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

will of attending physicians for referrals. Specialists who took patients from
primary care physicians by turning consultations into referrals saw their
consultations dry up, as did those who questioned the probity of the attending
physician’s care of the patient. The law, however, insists that the consultant’s
primary duty is to the patient, not the treating physician: the attending physician is
seen as the patient’s agent, with the delegated authority to hire other physicians on
the patient’s behalf.
A physician who is requested to consult on a particular case that involves contact
with the patient must first establish a physician–patient relationship with the
patient—usually accomplished by an introduction to the patient and an explanation
of the consultation requested. A consultant should not assume that the patient has
consented to the consultation simply because the attending physician has requested
it. Consultants should not rely on blanket consents such as those that authorize
treatment from “Dr. Smith and other physicians he or she may designate.”
Although these are adequate for radiology and pathology consultations and others
that do not require direct patient contact, they should be avoided by other
consultants. Observing the courtesy of consultation is important. Treating the
patient rudely increases the probability of a lawsuit if anything goes wrong and will
encourage the patient to refuse to pay for the consultant’s services if they are not
fully covered by insurance.
The consultant should explain the nature of the consultation and any tests or
procedures that will be done. It is wise to make sure that the expectations of the
patient and the attending physician are not unreasonable. The consultant should
dissuade the patient from the idea that specialists can work miracles. A patient who
has a close and long- standing relationship with his or her attending physician is
likely to blame the impersonal consultant for problems that arise. This is
sometimes implicitly encouraged by attending physicians, who may oversell the
consultant’s services.
Consultants should do a complete evaluation of the case as soon as the patient
accepts the consultation: reviewing the patient’s chart, examining the patient fully,
and talking with both the patient and the attending physician. Relying on
information gathered secondhand is dangerous. The assumption in bringing a
consultant into a case is that the attending physician is not as skilled or as
knowledgeable about the problem as the consultant. This makes it unacceptable to
rely entirely on the history and physical in the chart. Items critical to the specialty
consultation should be verified by the consultant.
b) Tests and Procedures
Consultants who conduct tests or procedures on a patient must first obtain proper
informed consent. They must inform the patient of any risks involved and any
available alternatives. In the case of diagnostic tests, the patient should be told
about the reliability of a test and whether it will make any difference in the choice
of therapy. A patient is likely to be angry if he or she is injured by a test that is of
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