Tips to Call a Consult
Written by Sara Kurtevski, MD
Imagine it is your first day as a resident on an inpatient rotation and you admit a patient with a possible Upper GI bleed to your service. You quickly assess the patient with your team and decide that the patient is stable, however, your attending says, “Please call GI and place a consult.” The request to reach out to a specialist, at least for me personally, was always one of the more intimidating things I have had to do. Although this can feel very intimidating, there are some ways to facilitate the interaction and take some of the pressure off of your shoulders.
Here are some tips:
Be polite and do not forget to introduce yourself: This can seem so simple, yet it is one of the easiest things to forget to do when you are under pressure and trying to do things with urgency. Making sure that you always begin with a greeting and a brief introduction of who you are, what service you are on, and who your attending is will help the consultant begin to recognize you in the future when you place another consult and it will help you build good report. Having a good report will make you feel much more comfortable with future consults, and it will increase the likelihood that the consultant will be more willing to help and be more responsive.
Know your patient: This is a very important one. Before you consult a specialist, try your best to do a thorough chart review and ask for a complete history with relevant information to the problem you will consult the specialist for. Although there may be situations where you will need to place an emergent consult and you may not be able to gather all of your information, do your best to know the story of the patient. This will not only help the consult by having a better idea of what is going on before seeing the patient, but it will also show that you are the expert in knowing the patient you are taking care of which will give you a little more confidence when approaching specialists.
Ask a specific question: The consulting service is there to help the primary care team when we need additional support in caring for a patient. That being said, whenever you will consult a service share the relevant information you have and ask a question that you specifically need that service in answering. And please do not forget, that radiology is also a consulting service meaning that every time an order is placed for an image there should be a question in mind that the image will help you answer. This will ensure that you have better utilization of consulting services as well as improve the quality of care you are providing to the patient.
Familiarize yourself with the consultants in your hospital and their fellow, PAs, and NPs if they have them: Get to know your consultants and their team! This is a great way to network and helps you build a report as it is much more comfortable to reach out to people with whom you are familiar. In addition to making official consults much more pleasant, this is also a great way to unofficially reach out to a specialty service when you are unsure if you should place an official consult. When you are a resident, there will probably be many times that you will be uncertain about management due to a lack of experience. Having someone to reach out to for unofficial questions is always a great help to the learning process and improving your patient management and appropriate use of consulting services.
When in doubt, ask your teammates and remind yourself that you are learning and it is okay to not know things: Whenever you are asked to reach out to a consultant, especially when you are new to a place, remember that you are part of a team and are not all alone in this battle. You have support from your co-residents and attendings to guide you and help you with these interactions, so do not hesitate to ask for help or tips from them. Being a resident also means that you are in a learning process and you are not expected to know everything. Even the most experienced physicians do not have the answers to everything and sometimes need help from other specialists. There is humility in recognizing your limits and knowing when to ask for guidance and help. If you do not know something, see it as a learning opportunity and a way to continue improving yourself as opposed to feeling embarrassed.
