Hallway Consultants: Beware!
Hallway Consultants are a colleague, employee, friend or family to approaches a physician in their professional capacity seeking advise, diagnosis and/or treatment. The common practice is the individual approaches a physician and states “Have had this problem, and my doctor provided me a prescription. I’m out of refills and he can’t see me for another couple weeks, can you write a prescription for my medications?”
Being a friend, employer, good colleague, or even a family member, you want to make that person happy. You do not want to appear unwelcoming or unable to help this person. The reason physicians choose this demeaning profession is to help people, but at the same time, protocols were established both to help the patient and the physician.
In engaging in a hallway consultation, one arguable establishes a physician-patient relationship. A physician-patient relationship is created a patient consults with a physician or receives medical care, and the patient reasonably believes that a consultation, examination, diagnosis or treatment took place. Therefore, whether a relationship was established is depended on what the patient thought, not what the physician thought or even if money was changed hands.
Providing a diagnosis, recommending treatment, or providing a prescription opens the genii’s bottle on what could occur. If someone walked into one’s office, and make a complaint, a reasonable physician would not provide a diagnosis, treatment or prescribe medications without a history and physical, and not making a record of this treatment. However, by providing a diagnosis, treatment or prescribe medications to someone in an informal setting, that is what you are doing. Without the proper information, one would provide incorrect diagnosis, treatment or prescribe the wrong medication.
Unlike most states, prescribing for yourself or family members is not against the law in Texas. The fact that there is not a law against it does not mean it is advisable. In fact recently, the Texas State Board of Medical Examiners instituted a rule (22 TEXAS ADMINISTRATIVE CODE §190.1(c)(1)(L)(M)) on prescribing habits that are not in violation to the Medical Practice Act.
Generally, the Board requires that one must first establish a proper professional relationship with the patient prior to prescribing either dangerous drugs and/or controlled substances. A proper professional relationship requires the following:
a. establishing that the person requesting the medication is in fact who the person claims to be;
b. establishing a diagnosis through the use of acceptable medical practices such as patient history, mental status examination, physical examination, and appropriate diagnostic and laboratory testing. An online or telephonic evaluation by questionnaire is inadequate;
c. discussing with the patient the diagnosis and the evidence for it, the risks and benefits of various treatment options; and
d. ensuring the availability of the physician or coverage of the patient for appropriate follow-up care.
If the person in question is oneself, a family member, or a “close personal relationship,” requires:
a. prescribing or administering dangerous drugs or controlled substances without taking an adequate history, performing a proper physical examination, and creating and maintaining adequate records; and
b. prescribing controlled substances in the absence of immediate need. “Immediate need” shall be considered no more than 72 hours.
Failure to follow these guidelines may lead to disciplinary action by the Board. It could lead to malpractice suit. Notably, some malpractice carriers will not cover negligent acts that took place outside the traditional practice setting.
The wise thing to do is to refuse to do any hallway consultations. Rather, you can ask the individual to come to your office and formally make them a patient of yours. You are not required to charge the person, but you should treatment them as a new patient. The person should complete a history, should undergo a physical, appropriate diagnostic testing, and documenting all that took place.