Legal liability of an online curbside consultation

These days, physicians are getting informal consultations (curbside consults) and "second opinion" feedback from other physicians by discussing patient care on closed, restricted online physician-only communities like Doximity. What is the legal liability of discussing a patient and getting input from physicians who have never seen or examined the patient?

According to this document from the University of Tennessee Health Science Center:

Some states have recognized that imposing liability for giving an informal opinion would have a chilling effect on the collegiality among physicians and, in the long term, have negative impact on patient care. Thus, a "curbside consultation" with another physician does not create a physician-patient relationship and, therefore, imposes no duty on the physician who informally shares his or her expertise with a colleague. Tennessee has yet to accept or reject the concept of a "curbside consultation." To the extent a physician affirmatively participates in the treatment or diagnosis, as opposed to expressing an opinion, Tennessee is likely to find a physician-patient relationship, even though the consulting physician did not examine the patient. See, Kelley v. Middle Tennessee Emergency Physicians, P.C., 133 S.W.3d 587 (Tenn. 2004).

In a 2003 article from Family Medicine (Fam Med 2003;35(7):476-81.), the authors write:

Courts have consistently ruled that no physician-patientrelationship exists between a consultant and the patient who is the focus of the informal consultation. In the absence of such a relationship, the courts have found no groundsfor a claim of malpractice.Malpractice risks associatedwith informal consultation appearto be minimal, regardless of the method of communication. While “informal consultation” is not a term used by the courts, the courts have applied a consistent set of criteria that help define the legal parameters of this activity.

The Doctors Company has an article written by Susan Shepard, MSN, MA, RN, director, patient safety education, and this article includes more information pertaining to the potential medical malpractice litigation risks associated with curbside consults. She writes:

Q: What are the legal issues raised by curbside consultations?
A: In a traditional face-to-face curbside consultation (as opposed to an electronic or written consultation), if an injury occurs to the patient and the patient can prove that the consult was the proximate cause of the injury, the physician who was consulted could also be named in the lawsuit.

There must be clear communication between the physicians that clarifies the nature of the attendant physician’s inquiry. In other words, if the conversation leads the attendant physician to rely on the consulted physician’s response when making a treatment decision and the patient suffers harm, there could be liability for both physicians. The legal questions are “was there a physician-patient relationship between the consulted physician and the patient” and “did the consulted physician owe a duty of due care to the other physician’s patient?”

So, where does this put us in 2013? If you're discussing a patient case within a closed, restricted online community? Will a patient be able to prove that the informal consultation led to injury? 

Practice Fusion Certified Consultant Network

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Learn more about the Practice Fusion Certified Consultant Network here.

Information Governance: The Foundation for Effective eHealth (Accenture)

Accenture recently published a paper titled, "Information Governance: The Foundation for Effective eHealth."

Holistic framework helps health care practitioners and organizations assess and overcome e-health challenges

Here's a brief summary:

Around the world, health care organizations are making unprecedented investments in e-health systems. While it’s easy to appreciate the potential advantages of such systems—including reduced errors, greater efficiency, lower costs and, ultimately, better care—it isn’t so easy for organizations to develop and execute an effective approach.

In this new paper, Accenture’s Institute for Health and Public Service Value explains critical challenges and proposes a new Information Governance Framework for Health. Drawing on what Accenture has learned through e-health implementations around the world, the framework articulates the five highly interrelated disciplines of information governance:

    * Data privacy
    * Data confidentiality
    * Data security
    * Data quality
    * Data integrity

You can download the report as a PDF here.

Accenture is a global management consulting, technology services and outsourcing company. Combining unparalleled experience, comprehensive capabilities across all industries and business functions, and extensive research on the world's most successful companies, Accenture collaborates with clients to help them become high-performance businesses and governments.

Twitter for STAT medical consults

In the medical world, the word "STAT" means that urgent/immediate. It's derived from the Latin word "statim."

So, when a doctor needs an immediate consultation, that's considered a "STAT consult." Could a physician use Twitter to obtain such a STAT consult? I think they could, especially if they're connected with the right physicians on Twitter. I'd love to see some physicians publish case reports where they effectively used Twitter for a STAT consult when they were dealing with an emergency. I suppose the biggest challenge is to explain the situation with only 140 characters. However, you could send out a tweet like, "STAT consult: should I give TPA for this stroke patient?" and then you could get a conversation going. Of course, once you get the conversation going, you should pick up the phone. So, maybe Twitter could be used to get you in touch with the right consultant when you're in need of a STAT consult.

PMSCO Healthcare Consulting

PMSCO Healthcare Consulting is a wholly-owned subsidiary of the Pennsylvania Medical Society. PMSCO Healthcare Consulting consists of three specialized service groups, providing a suite of management, process, and clinical resources for clients throughout the healthcare industry.

