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

equire a consultation before certain therapy begins. For instance, if a patient may
not be admitted to the coronary care unit without a cardiology consultation, the
general internist has a duty to obtain the consultation to provide the patient with the
needed care.
Often a physician must consult another physician to obtain a certain test for a
patient. The attending physician may believe that a specific cardiologist is skilled at
doing stress tests and cardiac catheterizations but is too quick to recommend bypass
surgery. In this case, the attending physician should let the patient know in advance
why his or her recommendations may differ from those of the consultant. The
attending physician should ensure that the cardiologist understands that this is a
consultation, not a referral. Conversely, the cardiologist may believe that the
attending physician is endangering the patient by downplaying the seriousness of
the condition. The cardiologist has a duty to inform the patient of this opinion, but it
is better if this is done in cooperation with the attending physician.
Physicians often obtain informal consultations from colleagues without appreciating
the legal significance of this process. Informal consultations are valuable and
should be used, but they have limitations. First is the patient’s right to privacy and
to choose physicians. An informal consultation should be anonymous. Any
information that would disclose the identity of the patient should be withheld. In
small communities, the physician should ask the patient to consent to an informal
consultation. The physician should ensure that informal consultations do not violate
any state or federal laws, as might be the case for substance abuse patients.
b) Patient Choice
Most practitioners are aware of the patient’s right to choose a physician for
consultation. In the outpatient setting, the patient is unlikely to go to another
physician if he or she does not want the consultation. A hospital patient has this
same right to choose whether another physician will be consulted. When a
consultation is considered, the patient should be informed and given the opportunity
to refuse the consultation or the consultant proposed.
When a patient refuses a necessary consultation, the physician should first
determine whether the refusal is based on financial concerns. If the patient’s insurer
will not pay for consultation, the physician has a duty to try to persuade the insurer
that the care is necessary. If this fails, the physician should try to persuade the
consultant to waive or reduce the fee. If the patient’s refusal is not based on
financial concerns, the physician should carefully explain (and document) the
necessity of the consultation. The problem then becomes the general problem of a
patient who refuses necessary care. Although the physician should try to continue
treating the patient, this may be impossible; the physician may be forced to
terminate the physician–patient relationship.
c) Using Consultants Properly
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