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

problematic because consultants such as pathologists and radiologists mistakenly
assume that they work for the attending physician rather than the patient.
1. Obtaining a Consultation
Virtually every physician sometimes relies on specialty consultants because of the
nature of modern medical practice. No physician can be all things to all patients.
Consultations can offer patients the comfort and continuity of receiving care from a
single physician, while benefiting from the expertise of specialists. The attending
physician benefits from the help and advice of other physicians but retains the
primary relationship with the patient.
Consultations have two functions. More commonly, they allow physicians to manage
problems that require additional expertise but are within the physician’s general area
of skill. They are also useful in helping physicians determine if a patient’s problem is
beyond their skills or available facilities, thus necessitating a referral. The
consultation itself does not transfer the responsibility for the patient’s care, but the
consultant does assume certain duties to the patient. Since the primary physician
retains the responsibility for the patient’s care, it is this physician, not the consultant,
who makes the final treatment decisions. Responsibility becomes an issue only when
the consultant and the attending physician disagree about the proper course of action.
The attending physician’s better knowledge of the patient and the history of the
condition may lead him or her to decide against the recommendations of a
consultant, or the attending physician may find that the consultant is not as
knowledgeable or skilled as was thought at the time the consultation was requested.
When the attending physician disagrees with the consultant, both parties should
discuss the disagreement with the patient and their reasons for recommending
differing courses of action. It is best for the attending physician and the consultant to
talk with the patient at the same time. In discussing the differing recommendations, it
is important to differentiate between facts, such as laboratory tests, and opinions,
such as interpretation of a panel of tests. This avoids misunderstandings and can
sometimes result in a negotiated care plan that meets the needs of all parties. The
attending physician should consider a second consultation, but this should not be
seen as a poll of the best two out of three. No matter how many consultations are
obtained, the medical responsibility remains with the attending physician. It is
critical, however, to obtain the patient’s informed consent when choosing to ignore
the recommendations of a consultant. If the patient decides to follow the advice of
the consultant rather than that of the attending physician, the latter should discuss
whether the patient needs a different attending physician.
a) Requesting a Consultation
In most cases the decision to ask for a consultation is a medical judgment. A
physician who believes that the patient’s care would benefit from another opinion
should ask for a consultation. Sometimes hospital or insurance company rules
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