PMSCO provides practice management consulting services and some of that revolves around health IT. So, if you're thinking about implementing an EHR or e-prescribing solution, consider a formal consulting service. To learn more about PMSCO, visit: http://www.consultpmsco.com/

Consulting for McKinsey or the Boston Consulting Group

It seems like many students who pursue a joint MD/MBA want to get a consulting job at McKinsey & Company. Who wouldn't? I've known several people who have worked at McKinsey and I'm always fascinated by the unique stories associated with the McKinsey culture. I've also met medical school graduates who have pursued opportunities at the Boston Consulting Group (BCG, not to be confused with the BCG vaccine). So what about you? Do you have strong interests in the business/consulting industry? If you're pre-med, are you planning on pursuing an MD/MBA program? As I look back on my education, I often wonder whether I would have pursued a combined MD/MBA. Since I lacked "real world" working experience before applying to medical school, I think I would have been lost in business school. Had a been a non-traditional student who had worked for several years prior to applying to medical school, then I would have seriously considered a combined MD/MBA program.

Healthcare IT Jobs

Healthcare IT News is published in partnership with HIMSS. Although I'm not looking for a new job, I like to glance at the job posts and see what's going on the health IT sector. Currently, many of the advertised job opportunities appear to be for health IT consultants who have extensive experience and expertise in the EMR/EHR space. People are looking for integration consultants, clinical documentation consultants, clinical systems analysts, and more. Expect to travel if you get hired as a consultant. Some of the job descriptions indicate "ability to travel 100%." Sounds like fun if you're single, but not if you have a family.

Retired Physicians

I met with some retired physicians today. It seems like retirement is when many physicians find the time and opportunity to pursue non-clinical opportunities. Many physicians enjoy teaching, writing, consulting, and doing many other things. Retirement is when they seem to find the time to do all the "fun" things in life. There's a new generation of physicians in today's world. The importance of work/life balance has never been stressed like ever before.

So what do you plan to do when you retire? Are you already preparing for that transition or will there be some major shifts in your life? It's hard to imagine the world of retirement, but I often do think about my current work/life balance.

Non-Clinical Careers and Opportunities for Physicians

- updated -

For more info, please visit (and bookmark) my other blog that is devoted to non-clinical opportunities: http://www.nonclinicaljobs.com/

If you're a physician and you're considering a non-clinical career, you may be wondering about all the opportunities out there. I get asked about this all the time. Over the years, I've had a chance to meet different physicians working in various companies and industries and here are my observations.

The following may apply even if you're not a physician. If you're a clinician (nurse, NP, pharmacist, PA, etc.), many of these opportunities may still apply.

First, ask yourself what you enjoy. After all, if you don't enjoy clinical medicine, you don't want to end up doing something else you're not going to enjoy. Then, start networking like crazy. Leverage all the online social networking sites (like LinkedIn, Facebook, Plaxo, etc.) and get reconnected with old colleagues, classmates, and friends. Find out what people are doing. They may help you get connected to some key people. You may find some of the best opportunities this way. If you're a woman, you may want to check out MomMD (www.mommd.com).

The following list of opportunities is clearly non-exhaustive. This list is based on my personal interactions with people in these roles and as I meet more people, this list grows.

Here is my growing list of non-clinical opportunities for physicians (not in any particular order).

1. Healthcare administration - Are you a seasoned healthcare executive? Do you enjoy making administrative decisions? Then join the American College of Physician Executives (ACPE) and run a hospital or a managed care organization. If you have a strong interest in managed care, then check out the NAMCP (National Association of Managed Care Physicians). You may want to get an MBA or an MMM (masters in medical management) if you don't already have one. A valid medical license is required for most (if not all) of these positions.

2. VC, finance, market research, etc. - Got an MBA? If not, are you thinking of getting one? Some will argue that once you have an "M.D." after your name, it may not matter as much where you get your MBA. However, I would argue that your MBA is your path to networking opportunities, so where you get your MBA is critical if you want to have a solid network. Once you get your MBA, you can work for venture capital (VC) firms, dig into market research companies, or work for Wall Street. Heard of the Gerson Lehrman Group (www.glgroup.com)? No clinical experience necessary for many of these opportunities. In fact, many joint MD/MBA students have ventured directly into very successful careers this way. Also, an MBA is not necessary if you have some good business skills and understand the healthcare industry.

3. Writing and medical communications - Do you enjoy writing? Many physicians and non-physicians have very successful careers as medical writers. The field is open to people who enjoy fiction writing, publications, research, or other types of writing. You can get involved working on journal publications, developing promotional content for marketing campaigns, or developing CME programs. Join the AMWA (American Medical Writers Association) and look for opportunities. You can work from home as a freelance writer and have a very flexible schedule. Or, you can work for a publisher or another type of healthcare communications company. You can find a list of some companies by looking at the North American Association of Medical Education and Communication Companies, Inc., (NAAMECC) website. No clinical experience necessary.

