Summary: If I give my opinion, do I establish a formal doctor-patient relationship that could perhaps come back to haunt me?
Dr. Mirvis is the Editor-in-Chief of this journal and a
Professor of Radiology, Diagnostic Imaging Department, University of
Maryland School of Medicine, Baltimore, MD.
Two months ago I
received a call from a young professional in another state who had a
variety of symptoms persisting a year after a motor vehicle collision.
She was experiencing a great deal of back pain and had undergone a total
spine magnetic resonance imaging (MRI) exam that was interpreted as
normal. She came across my name in association with imaging spinal
trauma and asked me to review her study to determine if I believed the
MRI was indeed negative. She sounded like a very reasonable and
well-spoken person with a real problem. I was in a quandary as to how to
proceed. Should I kindly refuse her request, as I am not her physician?
If I give my opinion, do I establish a formal doctor-patient
relationship that could perhaps come back to haunt me?1 Should I just review the case and offer my opinion?
month ago a former resident and friend called me at home to ask me to
review a computed tomography (CT) scan of a trauma victim at an outside
hospital. The patient had sustained a severe head injury in a vehicular
collision and was in a coma. A CT scan of the head showed significant
brainstem damage. The patient’s spouse was consulted by the hospital
physicians regarding discontinuation of life support given what they
believed was a hopeless prognosis. This radiologist, now in practice for
a few years, was asked by the spouse, a friend, for advice on this
excruciatingly difficult decision. I was consulted to support or perhaps
oppose his opinion concerning the prognostic implications of the CT,
having had a great deal of experience evaluating such injuries.
weeks ago my wife’s aunt, a lovely person, was hospitalized with a
saddle pulmonary embolism. That diagnosis was established and treated
without any involvement on my part, except for a hospital visit as
family and quite a fan of hers. Despite feeling lousy and appropriately
concerned over her condition, she was upbeat, laughing at my stupid
jokes, and being her usual charming self. That evening after our visit
she was transferred to a rehabilitation facility. The next morning she
called our home terribly upset and crying. The first reason was that due
to her fibromyalgia, she had severe pain in her arm when a blood
pressure cuff was used. This was attempted multiple times in one hour,
but she could not cooperate. When a staff physician saw her she was
crying over this situation. He asked if she was unhappy being in the
facility and she not surprisingly said, “I’d rather be at home.” So
antidepressants were prescribed. This was the other cause for her to be
upset. My wife, her niece, called the facility asking about this and was
promptly given over to the physician, rather than the nurse she
expected. Apparently, you can only get to speak to the doctor when you
don’t want to.
She explained her aunt’s problems with
fibromyalgia, but was not getting very far. She then, as I expected,
asked me to speak to the physician. I explained that this was the
happiest lady I had ever known and had been joking with us last evening.
He asked me if I was a psychiatrist, to which I responded in the
negative and informed him I was a radiologist. I could almost see his
smirk and feel his incredulity over the phone. At that point, he
commented that he had no reason to talk to us about her condition since
her daughter was the only contact for medical matters. I agreed with him
and the conversation was abruptly ended. She wasn’t put on
Finally, yesterday a co-worker, an excellent
nurse, asked me to read a report of her friend’s chest radiograph taken
for a prolonged cough. There was a 2-mm ground glass nodule described
and follow-up was recommended in the report. She wanted advice on what
her friend should do.
Having people asking you for medical advice
in a nonprofessional situation is probably nothing new to most of us.
You may be the only doctor in the family or just the one known and
trusted by friends. Perhaps a national reputation and lots of hits on
the Internet or Medline brings questions to you from far afield.
of us have been at parties and mentioned during a conversation to a
group of strangers that we were physicians. People often then ask about
your specialty. Even after knowing you’re a radiologist, folks seem to
have no problem asking all sorts of medical questions. A doctor ….is a
doctor…. is a doctor. I’m sure lawyers and some other professionals
occasionally get questions in their fields too. The worst encounters are
those who want to show me disgusting rashes. I am fully prepared for
this and quickly mention how I missed almost my entire medical school
dermatology rotation having been stuck at home in a blizzard (better
than being stuck in the hospital). I also mention I get severely
nauseated looking at diseased skin. Usually this drives them off without
my direct refusal to offer my opinion.
Are we being helpful by
giving free medical advice when we know almost nothing about the medical
details, have no professional relationship with the person requesting
your advice, and when we are perhaps not as knowledgeable about the
subject as we may think? Most of us have fairly strong egos and are
unlikely to say we know nothing of a medical subject, even one that we
barely remember from medical school and never see in our practices.
However, we assume that in the land of the blind (like at a party), the
one-eyed man is king. As one of my college roommates, a pre-law major,
opined, you really only get at most as much as you pay for. I think that
adage should apply to casual professional advice. I’m not suggesting
you charge for your offhand opinions, but I advise caution.
not know the potential medical legal consequences of offering
well-meaning advice that leads to a terrible clinical outcome. The lack
of a written record of such a communication will probably not offer much
protection. This is the ultimate in curbside consults.2 Even
advice to friends can get you sued if things go awry. It is certainly
appropriate to decline to offer an opinion for one of a large variety of
reasons. If you recommend a physician for the person to consult
professionally and things go wrong, are you in danger of second-hand
- Smith JJ, Berlin L. E-mail consultation. AJR Am J Roentgenol. 2002;17;179:1133-1136.
- Berlin L. Curbstone Consultation. AJR Am J Roentgenol. 2002;178: