Picture this…you’re working a typical clinical shift and find that you are in need of a consulting physician. You look to see who’s on call and realize it’s your nemesis. You muster up the strength and courage to call them. How do you approach this conversation? What are your best practices for dealing with consultants?

In emergency medicine, we depend on consultants to help us care for our patients. Learning to interact with them in a professional way is a necessary skill that will help to improve patient care. There are various ways to approach consultants and various ways in which the consultation may become difficult. A few things to consider with each consult are the clinical situation surrounding the consult and the timing of the consult.

Consultation Considerations:
  • Situation surrounding the consult:
    • May require multiple different consultants and sometimes one consult service will ask you to discuss the case with a different service.
      • Example: Leg injury that does not have bony involvement
        • May require orthopedics, general surgery, vascular surgery, etc.
      • You have to decide if the case requires urgent vs non-urgent consult
        • Important to learn what presentations each specialty considers emergent.
  • Timing of the consult:
    • Be mindful of the disruptive nature of your consult.
      • Is the consultant in the middle of an urgent case?
      • Are they at home?
      • Are they taking hospital call?
      • Are they asleep?
    • Recognize that although you may be calling at an inopportune time, the patient is being paid to be on call.


Tips for Improving Your Consults:
  • Relationships with consultants:
    • The better the relationship, the less likely you will receive pushback.
    • Dealing with consultants you don’t have a good relationship can be tough.
  • Start off conversation on a friendly note to avoid confrontation.
    • “Kill them with kindness.”
  • Know what specific clinical question you are asking the consultant.
  • Lead in with your punch line.
  • Sometimes, at the end of the day, it’s all about endurance.
    • If the consultant takes the conversation to an unproductive place, you can:
      • Just let them talk until they realize you are only interested in direct patient care.
      • Take the HOA approach of repeating a completely true statement like “I understand your concern, however I need your help with this patient.
Take Homes:
  1. Lead with the punch line
  2. Be nice even though you might be consulting with your “nemesis” consultant
  3. Sometimes it’s all about endurance and being persistent for the sake of the patient

Post by Rick Dasilva

  1. https://emovereasy.com/2016/06/20/episode-8-dealingwithconsultants/
  2. https://www.acepnow.com/article/tips-working-consultants/


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Dealing with Difficult Consultants

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