Consultants who personally examine and talk to the patient have a duty to make sure that a patient is informed about the results of the consultation. Since a consultation is intended to assist the attending physician in making medical decisions, it may seem that informing the attending physician should be sufficient. It may not be when the consultant has established a direct physician–patient relationship with the patient. Discussing findings with the patient gives the consultant the opportunity to ensure that his or her recommendations and findings are known and understood by the patient. It also gives the consultant the opportunity to withdraw explicitly from the case and relinquish responsibility to the attending physician. This gives the patient and the nursing staff a clear understanding of who is in charge of the care of the patient.

Sometimes a consultant has a duty to intervene in a patient’s care. In the case of the cardiologist who discovers a life-threatening arrhythmia, it is unlikely that the patient or the attending physician will object to emergency orders if the attending physician is not available. When the attending and consulting physicians do not agree, the consultant usually should not countermand the orders of the attending physician. It is best to discuss the problem with the attending physician before talking to the patient. The attending physician may be able to provide additional information or insight that will obviate the disagreement. If the consultant and the attending physicians still disagree, the consultant must fully inform the patient, or the person legally authorized to consent to the patient’s medical care, about the disagreement and the options for care.

Patients retain the right to choose their physicians and their care. In some cases, the patient will choose to follow the advice of the attending physician. If so, the consultant should document any disagreements and the patient’s choice and then formally withdraw from the case if the disagreements are important enough to warrant this decision. With a hospitalized patient, the consultant should file an incident report if he or she believes the patient is at risk. If the patient chooses to follow the advice of the consultant, the consultant should be prepared to act as attending physician for the patient. If the consultant cannot act as attending physician, both physicians should be ready to assist the patient in finding another physician who meets the patient’s needs. Neither physician should abandon the patient.