Physician alert: the legal risks associated with ‘on-call’ duties in the USA

On-call physicians encounter a diverse aggregate of interfaces with sundry persons concerning patient care that may surface potential legal peril. The duties and obligations of an on-call physician, who must act as a fiduciary to all patients, create a myriad of circumstances where there is a risk of falling prey to legal ambiguities. The understanding of the doctor–patient relationship, the obligations of physicians under the Emergency Medical Treatment and Labor Act, the meaning of medical informed consent and the elements of negligence will help physicians avoid the legal risk associated with the various encounters of being on call. After introducing the legal concepts, we will explore the interactions that may put physicians at legal risk and outline how to mitigate that risk. Being on call is time consuming and arduous. While on call, physicians have a duty to act morally and ethically in the best interest of the patients.

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Crisis and Informed Consent: Analysis of a Law-Medicine Malocclusion

American Journal of Law & Medicine ◽

10.1017/s0098858800007413 ◽

1987 ◽

Vol 12 (1) ◽

pp. 55-97 ◽

Cited By ~ 1

Author(s):

Fran Carnerie

Keyword(s):

Informed Consent ◽

Medical Treatment ◽

Clinical Setting ◽

Patient Relationship ◽

Physician Patient Relationship ◽

Catastrophic Illness ◽

Physician Patient ◽

Emotional Impairment

AbstractMany individuals develop a temporary state of cognitive and emotional impairment after being diagnosed with catastrophic illness. Thus, when crucial decisions about medical treatment are required, they are unable to assimilate information; or worse, the legal need to be informed can rival a psychological desire to not be informed. The Canadian informed consent doctrine is unresponsive to crisis and clinically impracticable, and so paradoxically compromises the integrity and autonomy it was designed to protect. Many aspects of the physician-patient relationship and clinical setting also undermine the philosophical values enshrined in this doctrine. This further jeopardizes the individual's integrity. The Article explores proposals for change such as delaying the informing and consenting, improving the concept of consent, and improving the role of the physician.

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Who Can Let You Die?

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.1017/s0714980800008862 ◽

1989 ◽

Vol 8 (3) ◽

pp. 238-243 ◽

Cited By ~ 3

Author(s):

M. Anne Bolton

Keyword(s):

Health Care ◽

Informed Consent ◽

Medical Treatment ◽

Health Care Professionals ◽

Chronically Ill ◽

Canadian Charter ◽

Legal Risks

ABSTRACTAging with grace and confidence would, for most people, be facilitated by the assurance that life would conclude with dignity. Unfortunately, such assurance is not available, especially if diminished competence does not allow the expression of a refusal to the continued administration of medical treatment. Health care professionals maintaining mentally incompetent patients on life supports should be aware of the legal risks of terminating treatment without valid informed consent. Yet who can give such consent? Does our law provide any guidance?This paper will examine the Canadian legal realities of obtaining valid informed consent to cessation of medical treatment for the terminally or chronically ill. References will be made to The Canadian Charter of Rights and Freedoms and the leading American jurisprudence.

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Rapid implementation of Inpatient eConsult Programme addresses new challenges for patient care during COVID-19 pandemic

BMJ Innovations ◽

10.1136/bmjinnov-2020-000557 ◽

2021 ◽

pp. bmjinnov-2020-000557

Author(s):

Sharon Rikin ◽

Eric J Epstein ◽

Inessa Gendlina

Keyword(s):

Palliative Care ◽

Infectious Diseases ◽

Patient Care ◽

Personal Protective Equipment ◽

Protective Equipment ◽

Qualitative Feedback ◽

The Usa ◽

New Challenges ◽

Science Framework ◽

Context Specific

IntroductionAt the early epicentre of the COVID-19 crisis in the USA, our institution saw a surge in the demand for inpatient consultations for areas impacted by COVID-19 (eg, infectious diseases, nephrology, palliative care) and shortages in personal protective equipment (PPE). We aimed to provide timely specialist input for consult requests during the COVID-19 pandemic by implementing an Inpatient eConsult Programme.MethodsWe used the reach, effectiveness, adoption, implementation and maintenance implementation science framework and run chart analysis to evaluate the reach, adoption and maintenance of the Inpatient eConsult Programme compared with traditional in-person consults. We solicited qualitative feedback from frontline physicians and specialists for programme improvements.ResultsDuring the study period, there were 46 available in-person consult orders and 21 new eConsult orders. At the peak of utilisation, 42% of all consult requests were eConsults, and by the end of the study period, utilisation fell to 20%. Qualitative feedback revealed subspecialties best suited for eConsults (infectious diseases, nephrology, haematology, endocrinology) and influenced improvements to the ordering workflow, documentation, billing and education regarding use.DiscussionWhen offered inpatient eConsult requests as an alternative to in-person consults in the context of a surge in patients with COVID-19, frontline physicians used eConsult requests and decreased use of in-person consults. As the demand for consults decreased and PPE shortages were no longer a major concern, eConsult utilisation decreased, revealing a preference for in-person consultations when possible.ConclusionsLessons learnt can be used to develop and implement inpatient eConsults to meet context-specific challenges at other institutions.

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Certified Patient Decision Aids: Solving Persistent Problems with Informed Consent Law

The Journal of Law Medicine & Ethics ◽

10.1177/1073110517703097 ◽

2017 ◽

Vol 45 (1) ◽

pp. 12-40 ◽

Cited By ~ 12

Author(s):

Thaddeus Mason Pope

Keyword(s):

Decision Making ◽

Informed Consent ◽

Medical Treatment ◽

Shared Decision Making ◽

Decision Aids ◽

Shared Decision ◽

Legal Doctrine ◽

Patient Decision Aids ◽

Patient Decision ◽

Decision Making Processes

The legal doctrine of informed consent has overwhelmingly failed to assure that the medical treatment patients get is the treatment patients want. This Article describes and defends an ongoing shift toward shared decision making processes incorporating the use of certified patient decision aids.

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