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Tests and Procedures

Consultants who conduct tests or procedures on a patient must first obtain proper informed consent. They must inform the patient of any risks involved and any available alternatives. In the case of diagnostic tests, the patient should be told about the reliability of a test and whether it will make any difference in the choice of therapy. A patient is likely to be angry if he or she is injured by a test that is of diagnostic interest to the physician but has no bearing on how the patient will be treated. Informed consent to dangerous tests is sometimes complicated by the unwillingness of the attending physician to acknowledge the risks of the procedure, thus undermining the consent obtained by the consultant.

Consultants should always determine for themselves if any contraindications exist to a particular procedure or therapy. For example, it is not a defense to say that the chart did not record that a patient was allergic to iodine. The radiologist is responsible for taking an adequate history to determine that it is safe to do an iodine dye study. And the nephrologist who orders an intravenous pyelogram (IVP) should personally ascertain that the patient is not dehydrated, is not pregnant, and is not allergic to the dye. The legal expectation is that all the physicians involved in the procedure will exercise caution to prevent avoidable injuries to the patient.

The results of tests and the recommendations of the consultant must be transmitted to the attending physician in a manner consistent with the urgency of the patient's condition. For example, a cardiologist who reads all electrocardiograms in a hospital may have the reading posted on the chart by the next morning. If a routine ECG turns out to have a life-threatening arrhythmia on it, the cardiologist must ensure that the patient is treated immediately. This duty is not discharged by noting the arrhythmia on the report and sending the report to the patient's chart, to be seen many hours later.


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