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Using Consultants Properly

An attending physician has the legal responsibility to obtain consultations when necessary for the patient's well-being. Physicians must choose consultants carefully, both as to specialty and personal competence. The attending physician must then oversee the actions of the consultant while continuing to provide the patient's general care. When orders are written or accepted by the attending physician, he or she has implicitly ratified the correctness of those orders. It is not a defense to say that the order was written at the suggestion of a consultant.

Physicians may be held liable for substandard care if they fail to obtain a consultation in a case that falls outside their areas of expertise or in a case in which only a consultant can provide necessary tests or procedures. If an internist who cannot do endoscopy is caring for a patient with occult intestinal bleeding, the internist has a duty to consult an endoscopist to obtain the procedure for the patient. The attending physician cannot force a patient to undergo the procedure but must ensure that the test and the consultation are available. If the attending physician leaves the arrangement of the consultation to the patient, the patient may later contend that he or she had no real opportunity for this care.

A physician has a duty to choose consultants wisely. The physician should know the consultant's qualifications and be assured of the person's competence before asking for a consultation. Usually the attending physician can rely on the process of admission to hospital staff as adequate verification of another physician's qualifications. This reliance assumes that the attending physician has no reason to suspect the consultant. If a consultant does not appear to have appropriate skills or is impaired, the attending physician has a duty to investigate before consulting that particular physician. For example, a surgeon typically may accept as an anesthesiologist any member of the anesthesia group that serves the hospital; the qualifications of the individual anesthesiologists have been checked by the hospital staff committee and the anesthesia group. If, however, the surgeon smells liquor on the anesthesiologist and notices impaired coordination, the surgeon has a duty to protect the patient by refusing the anesthesiologist's services.

An attending physician is liable for negligent care that a patient receives from a consultant because the attending physician retains responsibility for the patient's care. An attending physician should never simply turn over the care of the patient to a consultant. The attending should be informed of all actions taken by the consultant and should order all tests, medications, and other changes in the patient's care. If the attending physician does not wish to accept responsibility for the patient's care, the patient should be referred to the consultant or another physician.

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