How to engage in ‘curbside consultations’

PHILADELPHIA — Curbside consultations are “desirable and well-accepted when used appropriately” according to a discussion held at the American College of Physicians Internal Medicine Meeting.

“These informal discussions can benefit patient care and increase physician education — both good things,” Stephen J. Gluckman, MD, medical director at Penn Global Medicine and professor of medicine at the Hospital of the University of Pennsylvania told attendees. “But before you participate in one, weigh the benefits and risks of doing so.”

When determining whether to engage in these discussions, clinicians should weigh the following considerations: accurateness and reliability of the person providing the clinical data, reimbursement is nil, and time-saving when the curbside consultation involves subject matters that are difficult to look up or require judgement and/or experience.

“The best curbside consultations are ones that address generic questions rather than the specific management of a patient. For example, asking an infectious disease specialist like me what the treatment options for latent tuberculosis are, is an appropriate question to prompt a curbside consultation. Conversely, asking about a patient who has had recurrent infections in a failed total hip arthroplasty and whose last organism was a MRSA and asking what the next step in treatment should be, is not appropriate,” he said.

He added clinicians who engage in curbside consultations should so carefully.

“For the sake of our patients, the consultant must be cautious. If we do not get the patient’s information on our own, we are limited by the second hand information,” Gluckman told Healio Primary Care Today in an interview.

Curbside consultations are “desirable and well-accepted when used appropriately” according to a discussion held at the American College of Physicians Internal Medicine Meeting.

Source:Adobe

Even if done appropriately, curbside consultations can carry a legal risk, he added.

“As courts have repeatedly affirmed, actual liability, for which a physician could be held responsible for medical malpractice, requires the existence of a doctor-patient relationship. By definition this is not established during a curbside consult. In the absence of a doctor-patient relationship, a curbside consultation is generally regarded as a service provided to a medical colleague and not to the patient,” Gluckman said.

“However, we can be sued about anything by anyone. If our name is in the patient’s record, we are at risk of, at minimum, a bad time with lawyers and courts – even if we ultimately win – by establishing that there was no doctor-patient relationship,” he continued.

For those physicians who want to help, there are steps to take to limit potential legal ramifications.

“If you give a curbside consultation make sure that you are not identified by name in the record. You could also say ‘I can answer generic questions, but I cannot give clinical advice for a specific patient.’” – by Janel Miller

Reference:

Gluckman SJ. “Curbside consultations in infectious diseases.” Presented at: American College of Physicians Internal Medicine Meeting; April 11-13, 2019; Philadelphia.

Disclosures : Gluckman reports no relevant financial disclosures.