An article published in the Postgraduate Medical Journal assessed the various legal risks a physician may encounter while on call and provides guidance for navigating the various elements of patient care to “limit the potential for liability.”

Telephone answering services provide a “nexus between patient…and the on-call physician,” but may also present certain legal risks to hospitals. In particular, untimely responses to messages may make physicians liable for patient death or injury. The onus is on practitioners to maintain an organized answering service and to remain available to take calls while on duty or to respond to staff inquiries. Lead author Timothy Edwards Paterick, MD, of Aurora Health Care Green Bay in Milwaukee, Wisconsin, and colleagues suggested careful documentation of all patient interactions to ensure that proper care was administered. When responding to other physicians, nonphysician clinicians, and nurses, similar guidelines apply: careful listening, “harmonious” communication, and in-person evaluation of the patient when possible before making recommendations.

To mitigate legal risk, physicians must understand the physician-patient relationship properly, the Emergency Medical Treatment and Labor Act (EMTALA), medical informed consent, and the concept of negligence. In the physician-patient relationship, “mutual trust…[is] essential” and the practitioner is obligated to maintain proper communication. Withdrawing care from patients without proper notice could be regarded as “abandonment,” in which case the physician would be liable for charges of negligence. Similarly, physicians must understand that under EMTALA they are responsible for appearing to perform an in-person patient evaluation if summoned by another physician. Failure to do so is a violation of the act, and the physician and/or hospital may be subject to a fine. Additionally, physicians are obligated to understand the process of medical informed consent and to ensure that their patients are fully educated about their situation and options before proceeding.

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Negligence, Dr Paterick and colleagues concluded, includes failure to respond in a timely fashion or to respect EMTALA, similar laws, or the process of informed consent. Attending to these fundamentals of proper on-call care will assist physicians in avoiding legal risks and in providing proper care to patients.


Paterick ZR, Patel NJ, Paterick TE. Physician alert: the legal risks associated with ‘on-call’ duties in the USA. Postgrad Med J. 2018;94:411-414.