Abstract
Context: Doctors have been known to treat or give consultation to patients informally, with none of the usual record keeping or follow up. They may wish to know whether this practice is ethical.
Objective: To determine whether this practice meets criteria of medical ethics.
Design: Informal medicine is analysed according to standard ethical principles: autonomy, beneficence and non-maleficence, distributive and procedural justice, and caring.
Setting: Hospital, medical school, and other settings where patients may turn to physicians for informal help.
Conclusion: No generalisation can be made to the effect that informal medicine is or is not ethical. Each request for informal consultation must be considered on its own merits.
Guidelines: Informal medicine may be ethical if no payment is involved, and when the patient is fully aware of the benefits and risks of a lack of record keeping. When an informal consultation does not entail any danger to the patient or others, the physician may agree to the request. If, however, any danger to the patient or others is foreseen, then the physician must insist on professional autonomy, and consider refusing the request and persuading the patient to accept formal consultation. If a reportable infectious disease, or other serious danger to the community, is involved, the physician should refuse informal consultation or treatment, or at least make a proper report even if the consultation was informal. If agreeing to the request will result in an unfair drain on the physician's time or energy, he or she should refuse politely.
Full Text
The Full Text of this article is available as a PDF (62.2 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bergus G. R., Sinift S. D., Randall C. S., Rosenthal D. M. Use of an E-mail curbside consultation service by family physicians. J Fam Pract. 1998 Nov;47(5):357–360. [PubMed] [Google Scholar]
- Cates C. Chronic asthma. BMJ. 2001 Oct 27;323(7319):976–979. doi: 10.1136/bmj.323.7319.976. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Crane J., Pearce N., Flatt A., Burgess C., Jackson R., Kwong T., Ball M., Beasley R. Prescribed fenoterol and death from asthma in New Zealand, 1981-83: case-control study. Lancet. 1989 Apr 29;1(8644):917–922. doi: 10.1016/s0140-6736(89)92505-1. [DOI] [PubMed] [Google Scholar]
- Hendel Toni. Informal consultations: do new risks exist with this age-old tradition? J Med Pract Manage. 2002 May-Jun;17(6):308–311. [PubMed] [Google Scholar]
- Keating N. L., Zaslavsky A. M., Ayanian J. Z. Physicians' experiences and beliefs regarding informal consultation. JAMA. 1998 Sep 9;280(10):900–904. doi: 10.1001/jama.280.10.900. [DOI] [PubMed] [Google Scholar]
- Kinderman Karla. Professional liability: informal consults give rise to the physician-patient relationship? J Med Pract Manage. 2002 May-Jun;17(6):305–307. [PubMed] [Google Scholar]
- Kuo D., Gifford D. R., Stein M. D. Curbside consultation practices and attitudes among primary care physicians and medical subspecialists. JAMA. 1998 Sep 9;280(10):905–909. doi: 10.1001/jama.280.10.905. [DOI] [PubMed] [Google Scholar]
- Peleg A., Peleg R., Porath A., Horowitz Y. Hallway medicine: prevalence, characteristics and attitudes of hospital physicians. Isr Med Assoc J. 1999 Dec;1(4):241–244. [PubMed] [Google Scholar]
- Peleg R. Off-the-cuff cellular phone consultations in a family practice. J R Soc Med. 2001 Jun;94(6):290–291. doi: 10.1177/014107680109400610. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Spitzer W. O., Suissa S., Ernst P., Horwitz R. I., Habbick B., Cockcroft D., Boivin J. F., McNutt M., Buist A. S., Rebuck A. S. The use of beta-agonists and the risk of death and near death from asthma. N Engl J Med. 1992 Feb 20;326(8):501–506. doi: 10.1056/NEJM199202203260801. [DOI] [PubMed] [Google Scholar]
- Weingarten M. A. Off the cuff consultations. Br Med J (Clin Res Ed) 1985 Nov 9;291(6505):1321–1322. doi: 10.1136/bmj.291.6505.1321. [DOI] [PMC free article] [PubMed] [Google Scholar]