Our Risk Management team regularly monitors our members’ practice trends to proactively identify potential risk exposures. This highlight of “lessons learned”—gleaned from various resources and approved by Risk Management consultants—could help reduce our members’ liability and risk exposure and improve patient safety and outcomes.
WHAT CONSTITUTES A CURBSIDE CONSULT
One type of consultation that occurs in medicine is known as a “curbside” consult, which takes place when a provider informally seeks advice about a patient from another provider who is not otherwise involved with the patient. The issues are not complex, and the treating provider presents only basic details of the case. It is strictly a discussion, and does not involve seeing the patient or reviewing medical records.
The following are not considered characteristic of curbside consults:
- The consultation involves a question posed to an on-call provider.
- The consultation occurs between a supervising physician and the healthcare provider being supervised.
- The consultation is rendered by a provider who has a preexisting patient/provider relationship with the patient in question, or who is covering for a provider who has that relationship.
- The consultation is for a patient in active labor, a patient who is critically ill, or a patient whose condition is rapidly deteriorating.
The situations listed previously describe formal consultations rather than curbside consults.
BLURRING THE LINES MAY INCREASE LIABILITY
When the dividing line between curbside and formal consults becomes blurred, greater liability concerns may arise. Traditionally, medical malpractice liability exists in the context of a provider-patient relationship, and a true curbside consult should not give rise to one because the consulting provider has not seen, treated, or cared for the patient themselves. But liability problems can arise when the dialogue moves beyond generality and into the realm of specific patient care.
In the following situations, a formal consultation is likely more appropriate than a curbside consult and should be considered:
- The medical situation is complex, or advice cannot be given without examining the patient or the records.
- The scope of the discussion identifies a patient and involves his or her specific medical issues.
- The treating physician returns with a second question regarding the same patient.
- The treating physician is suspending his or her own professional judgment and is relying on the consultant’s advice to determine the course of the patient’s care.
- The patient has requested the consult or knows that a consultation is being obtained, and therefore, arguably, a physician-patient relationship has formed.
PRACTICAL CONSIDERATIONS
Here are some practical considerations to follow when using curbside consults:
- At the outset, the requesting and consulting provider should explain the expectations and understand that the consultation is informal.
- Generally, patient identifiers and medical records should not be reviewed during a curbside consult. The dialogue should address general issues and be relatively brief.
- The treating provider should alert the consulting physician if the consultation is being included in the medical record.
- When a physician does document a curbside consult, the note should be brief and include the nature of the consult.
To help ensure minimal risk of liability for the treating or consulting provider, it is important that providers communicate clearly and avoid common pitfalls that can create the impression of a more formal consultation. The convenience and ease of curbside consults must be balanced with the needs of the patient, and when in doubt, a formal consultation should be obtained.