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How to be a good consultant

How to be a good consultant. Deborah J. DeWaay, MD, FACP Medical University of South Carolina April 16, 2013. O bjectives. Knowledge Define the role of a consultant Describe the components of an effective consultation Skills Assess the urgency of the consultation

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How to be a good consultant

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  1. How to be a good consultant Deborah J. DeWaay, MD, FACP Medical University of South Carolina April 16, 2013

  2. Objectives • Knowledge • Define the role of a consultant • Describe the components of an effective consultation • Skills • Assess the urgency of the consultation • Obtain a thorough and relevant history and review of the medical record • Perform a relevant physical exam • Synthesize a treatment plan based upon patient data. • Effectively communicate with the primary team

  3. Objectives • Attitudes • Understand the importance of establishing the exact question the consulting team is asking and the urgency of the consult. • Understand the importance of augmenting the medical record, not repeating it. • Understand the importance of direct, verbal communication with the primary team • Understand the importance of follow-up communication, both written and verbal

  4. Key Messages • Determine the question the primary team is asking and establish the urgency for the consult. • Gather all necessary data yourself. • Provide the primary team contingency plans for what may happen with the patient. • Communicate with primary team verbally and via medical record. • Respect the primary teams ownership of the patient. • Follow-up regularly.

  5. Determine the question • Background – multiple studies have shown that a large portion of the time the consultant doesn’t know the question that is being asked. • Practical tip – when you are doing a consult, write the question being asked in your note. If you don’t know the question, contact the primary team for clarification.

  6. Establish urgency: emergent, urgent, elective • There are three parts to this: • How urgent does the primary team believe the consult is? • Remember if someone is asking for help – they probably need it • How urgent does the consulting team believe the consult is? • Practical tip: Ask yourself: “how urgent would I think the consult is if my mother was the patient?

  7. Gather your own data independently • Apply everything you already know to obtaining a good history and physical • Review all labs and radiology yourself • Don’t depend on the primary teams documentation for your information • Most of the time the primary team is not calling to interpret data already present

  8. Be concise • Technically speaking you do not have to rehash everything that is already in the chart • For billing purposes, there needs to be rehashing • Be concise in your assessment and plan

  9. Be specific • Case: you are on the General Medicine Consult service. You are called to help evaluate and manage a 55 yo white male who developed acute kidney injury after a hip replacement. • What would a non-specific consult assessment and plan sound like? • What would a specific consult assessment and plan sound like?

  10. Give contingency plans • Try to anticipate what problems may occur and give the primary team a plan • If the blood pressure exceeds 180/90 give lopressor 50mg PO every 6 hours • If the blood pressure drops below 100/60 give a 1L bolus of normal saline

  11. Respect the primary teams responsibility for the patient • Ultimately the primary team is in charge and gets to make the decisions. • Practical tip: don’t say negative things about the primary team because they didn’t listen to you (especially if you haven’t spoken to them in person.)

  12. Share your expertise • Explain why you are making the recommendations that you are making • Practical tip: leave articles that relevant • (When you are primary: read articles that are left)

  13. Verbally communicate with the primary team • Despite a physicians best efforts, the thought process behind the decision making is not always documented • Verbal discussion allows for physicians to understand how the decision is being made and to “bounce ideas”off of each other • Having said that – written communication about the thought process behind the decision making is crucial • Different subspecialties have different expectations from the consult. Verbal communication helps bridge that gap

  14. Provide follow-up • A consultants suggestions are followed more accurately if the consultant follows up with the primary team

  15. References • Goldman L, Lee T, Rudd P. Ten Commandments for Effective Consultations. Arch Intern Med Vol Sept 1983; 183: 1753-1755 • Pupa L, Coventry J, Hanley J, Carpenter J. Factor affecting compliance for general medicine consultations to non-internists. AM J Med 1986; 81: 508-514 • Devor M, Renvall M, Ramsdell J. Practice patterns and the adequacy of residency training in consultation medicine. J Gen Intern Med. 1993;8(10):554 • Salerno SM, Hurst FP, Halvorson S, Mercado DL. Principles of effective consultation: an update for the 21st-century consultant. Arch Intern Med. 2007; 167(3):271

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