J Am Acad Dermatol. 2012 May;66(5):827-9.
The curbside consultation: Legal, moral, and ethical considerations.
Source
Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
"Curbside consultation is defined as an “informal and unofficial consultation obtained from a health professional by either a layperson or a fellow health care professional.”1 For dermatologists, this is a widespread occurrence that is both vexing and laden with myriad potential pitfalls.
There are two scenarios to consider. As in our case scenario, a layperson may “corner” a physician in order to obtain an opinion about a medical condition, diagnostic modality, or therapeutic option. The fact that this scenario creates potential liability for the physician and conceivably violates social boundaries is rarely appreciated by the layperson. Historically, this form of consultation is dangerous for the opining physician, because the physician being cornered may not have expertise in the designated area, the layperson may be asking for information about another person (in which case the information being exchanged with the consultant may be confusing or inaccurate for both the consultant and the surrogate consultee), and/or in today’s litigious environment the consultant may be legally liable for misinformation that an allegedly damaged party was provided. If one, however, refuses to render an opinion or to assist, the physician may be perceived as uncaring, unkind, or greedy.
In an alternative scenario, a physician asks a colleague in another specialty or with an expertise in the same specialty for the best method of managing a particular clinical problem. These consultations are common particularly in health maintenance organizations, multispecialty groups, and vertically integrated environments. [2] and [3] Generalists tend to use and approve of curbside consults more than specialists.4However, in one study, 70% of primary care physicians and 68% of subspecialists participated in at least one informal consult a week either in the hallway or on the telephone.4 Interestingly the subspecialists most commonly consulted were not dermatologists but cardiologists, gastroenterologists, and infectious disease specialists. [5], [6], [7], [8] and [9] Curbside consultations have become even more common with the advent of e-mail. In dermatology, it has become routine for a primary care physician to send a photographic attachment of the clinical problem to the dermatologist when seeking a second informal opinion. Such e-mail consultations do not replace a full skin examination, do not permit palpation of the skin lesions, nor do they afford the consulting dermatologist the opportunity to scrape the lesion for microscopic examination or examine the lesion with dermoscopy. In addition, issues regarding the Health Insurance Portability and Accountability Act and privacy, confidentiality, and Internet security are often ignored at potentially great peril."
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