In most cases the decision to ask for a consultation is a medical judgment. A physician who believes that the patient’s care would benefit from another opinion should ask for a consultation. Sometimes hospital or insurance company rules require a consultation before certain therapy begins. For instance, if a patient may not be admitted to the coronary care unit without a cardiology consultation, the general internist has a duty to obtain the consultation to provide the patient with the needed care.

Often a physician must consult another physician to obtain a certain test for a patient. The attending physician may believe that a specific cardiologist is skilled at doing stress tests and cardiac catheterizations but is too quick to recommend bypass surgery. In this case, the attending physician should let the patient know in advance why his or her recommendations may differ from those of the consultant. The attending physician should ensure that the cardiologist understands that this is a consultation, not a referral. Conversely, the cardiologist may believe that the attending physician is endangering the patient by downplaying the seriousness of the condition. The cardiologist has a duty to inform the patient of this opinion, but it is better if this is done in cooperation with the attending physician.

Physicians often obtain informal consultations from colleagues without appreciating the legal significance of this process. Informal consultations are valuable and should be used, but they have limitations. First is the patient’s right to privacy and to choose physicians. An informal consultation should be anonymous. Any information that would disclose the identity of the patient should be withheld. In small communities, the physician should ask the patient to consent to an informal consultation. The physician should ensure that informal consultations do not violate any state or federal laws, as might be the case for substance abuse patients.