4. Technology and Informatics - Want to develop or improve an electronic health record (EHR) system? Do you love informatics? Then join the CCHIT (Certification Commission for Healthcare Information Technology), the AMIA (American Medical Informatics Association), and the AHIMA (American Health Information Management Association). Clinicians use EHRs and patients (or consumers) use PHRs (Personal Health Records). There are many companies attempting to integrate the data between PHRs and EHRs. There is a national initiative to improve and standardize public health informatics, so now is a great time to enter this industry. No clinical experience necessary, but you should be familiar with ICD, CPT, and other billing codes used in this industry.

5. Disease management - Managed care organizations (MCOs) are always looking for better disease management (DM) programs for their plans. Some MCOs develop their own DM plans and others outsource them to external companies. These companies create and deliver various services to managed care organizations, including DM, wellness programs, personal health record (PHR) services, etc. Do you ever get educational pamphlets from your own health plan? Who puts them together? Who designs and develops these wellness and preventive health programs? It's not always WebMD. There are other companies that provide similar services.

6. Pharma/Biotech/Device - If you're a medical specialist, there are many opportunities to do research for these companies. If you don't enjoy research, then you can develop marketing strategies. Direct-to-consumer (DTC) advertisements have become very popular these days. See all those ads in the medical journals? Get ready for that "corporate America" lifestyle if you plan to venture into industry. You may be working even more hours and carrying a Blackberry instead of a pager, but if you climb that "corporate ladder" and play the corporate game, you may qualify for an early retirement.

7. Expert witnessing - Personal injury, medical malpractice, nursing home care, etc. There are firms that specialize in specific areas (like nursing home cases). Want more information? Take a look at www.seak.com

8. Public health - Get an MPH, join the APHA (American Public Health Association), and find a local health department. Or, join the CDC and travel the world. Develop strategies to improve population health. Some pharmaceutical companies also have public health sections and are very devoted to public health and international health (Pfizer in particular comes to mind). Bridge gaps in healthcare disparities.

9. Consulting - The world is open. Want to work for yourself or for a company? Many healthcare companies are looking for experts to help them develop, refine, and improve their products and services. It may be hard to get started unless you've already established connections. Once again, networking becomes critical.

10. Research - Academia vs. private vs. industry vs. CRO. You don't have to go into industry to do research. Look for a Contract Research Organization (CRO) in your area. Join the ACRO (Association of Clinical Research Organizations). Start with PPD (no, this is not the TB skin test).

11. Executive recruiting - Physicians can work as an executive recruiter to hire and place other physicians. You can also work your way up and manage other recruiters who do the hiring. Remember, these 'head hunters' get paid a commission based on the salary of the person they place. The $ earning potential can be tremendous if you're successful.

12. Start a company - Have an innovative idea? Start a company! New companies seem to be sprouting all the time. Stay connected with people and keep your eyes open for new ideas. Get an MBA and meet people who can help you get a concept off the ground.

Not sure where to start? As I mentioned above, start building your social and professional network. Reconnect with people and ask many questions. Find people who are in various positions and ask them what they like/dislike.

Join some associations to build your network and to find companies. Note that some associations are specifically for physicians, but many are open to all types of healthcare professionals. Also, even those that are specifically for physicians (such as the ACPE) offer affiliate memberships for certain non-physicians.

ACHE: American College of Healthcare Executives
ACPE: American College of Physician Executives
ACRO: Association of Clinical Research Organizations
AMDIS: Association of Medical Directors of Information Systems
AHIMA: American Health Information Management Association
AMIA: American Medical Informatics Association
AMWA: American Medical Writers Association
APHA: American Public Health Association
CCHIT: Certification Commission for Healthcare Information Technology
NAMCP: National Association of Managed Care Physicians

National Association of MD/MBA Students
http://www.md-mba.org/


Thinking about getting an MBA? Take a look at some of these articles and consider the ROI (return on investment) of your education:

http://medicaleconomics.modernmedicine.com/memag/article/articleDetail.jsp?id=322635
http://www.acponline.org/clinical_information/journals_publications/acp_internist/mar03/mbas.htm
http://www.physicianleadership.com/articles/physician_MBA.htm
http://www.mommd.com/mdmba.shtml
http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/378.htm


Finally, you may want to take a look at these programs, since they may offer excellent networking opportunities:

MBA in a Day
http://www.mbainaday.com/physicians.html

SEAK - Non-clinical careers for physicians
http://www.seak.com/semncc08.htm

SEAK - MBA skills for physicians
http://www.seak.com/semncc08mbaskills.htm

Hope all this is helpful. I'm always revising this as new information comes in, so check back to see what's new.

For more info, please visit (and bookmark) my other blog that is devoted to non-clinical opportunities: http://www.nonclinicaljobs.com/