If I do a “curbside consult” on a patient whom I have never met, have I established a physician-patient relationship with them?
You do not enter the patient’s care as a participating physician in this limited situation because there is no consent on your part to the relationship.
However, the more involved that you become, the more it will appear that you did consent to being active in the case, such that you can be held to have actually established a relationship of your own with the patient, just as in the case of a formal opinion. That you did not bill for your services will be irrelevant to that analysis. Therefore, if an informal request from a colleague turns into an increasingly serious involvement in the case (e.g.: many discussions or your colleague citing you in their notes) you must instead request that a formal consultation be set up under which you can fully examine the patient and have access to the records and can enter your conclusions and recommendations into the chart in your own words. If you are going to be held liable as a de facto treating physician then you need to be able to conduct your involvement as an actual treating physician.
Is there a physician-patient relationship with patients I give a formal medical opinion on but whom I never meet or examine?
Consulting physicians such as radiologists and pathologists, physicians who consult via telemedicine and on-call and covering physicians who render an opinion on a patient over the phone without examining them are all participating in full physician-patient relationships.
The patient has consented to being tested or consulted about or to dealing with an alternate doctor and the fact that they did not select you personally or may not even know who you are is irrelevant to that. You, as the doctor, have accepted to become actively involved in the care of the patient. Consent to the relationship is therefore demonstrated by both sides.
Stay tuned for Part II…
Dr. Medlaw is a physician and medical malpractice attorney.
This article originally appeared on SERMO, which retains all rights to it.