Treating by phone? Be careful

A. Giving telephone advice is certainly convenient for both doctors and patients. And it's relatively safe for patients with recurrent conditions that you've treated successfully in the past, or for those who relate obvious symptoms that can be managed with basic advice such as bed rest or over-the-counter medication.

But practicing medicine by phone can be risky. Diagnosing medical conditions without examining the patient means that you won't be able to assess the person's appearance, body language, severity of symptoms, or other factors you'd normally consider during a physical exam.

In one malpractice case, a mother called the doctor to report that her child was acting sluggish. When the doctor asked if the child had a fever, she said he didn't. But what the doctor didn't realize is that the mother had never actually taken the child's temperature. Because she didn't have a thermometer, she'd simply felt his forehead. The family later sued the doctor for failure to diagnose meningitis.

Some high-volume practices have a formal telephone advice system staffed by a trained triage nurse. She typically decides which calls she can handle by phone, which require the doctor's immediate attention, and which require an office visit. Some smaller practices use their own employees to perform the same service, working from well-defined protocols.

Whether or not you have a formal system, the following guidelines can minimize your liability risk:

The author is a risk management and loss prevention consultant in Cloverdale, CA. He can be reached by e-mail at lossprevention@earthlink.net

This department answers common professional liability questions. It isn't intended to provide specific legal advice. If you have a question, please submit it to Malpractice Consult, Medical Economics, 5 Paragon Drive, Montvale, NJ 07645-1742. You may also fax your question to 973-847-5390 or e-mail it to memalp@advanstar.com