal example is the person drowning in a lake. There are several boats
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