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Invisible Patients

Radiologists, pathologists, and other strictly consultative specialists have the same medical and legal responsibilities as direct patient care physicians. Their role is to evaluate certain test results in the context of the patient's overall medical condition. When they exercise independent medical judgment, they enter into a physician-patient relationship with their invisible clientele. Because these specialists usually perform their work at the request of a primary treating physician, they often see their duty as flowing to the physician rather than to the patient--a concept that creates risks for the patient and both physicians.

Unlike nonphysician technical personnel, physicians always retain their independent duty to evaluate the patient's condition. This duty is most obvious in cases in which a consultant specialist is asked to perform an invasive test such as an intravenous pyelogram (IVP). In this case the radiologist has the duty to determine if the patient is in acceptable physical condition to undergo the test and whether the test is appropriate to the diagnostic question at issue. He or she also has a duty to interpret the results of the test properly.

Complying with these duties sometimes requires the consultant specialist to evaluate the patient's condition personally by reviewing the medical chart and examining the patient. The consultant physician usually relies on the ordering physician to provide this information. If the information provided is incorrect, the consultant specialist will be legally liable for any injuries the patient suffers as a result. If an IVP throws the patient into renal failure because the attending physician made a mistaken diagnosis, the radiologist would be liable because he or she did not rectify the mistake.

More problematically, nonpatient care specialists have the duty to ensure that patients are properly informed of the results of their evaluations and the need for any further care. Traditionally, this duty has been delegated to the ordering physician. The consultative specialist will send a report to the ordering physician or have this report entered into the patient's hospital chart. It is assumed that the ordering or treating physician then has the duty to ensure that the patient is properly informed and managed.

This assumption is not well grounded legally. Putting aside the independent professional duty implicit in the physician-patient relationship, these specialists bill patients directly for their services. When jurors are shown that a patient received substantial bills for professional services, they see this as the strongest evidence of a physician-patient relationship. And, they will assume that if the physician managed to get a bill to the patient, he or she could have gotten the test results and recommendations to the patient. Consultative specialists must ensure that systems failures do not injure the patients with whom they share a physician-patient relationship.


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