Expectations for Subspecialty Consultations

High quality systems of care dictate that communication be respectful and that members of the healthcare team trust each other. Without trust and respect there can be no teamwork and the care of our patients will suffer. Disagreements among physicians are quickly detected by patients and can lead to distrust of the healthcare system and of the physicians.

Obligations of the Consultant

  • Act as a supplier of a service and make every effort to please the customer (consulting team).
  • Respectful communication as a colleague is critical. The person consulting wants your help, not your criticism!
  • Respond within 24 hours of a request, and in a true emergency within one hour (example: ER consults).
  • Communicate with the attending directly, in addition to the house staff responsible for the patient’s care. Provide contact information that will enhance attending-to-attending communication.
  • Recommendations need to be logical, practical, and based on an accurate assessment of the data.
  • Respond quickly to any concerns or questions by the team.
  • Follow-up visits on all cases in which problems remain active and are evolving.

Obligations of the Consulting Physician

  • Clearly define the question you are asking of the consultant and/or clearly define the specific service you are requesting.
  • Consult early in the day and early in the hospitalization. Whenever possible make the request before 12 noon to allow the consultation team to efficiently manage their consultations. Consultations early in the hospitalization lead to more efficient and higher quality care.
  • Follow the recommendations of the expert consultant. Failure to do so conveys a lack of trust and disrespect for the consultant.
  • If the team does not agree with the consultant’s recommendations, the attending is obligated to immediately contact the consultant and discuss the reasons for this disagreement.
  • Respectful behavior and constructive communication are vital. When a disagreement persists, a compromise should be established. There should never be a “chart war”.
  • Constructive feedback is vital in order to improve our systems of care. If, after discussing the case with the consultant, the attending is unhappy with a specific consultation because of delay, inappropriate recommendation, or disrespectful communication, he or she should immediately contact the Chief of the Division or Department responsible for providing this service.

Example of what can go wrong (simulated video): In this video the person calling in the consult knows none of the key details to guide the consultant. Unfortunately the consultant is disrespectful to the caller and is not acting as the supplier of a service. Can you imagine a store salesman speaking to a prospective  buyer in this way? Do you think they would get the sale?  Who is acting like the customer in this video?

Example of an ideal consultation interaction (simulated video): In this video the consultant is positive, encouraging and respectful. The person requesting the consultation is able to relay the basic facts about the patient and provide a clear problem for the consultant to solve.