Giving informal advice to colleagues

Dr Edward Farnan discusses the medico-legal implications of giving informal advice to colleagues.

Medicine is a necessarily collaborative profession. Doctors commonly discuss difficult, interesting or unusual cases with colleagues, and seek advice about how best to manage patients. But when does 'informal' advice become formal, and what are the implications of colleagues relying on it?

Consider the following scenarios.

• Two doctors discuss an unusual case hypothetically, in the hospital canteen.
• A cardiologist, passing through Accident and Emergency, is asked to glance at an ECG.
• A radiologist is asked to have a look at an MRI scan before a surgeon operates (as opposed to providing the formal report).
• A paediatrician is asked for an opinion about a child on the surgical ward, pre-operatively, which is then recorded in the clinical records.

With each case, there is progressively increasing 'formal' involvement of the doctor in the patient's management. The doctors giving less formal opinions, however, may wish to consider to what extent their informal advice may be relied on in determining how the patient may be managed. While a hypothetical discussion over coffee, without specific patient details, may not influence how a particular patient is treated, a formal pre-operative opinion provided by a paediatrician more obviously will do so. 

The advice provided by the cardiologist or the radiologist may have been given informally, in passing, without necessarily seeing the patient or having access to the full or relevant history. Nonetheless, it is likely that the doctor seeking the opinion may rely on it to inform their decision making, and may indeed document that they have discussed the ECG or MRI scan with a specialist colleague.

Where you give advice to colleagues in the clinical setting, it is important to consider the following points:

• to what extent will that advice be relied on
• how much knowledge of the patient's history will be needed in order to form an opinion about diagnosis or treatment
• will it be necessary to personally examine the patient
• are you working within the limits of your competence and expertise, and
• will your opinion be accurately recorded by you or a colleague?

It is important, when giving advice, even where this appears informal, that you put yourself in a position to exercise sound clinical judgment. What risk is there in commenting on an ECG in passing where you have not been told the patient's history, or have not made a point of asking?

In such circumstances, it may be hard for the doctor to defend their position, and they may indeed be vulnerable to criticism if they have not kept appropriate records. If an opinion is sought, however informally, it can reasonably be assumed that the opinion will be relied on in order to determine how a patient will be managed. This is particularly the case where a junior doctor seeks the views of a senior, or a generalist the advice of a specialist.

Before providing an opinion, doctors may wish to ensure that they have all of the relevant clinical information to hand, including any previous relevant opinions, and that they appropriately document their thinking and the reason for giving that opinion.

It is a useful maxim that there is no such thing as an informal opinion.

Dr Edward Farnan
MDU medico-legal adviser

This article originally appeared in the printed version of the April 2014 MDU journal entitled "Informal opinion"

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