The consult

© Fox

Making the consult is one of the most daunting tasks I've had to deal with. I go through more anxiety than I did when I asked my first crush out on a date.





At first, I thought it was like presenting to your preceptor: just go down your SOAP note like a checklist.




Boy was I wrong. Odds are your consulting physician is at home, office, or arms deep in a hemicolectomy; it's always an inopportune moment. Here are some tips to help make sure your patient gets the care they deserve:
1) Who? figure out what group you are admitting to. This one is a utterly, hopelessly confusing mess that is dependent on your institution. If you can, talk with your case managers or supervising physician.
1) BE CONFIDENT!! Keep it short and sweet (< 30 seconds). Find a quiet place to talk!
2) What? go straight to the point. "I have a patient who needs admission to r/o sepsis". Know the chief complaint and be clear. Have the patient's MR or account number handy!
3) Always include this statement; "I discussed this case with my attending physician (insert name here) and he/she agrees." 
4) explain your pertinent positive or negatives
5) Two is better than one: Additional consult? For example, you have a patient and suspect GI bleed, Don't just call your hospitalist, call GI first and give them a heads up.
6) Where to admit? Floor/Tele/ICU? Some institutions have set algorithms, but I think it doesn't hurt to ask.
7) Prepare for questions
8) Finally, ask if they would like anything done in the ED: extra labs? antibiotics? tall skinny latte?
9) Be polite: Thank them!!!

Before the call, it would be good idea to jot down what you are going to say. Good luck!