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Optimizing Patient Safety When Primary Care and Subspecialty Practitioners Work in Concert to Prescribe Medications

Paterick, Timothy J.; Paterick, Timothy E. MD, JD

doi: 10.1097/PTS.0b013e318165de6
Original Articles

Subspecialty physicians consult with primary care providers (PCPs) about treatment of complex diseases, frequently recommending drug therapy as part of treatment strategy. Initiation of drug therapy may produce adverse effects. Neither case law nor statutory law addresses the issue of the applicable standard of care when a specialist and PCP act in concert during a patient's care. Generally, however, a physician is held to the standard of care of a reasonable practitioner in that particular physician's specialty. In deciding what weight to give expert medical opinion, courts have considered factors such as whether the expert had a treatment relationship with the patient, the length of such a relationship, and the frequency of medical encounters within the relationship. Historically, PCPs were held to a more locally defined standard of care than specialists; however, there has been a transition to applying a national standard of care to PCPs and specialists. Thus, both PCPs and specialists may bear some responsibility for informing the patient of the risks of a proposed course of therapy and may bear some liability for harm resulting from a failure to inform the patient of these risks, separate from which physician wrote the prescription. Thus, the subspecialist and PCP are wise to understand the duty to monitor drug therapy recommended in consultation, in particular, to devise methods to track adverse drug effects unique to their practices.

From the Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida.

T.J.P. is a clinical research trainee at the Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida.

Editing, proofreading, and reference verification were provided by the Section of Scientific Publications, Mayo Clinic.

Correspondence: Timothy E. Paterick, MD, JD, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.