0:01

Issue that I'd like to mention briefly is the topic

0:03

of a curbside consult, which tends to cause some distress

0:08

to radiologists in particular.

0:10

So let's take a look briefly at this, uh, entire consult.

0:15

So the, the main issue as in, uh,

0:19

duty breach causation and harm is whether

0:23

or not there was a physician patient

0:26

relationship established.

0:28

And if you're walking down the hall

0:29

and your buddy says to you, Hey, can you take a look at this

0:32

and let me know what you think?

0:33

Um, you may not even know the patient's name,

0:36

the context or anything else.

0:37

And, and so that all has to be factored in.

0:41

So the more informal the consult is, the less likely

0:45

that you've even established

0:47

that very first element of duty.

0:50

So you have to look at that to begin with.

0:53

Um, so here's a little at a little image that, um,

0:59

you know, deals a lot with how radiologists, uh,

1:02

sometimes get worried and equivocate,

1:05

but it has to do with, um, whether

1:09

or not you have to remember that very first element.

1:12

Was there a relationship established?

1:15

You can give your opinion on films or what are you seeing,

1:18

but there's more involved in whether

1:20

or not you've actually met that first burden

1:22

of proof in terms of creating, uh, that duty relationship.

1:27

The other thing to remember is that in general,

1:30

curbside consults are favored by the courts.

1:36

Uh, medicine is a collegial profession.

1:39

They want you guys collaborating, talking to each other,

1:42

and in general feel that that is something that is

1:45

for the most part very beneficial to patients.

1:48

Um, I have, again, in my 30 year plus years

1:51

of practice in this area,

1:52

I've never seen a curbside consult case

1:56

or an allegation against a physician

1:58

who may have offered an opinion along the way.

2:01

So, um, the curb curbside consult does enhance

2:06

in general patient care.

2:08

Courts and lawyers, I think are kind of loathed

2:12

to bring in someone who may have been involved

2:15

or just ask for a second opinion that, again, is designed

2:19

to benefit the patient.

2:20

Um, and finally, in looking at these, I have never,

2:25

or rarely, I should say, rarely come across where it says,

2:28

Hey, I had a conversation with so

2:31

and so about what their opinion was, uh,

2:33

because doctors typically just don't put that in the case

2:36

or in the record for this reason.

2:39

So it's, it's a pretty minor worry.

2:42

Um, so in terms of looking at what,

2:45

however, can create risk

2:49

is if you're looking at an image

2:51

or you're talking to your friend

2:53

and say, oh, wow, yeah, I know this patient,

2:55

and then wow, I'd consider doing this,

2:57

and you start writing out, do this test, do that test

3:01

and have 'em see me in three months

3:03

or whatever, then you're gonna start to bring yourself

3:06

and insert yourself into the process.

3:09

And that could result in, you know,

3:12

an allegation against you and whether

3:14

or not you met the standard of care.

3:16

Again, does the patient know that you were involved?

3:19

Sometimes a physician will say, well, hey, I don't know.

3:23

I'm gonna go talk to Dr. Jones and let's see what he

3:26

or she thinks about this.

3:27

And, and we'll get back to you.

3:29

Well, now you're starting to become more involved.

3:32

And then the, there's a legal concept,

3:35

which is foreseeable reliability.

3:38

Is there a reasonable likelihood

3:40

or impression that the patient

3:43

is actually relying on your opinion

3:45

or advice in terms of their care from you reading, uh,

3:50

a study or recommending additional tests,

3:54

that type of thing.

3:55

So that's another consult and

3:57

or another factor involving that.

3:59

And then finally, you've got the issue of urgency.

4:02

How urgent is this? Is, do you need to be involved?

4:06

Are you, you know, brought in to see the patient?

4:09

What's your level of care?

4:10

But in general, it's a pretty minor thing

4:13

to be concerned about.

4:15

Um, you know, was HIPAA involved?

4:16

Was anybody signing releases for you to look at records?

4:20

Those types of considerations.

4:23

Um, so these are the things that you

4:27

as a physician, um, need to look at.

4:30

How much information were you provided?

4:33

Um, there, you know, I think you should have a low

4:37

threshold in terms of saying, you know, those,

4:39

that's a really good question.

4:41

Why don't we have a specialist read that?

4:43

Or why don't, you know, you send that in

4:45

for an actual formal consult, then you're gonna be involved

4:48

with maybe interpreting a study, billing

4:51

for a second opinion, those types of things.

4:54

And you should always, you know, if it starts

4:57

to get a little above

4:58

and beyond, you wanna make sure that you know

5:02

what your specific involvement is

5:05

in terms of looking at that.

5:07

And how much control do you have in terms

5:12

of the patient's care moving forward?

5:14

It's a, it's a pretty, it's, as I say, it's a pretty, uh,

5:18

rare thing to have happen,

5:20

but it is something that, uh, as long as you're asked

5:23

an opinion about something

5:24

and then the involvement starts to escalate,

5:27

you might wanna be aware of.

5:30

So a final area I'd like to talk about briefly

5:33

regarding curbside consults

5:35

that I get asked about is tumor boards, that type of thing.

5:39

Um, when, when groups of physicians get together

5:42

to discuss cases in whatever setting.

5:45

And I think sometimes physicians may, may worry,

5:49

I can pretty much set your ease for the mo

5:52

or your mind at ease for the most part in that regard,

5:54

because those tumor boards

5:57

Or, um, settings where everybody brings stuff in

6:01

to discuss are typically fall under the area

6:04

of something called quality assurance,

6:07

which means I'm never gonna know about it

6:09

or find out about it.

6:10

And that's, uh, so that pretty much takes most

6:13

of the worry out.

6:15

Now if other things start to happen,

6:17

like your doctor comes in

6:18

and says, well, I took it to tumor board

6:20

and Dr. Jones said X, Y,

6:22

and Z, that may start to happen, uh,

6:26

or cause a problem where you might be involved,

6:29

but for the most part, that really doesn't happen.

6:32

It's very, it's a very generic setting.

6:35

I think physicians are largely aware of that.

6:38

Um, and again, this goes back to the concept of they,

6:42

the courts, the legal system wants you guys discussing this

6:46

and bringing this up

6:47

because you're attempting to provide the best possible care

6:50

for the patient at that point.

6:53

So that's something that I can try to get my hands on

6:57

and say, okay, let me have your tumor board notes.

7:01

Typically that's never recorded. Nobody's making any notes.

7:04

So, you know, participate in the process, try

7:07

to do the best thing for your patient.

7:09

And I wouldn't spend a lot of time worrying about, um,

7:12

you know, what you say in a, you know,

7:14

giving an opinion about a slide

7:16

or a film, uh, during a tumor board, that type of setting.