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Dr. MedLaw discusses where the line between safely offering informal consultation, or “curbsiding,” and taking on the liability of a consultation gets drawn.

Informal consultation—curbsiding—is good for patients. It is also generally known that a curbside statement will not support a malpractice claim because it is seen as a service to the other doctor that does not create a physician-patient relationship.

The problem that doctors worry about, though, is where the line between safely curbsiding and taking on the responsibility and liability of a consultation gets drawn. Let’s examine how the law views the situation. In the most common situation of a question from a colleague, the issue will be whether your role in the case was foreseeably going to be dispositive in the patient’s care. To understand how this will play out, let’s look at two contrasting situations.

In an Illinois case, a child was admitted to a hospital after a fall. The treating pediatrician spoke with a neurosurgeon who discussed diagnostic possibilities in general and offered to see the child but was not requested to do so. The child subsequently became quadriplegic due to a spinal cord injury. In the following lawsuit, the neurosurgeon was dismissed.

In a New York case, a cardiologist was contacted by a physician in the ED treating a patient with chest pain and elevated cardiac enzymes. The cardiologist told the physician that he did not think the clinical presentation was consistent with a cardiac event and that the patient could be released. The patient had a myocardial infarction 3 hours later at home. In the following lawsuit, the cardiologist was denied dismissal from the case.

In both situations, a doctor requested input from a specialist. The neurosurgeon never engaged in the case with a specificity that would alert him to this likelihood, while the cardiologist intervened directly in the treatment.

When you start a curbside, you are starting from a position of on-liability. You then want to retain that by being general, brief, and clear about the actual limitations of the process. This will allow you to provide clinically valuable answers that support your reputation as a helpful expert without stepping outside of the curbside limits.