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

any differences of opinion between the physicians and the basis for the difference.
The last should be done clearly and factually, without subjective comments. The
chart should reflect that the attending physician appreciated and differed with the
consultant’s findings. Neither party should denigrate or belittle the other’s analysis.
Offhand remarks can take on unintended significance when presented in a legal
proceeding.
2. Referral
A referral is the correct choice for a physician when a patient’s condition requires
care that the attending physician cannot provide—perhaps because of a lack of
proper facilities, because it is an area in which the physician lacks sufficient training,
or because the physician does not choose to practice medicine in that area. By a
proper referral, the original physician may shift the responsibility for the patient’s
general care or refer the patient only for specialty treatment. In either case, the
physician who accepts the referral accepts responsibility for care of the patient.
A physician may refer a patient for specialty care without transferring all
responsibility for care. For example, a pediatrician may refer a patient to an
otorhinolaryngologist for evaluation and insertion of tympanotomy tubes. This
referral is necessary if the pediatrician lacks the training and surgical privileges
necessary to provide the needed service. The referring pediatrician could remain the
primary physician for the child’s preventive care and for other acute problems.
After the surgery and necessary postoperative care, the otorhinolaryngologist sends
the child back to the referring pediatrician. However the responsibility for the
patient’s future care is allocated, it is critical that the physicians involved understand
their continuing areas of responsibility. The pediatrician should not assume that the
otorhinolaryngologist will provide general medical care to the child; the
otorhinolaryngologist should not assume that the pediatrician can manage
postoperative complications. Both physicians must take responsibility for the care of
the whole patient, with each concentrating on his or her appropriate area of expertise.
The referring physician has a limited duty to ensure the competence of the receiving
physician. This is primarily a duty to determine if the physician provides the type of
care the patient requires. If the referring physician has reason to believe that the
receiving physician is incompetent, there may be liability for negligently selecting
the receiving physician. This is a problem in MCOs that dictate the panel of referral
physicians. While the primary physician may have no control over the referral, the
court may find that there is still a duty to not refer to a physician who is known to be
incompetent. If there are questions about the appropriateness of the referral, the
referring physician should follow the patient’s progress until he or she is confident
that the patient is receiving appropriate care.
a) Duty To Refer
A physician may have the personal skills necessary to provide certain types of
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