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Introduction

The legal rules governing referral and consultation evolved in earlier times when patients tended to have long-term relationships with individual physicians. With the advent of team care and the corporatization of medical practice, sorting out the individual responsibilities for a patient's care has become a difficult problem, complicated by the economics of current medical practice. Referrals are sometimes a battleground in the fight to retain well-insured patients while minimizing responsibility for uncompensated care. These financial issues complicate malpractice litigation arising from referral-related injuries.

The distinction between a consultation and a referral has become blurred. Nevertheless, it is legally important because it determines whether the responsibility for the patient's care shifts from one physician to another or whether it simply encompasses more physicians. In a consultation, the original physician retains the duty to oversee the patient's care. Consultants have an independent duty to the patient, but this does not supplant the duty of the attending physician. In a referral, the responsibility for the patient's care shifts from the original physician to the recipient of the referral, who then becomes the attending physician. The consultant relationship is problematic because consultants such as pathologists and radiologists mistakenly assume that they work for the attending physician rather than the patient. Sending a report to the attending physician does not satisfy their independent duty to the patient if the attending fails to inform the patient of the problem.


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