This is another post in the Clerkship Pearls series for medical students going through clerkship, and today I’ll be discussing
How to Effectively Get a Consultation for Your Patient
One of the scariest things to do as a clerk is to ask another consult service to help you with the care of your patient. A consultant, or consulting service, is usually another doctor or team that specializes in a certain area of medicine. When you ask for a consult, you are asking another doctor to aide in the care of your patient. Whether that’s getting a CT scan approved by the radiologist or asking a busy service such as ortho to come assess for surgery, making that phone call to get a consult isn’t always easy.
I remember a time when my staff in Internal Medicine thought there was an abscess that should be assessed. I was given the ask of finding a surgical service to come see the patient. I was turned down and harshly called out for inappropriate consults by both General Surgery and Plastic Surgery before someone finally agreed to come see the patient.
Sometimes it’s the consultant or their resident that’s rude. But there are a few things I have figured out you can do to make it more likely and easy for a consultant to see your patient.
1. Identify Yourself
When you make a phone call to a consulting service, identify yourself. “Hi, this is medaholic, clinical clerk year 4, from Internal Medicine and I have a patient that I would like you to provide your expertise on and to come and see.” The point is to make a connection with the person on the other end of the line so that you become a person asking them to help you, not just another “consult”
2. Clear Communication
There is a technique for health care communication called SBAR that you should become familiar with. The acronyms identify a method that you should follow to communicate effectively. SBAR stands for Situation, Background, Assessment and Recommendation.
Situation – encompasses identifying yourself and identifying your patient. Remember to include the patient’s full name, age, sex, health care number and location. If it’s an urgent call, make sure you let them know right away.
Background – Be brief. Tell the consultant why the patient is here and why you are requiring their consultation. List any information that is pertinent. Past medical history, relevant medications, investigations you have done and treatment.
Assessment – The assessment is always tricky for new learners, but let the consultants know what you think is going on. Explain to them why you think their services are needed.
Recommendation – If you want something explicitly, let them know. If you want their expertise and their opinion, state that’s what you want. Be clear on your expectations and make it possible for them to deliver.
3. Call before Noon or at a Convenient Time
Nobody likes getting a new consult to do just as they are planning to go home. Call as soon as you know you need a consultant’s help. If possible, call before lunch. Don’t call during lunch time unless it’s urgent.
Try to give them as much head’s up as possible so they can plan their day accordingly.
4. Leave Good Notes
Good documentation on your part makes a consultant’s life much easier. If you can provide them with as much information as possible, so they don’t have to start from scratch, you will facilitate patient care. Outline your reason for referral and possible expectations. Remember to leave your contact information so they can get in touch with you.
5. Do the Proper Workup
If you’re going to enlist the help of a consultant, you are expected to help them out too.
If you’re consulting orthopedics regarding a bone – take an xray of the bone. If you’re consulting nephrology – make sure you order urine tests. Likewise, if you’re consulting surgery, make sure you have the necessary bloodwork drawn such as PTT, INR, Cross & Type.
6. Follow up with the consultation
When you ask a consultant to come see your patient, you create an open loop, a task that is not closed or complete. Sometimes it can take a long time to get a consult, follow up on it until it gets completed and “closed.”
Similarly, it’s always a nice gesture to call them afterwards to see their recommendations and implement their plans accordingly.
If you no longer need the assistance of a consultant, contacting them and letting them know that they can sign off is a nice courtesy.