Consults

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Calling Consults

Calling a consult can be a daunting task, especially when the consultant is an experienced attending and the caller is a young intern. However, consults are an essential part of the medical profession. Learning how to request a consult effectively is an essential part of resident training. Below are general steps and guidelines to calling a consult.

Before you Call

  1. If there is time, make sure you know the patient before calling. True emergencies are rare. Consults are urgent, but there is usually enough time to figure out the patient.
  2. Call consultants sooner, rather than later. This is both the polite thing to do and better for the patient.
  3. Contact the consultant using their preferred method of contact. This is listed on the call schedule. In many cases, you will be speaking with the PA.
  4. If the preferred method of contact is paging, page directly to your cellphone if you are going to be moving around the hospital.
  5. If the preferred method of contact is cell, call the phone directly. Respect that this is their private individual phone number. Avoid texting consultants. The amount of information that can be shared is prohibitive. It is important to gain experience talking to consultants directly.

The Call

  1. Introduce yourself. Clearly identify your role as a resident. Identify your attending.
  2. Identify the patient. Include patient name and room number at minimum. Offer to include MRN or DOB if needed.
  3. Give a quick one-liner that includes the patient's age, sex, and reason for admission.
  4. Cut to the consult question. This is usually the specific reason or question you are calling for.
  5. Provide a very brief narrative regarding the patient, 4-5 sentences max. Often the consultant will cut you off during this.
  6. Ask if there are any questions or orders needed at the time of the call.
  7. Some consultants like to stay and chat a little or provide some teaching when you call. Be grateful for this. Some are strictly business and are done when you are.
  8. Some consultants did not understand that when they placed their name on the call schedule that it would mean that they actually have to work when they are called. Do not take this personally. If a consultant is rude or verbally abusive, let your attending know. If necessary, escalate to the Program Director.

Follow-up

  1. Consults do not end after the first phone call. Read their notes. If the consultant is actively following your patient, touch base with them daily.
  2. At this hospital, consultants typically place orders that they have recommended. Trust, but verify with the consultant if an order has not been placed.

Sample Script

Hello, this is Scott, one of the internal medicine residents. I'm working with Dr. White today.
I am calling for a consult on Mr. Baylor in room 1000. Do you need the MRN or date of birth?
This is a 60 year old male who was admitted with acute cholecystitis.
We are calling to ask if surgery would be appropriate in this case.
Briefly, the patient reports intermittent abdominal pain after eating over the last two months.
Pain suddenly become more severe and non-resolving after eating lunch today.
Initial ultrasound had positive sonographic Murphy's sign.
CT has been ordered, but is pending at this time.
Patient does not take any blood thinners and is NPO.
He has been started on IV Zosyn and lactated ringers.
Do you have any questions regarding the patient or are there any orders you need placed at this time?

References

  1. The Courteous Consult: A CONSULT Card and Training to Improve Resident Consults. J Grad Med Educ. 2015 Mar; 7(1): 113–117. PMID:26217436
  2. A prospective, randomized, controlled study demonstrating a novel, effective model of transfer of care between physicians: the 5 Cs of consultation. Acad Emerg Med. 2012 Aug;19(8):968-74. PMID:22905961.