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

diagnostic interest to the physician but has no bearing on how the patient will be
treated. Informed consent to dangerous tests is sometimes complicated by the
unwillingness of the attending physician to acknowledge the risks of the procedure,
thus undermining the consent obtained by the consultant.
Consultants should always determine for themselves if any contraindications exist
to a particular procedure or therapy. For example, it is not a defense to say that the
chart did not record that a patient was allergic to iodine. The radiologist is
responsible for taking an adequate history to determine that it is safe to do an
iodine dye study. And the nephrologist who orders an intravenous pyelogram (IVP)
should personally ascertain that the patient is not dehydrated, is not pregnant, and
is not allergic to the dye. The legal expectation is that all the physicians involved in
the procedure will exercise caution to prevent avoidable injuries to the patient.
The results of tests and the recommendations of the consultant must be transmitted
to the attending physician in a manner consistent with the urgency of the patient’s
condition. For example, a cardiologist who reads all electrocardiograms in a
hospital may have the reading posted on the chart by the next morning. If a routine
ECG turns out to have a life-threatening arrhythmia on it, the cardiologist must
ensure that the patient is treated immediately. This duty is not discharged by noting
the arrhythmia on the report and sending the report to the patient’s chart, to be seen
many hours later.
c) Informing the Patient
Consultants who personally examine and talk to the patient have a duty to make
sure that a patient is informed about the results of the consultation. Since a
consultation is intended to assist the attending physician in making medical
decisions, it may seem that informing the attending physician should be sufficient.
It may not be when the consultant has established a direct physician–patient
relationship with the patient. Discussing findings with the patient gives the
consultant the opportunity to ensure that his or her recommendations and findings
are known and understood by the patient. It also gives the consultant the
opportunity to withdraw explicitly from the case and relinquish responsibility to the
attending physician. This gives the patient and the nursing staff a clear
understanding of who is in charge of the care of the patient.
Sometimes a consultant has a duty to intervene in a patient’s care. In the case of the
cardiologist who discovers a life-threatening arrhythmia, it is unlikely that the
patient or the attending physician will object to emergency orders if the attending
physician is not available. When the attending and consulting physicians do not
agree, the consultant usually should not countermand the orders of the attending
physician. It is best to discuss the problem with the attending physician before
talking to the patient. The attending physician may be able to provide additional
information or insight that will obviate the disagreement. If the consultant and the
attending physicians still disagree, the consultant must fully inform the patient, or
the person legally authorized to consent to the patient’s medical care, about the
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