VIEWPOINT * POINT DE VUE

Consultation protocol

Arthur Dodek, MD

A- few months ago I received a consultation request from a unit clerk on a medical teaching ward, who politely asked me to perform a pulmonary angiogram on a patient. This was a significant request, and I thought that a medical intern, resident, or member of the attending staff would call me that afternoon to give me a reason for it. The call never came.

do expect that doctors, not paramedical personnel, will be consultants for my patients.

Who calls? Communication between physicians is essential before and after consultations as emphasized in recent literature.1-3 This is simply an example of interphysician courtesy.4 When the consultee indicates the nature of the problem, the consultant may produce a more cogent and precise report.2'3 If pertinent information is not available to the consultant, it is possible that the patient may be inconvenienced by the repetition of unnecessary tests. Or worse, the case may be mismanaged. When I was a resident I was eager to speak with consultants and hear their recommendations.

Some of my teachers annotated medical references or supplied photocopies of pertinent articles. Today, I apply these same techniques to stimulate the teaching of house staff and to provide continuing medical education for prac-

tising physicians.5 Should I now give the photocopy of the reference article on indications for pulmonary angiography to the unit clerk?

Who comes?

Recently I had a depressed patient who was placed in the coronary care unit after a myocardial infarction. I called the Department of Psychiatry to request Arthur Dodek, a cardiologist at St. Paul's a consultation and left a message Hospital, Vancouver, is a clinical professor of medicine at the University of British on the telephone answering machine. Eventually a psychiatric Columbia. SEPTEMBER 15, 1992

nurse came to assess my patient it was as if a scouting party had been sent to check if the situation was safe or appropriate for the

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psychiatrist. One Saturday afternoon a few weeks later, the tables were turned. I was called for an urgent cardiology consultation on the psychiatric ward - the patient had a heart murmur - and I thought about sending my own scouting party. I did not, of course. I went to see the patient because that was my duty as a consultant. My apologies to the Department of Psychiatry - that episode occurred under a previous regime - but I do expect that doctors, not paramedical personnel, will be consultants for my patients. CAN MED ASSOC J 1992; 147 (6)

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Who initiates?

patient for fluid depletion or over- sultants should indicate in their load?

Occasionally, nurses in acute

care or surgical areas will initiate Who pays? a consultation. Instead of employing the house staff or primary When consultations are resurgeon, they will call a consul- quested from teaching wards for tant. We must be prudent about "teaching purposes," this should consultations not initiated by phy- be specifically noted on the chart. sicians. This is a time of thrift, A consultant is glad to respond to accountability and responsibility such a request after the appropriin the health care field. Can't the ate communication, but after the surgeon or house officer assess the scientific opinion is provided con-

notes for the medical record that "this consultation is for documentation and teaching and there is no charge to the provincial health

plan." Who cares? Yes, there have been changes in the practice of medicine in our hospitals. Today, many doctors may be involved in the care of a

single patient. However, someone patient's advocate.

must be the

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Consultation protocol.

VIEWPOINT * POINT DE VUE Consultation protocol Arthur Dodek, MD A- few months ago I received a consultation request from a unit clerk on a medical...
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