Medicine is a team sport. The NCI and ASCO promote oncology teams [1], believing that team-based cancer care can improve treatment delivery and overall patient outcomes.
The core members of a multidisciplinary cancer team are often an oncologist (medical, surgical, radiation), pathologist, radiologist, and nurses [2]. Oncologists often organize multidisciplinary tumor boards to discuss cancer patient cases. A tumor board is a recurring formal meeting involving various specialist doctors and other health providers to discuss cancer cases and align on a treatment approach. Outside of tumor boards, oncologists may seek advice from other specialists to aid the treatment of their patients.
Sometimes, a physician consults a medical specialist to discuss the best care strategy for a specific patient. A medical consultation is a formal process whereby a physician reviews the patient's chart and other medical information with a medical specialist seeking a recommendation on what to do next. A formal medical consultation is often time-consuming and energy-intensive because the consultant must examine the chart, meet with the patient, and sometimes order more procedures before rendering an opinion. A curbside consultation might be the better option when the question is straightforward or when a quick answer is necessary. What does this entail?
What is a curbside consult?
A curbside consult is an informal process in which a physician gets advice from another physician to better understand a particular clinical situation [3]. The consulting physician likely has not examined the patient directly or viewed the patient’s chart, labs, or images. Unlike a formal consultation, the consultant's recommendations are based solely on information supplied by the physician seeking advice.
Curbside consultations occur frequently in a hospital setting where many healthcare professionals are co-located, making it easy to find someone with whom to discuss a patient case. Text, email, and phone have enabled curbside consults over large distances. While informal, the curbside consult provides physicians important guidance they can leverage to better care for their patients.
The treating physician’s primary goal for a curbside consult is to quickly receive advice from another physician. A secondary benefit is that this knowledge can apply to future patients. While curbside consults are helpful, there are common questions about the liability risk of these discussions.
Does a curbside consult introduce liability risk?
Doctors should consider several key factors before or during a curbside consultation. They include:
What information does the specialist require to quickly and accurately advise on the appropriate diagnostic or treatment option?
Can I concisely describe the patient case without omitting vital information?
Who is the right specialist for the curbside consultation?
How can I conceal protected health information?
Is a curbside consultation appropriate? Or, do I need a formal consultation?
These factors are important because a typical curbside consult may introduce some liabilities. They include:
Primary treating physician liability: the primary treating physician retains the majority of the medical liability because no formal patient relationship exists between the specialist and the patient.
Specialist liability: A patient who can prove the specialist’s treatment advice injured them can draw the specialist into legal proceedings. However, their liability is potentially minimal because they have not seen the patient and have not established a relationship with the patient.
HIPAA violations: If the physician discloses protected health information that is intercepted by someone other than the patient’s care team, they could be at risk of a HIPAA violation.
For all of these reasons, it is critical to manage curbside consultations appropriately.
We designed Primum to limit physician liability during a curbside consult. We offer terms of service limiting the risk to the primary treating physician and the specialist, and we request that no PHI be included in messages on the platform.
How to conduct a curbside consult
If you need to conduct a curbside consult, there are several steps to consider when executing a curbside consult.
Find a specialist with the training and experience necessary to help you address your specific patient care question.
When you approach the specialist, have a particular question in mind. What is the critical question you need to answer for this patient case?
Gather the patient information to describe the case to the specialist before engaging in a curbside consult. Being organized can save you and the specialist time.
Avoid violating HIPAA by only discussing protected health information over secure channels.
If the patient situation is an emergency, don’t engage in a curbside consult.
Curbside consult tips and best practices
Curbside consults are a vital part of medical care. To ensure your curbsides are conducted appropriately, you should consider the following:
Be respectful of the specialist’s time. If you feel you need a deep conversation with multiple follow-ups, it may be better to request a formal consultation.
Before requesting a curbside consultation, take a few moments to condense the patient history. Approach the sub-specialist with a specific question.
If you need to share a great deal of patient information, don’t hesitate to request a formal consultation. It may be helpful for the specialist to have the full picture before answering your question.
It takes some practice to hold an efficient and effective curbside consultation. With a bit of experience, it will become easy to determine when a curbside consult is appropriate and when a formal consultation is better.
How to establish or maintain physician/sub-specialist relationships curbside
When you request a curbside consult, it is important to maintain a strong physician-specialist relationship. Colleagues are more open to curbside consults after establishing a relationship with them. Thank the specialist for their time, and make sure you are respectful of when you should request a formal consultation instead of a curbside.
Improve your curbside consultations with Primum
One way to improve your curbside consult is to work with Primum to gain access to a larger network of physicians. You can engage talented physicians from all over the US who can help you navigate some of your more challenging cases. Discuss with other experts various diagnostic modalities and request specialty treatment advice. In addition, you can protect yourself by using a secure portal, adhering to Primum’s terms of use, and learning more about some of the most advanced treatment options in the medical field. For all of these reasons, consider joining Primum.
Ultimately, there are many situations where a doctor may need to request a consultation from a specialist. Doctors should leverage their physician community to provide the best possible care to their patients.
Primum has a robust network of physicians to help you offer better care to your patients. Primum encourages its members to follow best practices for curbside consults, not disclose PHI on the platform, and be concise and to the point when asking questions. We’ve even negotiated special liability coverage for Primum.
With Primum, you receive a timely response with accurate and relevant information needed for your complex patients, and you strengthen relationships with other physicians in your field. Learn more about us today, and join Primum to take advantage of a rapidly growing physician community.
Sources:
[1] Kosty MP, Hanley A, Chollette V, et al.: National Cancer Institute-American Society of Clinical Oncology Teams in Cancer Care Project. J Oncol Pract 12:955-958, 2016.
[2] Silbermann, M., Pitsillides, B., Al-Alfi, N., Omran, S., Al-Jabri, K., Elshamy, K., Ghrayeb, I., Livneh, J., Daher, M., Charalambous, H., Jafferri, A., Fink, R., & El-Shamy, M. (2013). Multidisciplinary care team for cancer patients and its implementation in several Middle Eastern countries. Annals of oncology : official journal of the European Society for Medical Oncology, 24 Suppl 7(Suppl 7), vii41–vii47. https://doi.org/10.1093/annonc/mdt265]
[3] Kuo D, Gifford DR, Stein MD. Curbside Consultation Practices and Attitudes Among Primary Care Physicians and Medical Subspecialists. JAMA. 1998;280(10):905–909. doi:10.1001/jama.280.10.905]
Corey Zankowski
Corey is Primum's CEO. Prior to leading Primum, he was an accomplished C-Suite executive with 20+ years' experience in the highly competitive oncology medical device industry.
