Photo Credit: Istock.com/napong rattanaraktiya

You ask, she answers! Dr. MedLaw responds to a physician’s question regarding how to decrease liability risk for on-call telephone consultations.

 Physician: When I’m on call for orthopedics for the ER, I have several telephone discussions with the staff that don’t end up with them asking me to come in and see the patient. How can I protect myself against the ER putting something that I did not say in the chart and attributing it to me? I may not get back into that hospital – I have privileges at another site and a busy office – for a few days, and I can’t access the hospital EMR from my office, so there is no way to check in real-time.

Dr. MedLaw: The best practice when a physician does a telephone consult is to put a note in the chart the next day, but, as you say, this is often not practically possible. An alternative is an on-call log.

If you keep this for every case it becomes something that you do “in the ordinary course of business” and so can come into evidence under the Business Records exception to the Hearsay Rule just as the medical record can, and if you do it at the time of the call and on an electronic system that time-stamps it will be shown to be reliable because it was contemporaneous rather than later and self-serving after a problem developed.

A note would go something like: “Date/Time/Called by (Name) R.N., ER nursing supervisor at (name of hospital), regarding (name of patient), a 7-year-old male with a non-displaced greenstick fracture of the left mid-radius. X-ray of left forearm (date, time) transmitted by ER and reviewed on my laptop. Advised that a splint should be applied by the PA and the patient’s parents instructed to follow-up with me or the Orthopedics clinic on (date). Prescription for (name of drug, dose) for pain relief as needed approved.”

If it turns out that someone then mistakenly tells the parents that this was just a sprain and the child then severely fractures his now-compromised bone or the child is mistakenly given an adult dose of pain medication and becomes ill from it you will have a record that stands on its own to refute that you were the one who provided incorrect information to the ER.

Of course, you should check the actual chart when you can and in that setting the log is both a good memory device and your proof if there is an error that you have to bring to administrative attention, taking it out of a “you say – they say” situation when the ER staffer swears on a stack of Bible that you really did say a sprain and really did prescribe an adult dose.

In short, keeping an on-call log is a habit to get into and something that you will never be sorry that you did.

Check out Dr. MedLaw‘s prior Q&A columns regarding navigating the complexities of a salary structure shift, and gaining patient consent during medical emergencies, and watch for her next column addressing how to avoid a regulatory kickback claim.

Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Physician’s Weekly, their employees, and affiliates.