Eric I. Rosenberg, M.D., M.S.P.H., F.A.C.P.
1. Why do physicians request medical consultation?
& For assistance in making a diagnosis in a patient with symptoms and signs suggestive of an unknown disease or syndrome
& To obtain advice on specific disease management (such as diabetes or hypertension)
& To obtain a procedure usually performed by a subspecialist (e.g., coronary angiogram in a patient with persistent angina)
& To evaluate a patient’s ability to safely undergo surgical procedures
& To obtain advice on specific disease management (such as diabetes or hypertension)
& To obtain a procedure usually performed by a subspecialist (e.g., coronary angiogram in a patient with persistent angina)
& To evaluate a patient’s ability to safely undergo surgical procedures
2. How can one assess the effectiveness of medical consultation?
& Is the consultation question answered?
& Does the patient benefit from disease improvement or promotion of better long-term health?
& Are the consultant’s recommendations actually implemented?
& Is the consultation question answered?
& Does the patient benefit from disease improvement or promotion of better long-term health?
& Are the consultant’s recommendations actually implemented?
3. What factors increase the likelihood that the consultant’s recommendations
will be ignored by the referring physician?
& Poor communication between the requesting physician and the consultant (occurring 12–24% of the time in some studies)
& Delayed response to the consultation request
& Failure to address the requesting physician’s key clinical question
& Prematurely ending the consultant’s involvement in the patient’s care
& Infrequent follow-up visits
will be ignored by the referring physician?
& Poor communication between the requesting physician and the consultant (occurring 12–24% of the time in some studies)
& Delayed response to the consultation request
& Failure to address the requesting physician’s key clinical question
& Prematurely ending the consultant’s involvement in the patient’s care
& Infrequent follow-up visits
Goldman L, Lee T, Rudd P: Ten commandments for effective consultation, Arch Intern Med 143: 1753–1755, 1983.
Horwitz RI, Henes CG, Horwitz SM: Developing strategies for improving the diagnostic and management efficacy of medical consultations, J Chronic Dis 36:213–218, 1983.
