Consult Courtesy

Abstract

It's Sunday and you are covering 3 hospitals as a consultant for otolaryngology. A fairly urgent consult awaits you at the children's hospital. You receive a call from a primary care team at another hospital asking you to evaluate an oral lesion in a patient who has been in the hospital for 1 week. The primary team wonders if this lesion needs surgical management before they move forward with placement of a left ventricular assist device and chronic anticoagulation, planned for the next day. The lesion has been present for more than 1 year. When asked what the lesion looks like, there is no response. After a pause, the referring intern admits that he hasn't looked in the mouth.What ensues after this phone exchange?Consultants may be frustrated with this addition to their workload and may vent their irritations with rude, unprofessional comments on the phone. It is common for the consultant to believe that the person calling the consult (often an intern or medical student) does not have key information, and for the primary team to feel slighted by the line of questioning they receive from the consultant. Primary teams, busy addressing a host of complex medical and social needs for each patient, may feel that their concerns are being inappropriately minimized. Most of the time this conversation doesn't change the fact that eventually, after a phone call full of dispute, the consultant team will need to see and evaluate the patient.After fielding otolaryngology consults for the past year, one of the authors (R.A.B.) discovered that adherence to a few simple guidelines minimizes the frustration experienced by all involved parties. Similarly, while managing primary teams the other author (E.G.B.) found that several steps could improve interaction with consultants. We hypothesize that the following suggestions could transform the teaching hospital into a more professional and courteous place.The same assumption—that we are all working together, on the same team—also improves interactions with primary teams at the time of a consult. In the scenario described above, the lesion did require biopsy to rule out malignancy. Thus the consult, initially assumed to be inappropriate, was indeed in the patient's best interest.Ideally, the hospital provides a professional and courteous environment with varied staff caring for patients in the most efficient way possible. It should be a place where consultant teams happily offer their assistance, and consultation requests are appropriate and judicious. These suggestions are offered to minimize the sometimes negative attitudes surrounding consults and to produce a more enjoyable and educational hospital environment as well as improved patient care.