Happy Sunday!🌅
This week on Sunday Morning Rounds, I want to talk about speaking with consultants🗣️.
Speaking with consultants is something we have to do frequently in the hospital🏥. From Infectious Disease🦠 to Psychiatry🧠 to General Surgery🔪, medicine is a team sport, and a multi-disciplinary approach is necessary for complex patients🤒.
Regardless of our level of training, there is an art to this communication and there are do's and don'ts⚖️.
Because it's still early in the year for new interns and medical students on rotations, I'd figure it'd be a good topic to cover, so let's get to it⤵️.
✅ DO's
- Introduce yourself👋🏻. A new academic year means a lot of new faces in the hospital. When seeking a consult, whether in-person or over the phone, be sure to share your name, your department, and your role☎️. Not only is this important for the consultant to understand who is consulting them and why, but it can also help us to connect with peers (and maybe even eventually friends) in the hospital.
- Be prepared. Rarely in medicine do we call a consultant as soon as a patient comes through the door. We usually have some information, some type of physical exam or blood work started that we can refer to. If we're consulting Nephrology, we should know the patient's creatinine🌀. If we're consulting Ophthalmology, we should have the patient's visual acuity ready👁️. Having all of our information organized and prepared not only helps the consultant (and the patient) but avoids miscommunication and wasted time.
- State your clinical question upfront💭. Have you ever been in a conversation with someone and listened to them go on and on before they finally get to the point😪? Nobody wants to hear that, and consultants are no exception! When speaking with a consultant, be sure to state the reason for the consult or your clinical question first. That way, the consultant knows what the concern is and can listen for important information. This is especially important for critically ill patients that require time-sensitive interventions⏳.
- Respect the consultant's time🕐. In the Emergency Department, we sometimes have to call consultant's in the early morning hours to ask critical questions or ask an entire team to come in the hospital. These situations are less common, and if there isn't a medical emergency we should try to be respectful of the consultant's time and their on-call hours. Think about how you'd feel getting woken up at 3:00 AM just to have someone ask if it's safe for a patient take Ibuprofen?😡
- Ask for clarification and learning points🙋🏿. If we've called for a consult, it's important to ensure we get the information we were looking for. If a consultant says something along the lines of "do whatever you want" or "I don't care", push to have a clear, agreed upon plan before getting off the phone. If the consultant says something particularly interesting or that you don't understand, it's perfectly okay to ask for clarification. I still do this as an attending and usually frame it as "Just for my own learning, why do you think XYZ?".
🛑 DON'TS
- Be disrespectful😠. I still remember being a medical student and a resident, and I know that not everyone consultant is a ray of sunshine. If a consultant starts getting upset or speaking rudely, remain calm, find a stopping point in the conversation, and escalate the matter to the appropriate party, which might be a charge nurse, the senior resident, or your attending.
- Be okay with ambiguity🤷♀️. At the end of the day whether the consultant wants to talk to us or not, it's all in the name of patient care. If a consultant is being confusing or ambiguous, do your best to make sure there is a clear plan of care. One strategy I use is telling the consultant exactly what I plan to do and giving them the opportunity to agree or disagree and correct me. If you're a medical student, it may be helpful to discuss the anticipated plan with your team prior to seeking the consult.
- Get caught in turf wars⚔️. Unfortunately, sometimes in the hospital two specialties disagree on how to care for a patient or worse, both refuse to take any responsibility for the patient. This can be a frustrating and complex situation, so it's critical to pass these issues on to the attending immediately. There are sometimes various protocols and ongoing conversations when it comes to issues like which specialty is responsible for a specific joint or medical condition.
Not every interaction with consultants will go smoothly, and I personally have gotten into it with other doctors several times. But by keeping these do's and don'ts in mind, we take a big step in setting ourselves up for success and ensuring our patient's receive the high quality care they need and deserve.
📚 Improve Your Communication: Here are some popular books I've used to improve my own communication skills:
- Crucial Conversations by Joseph Grenny
- How to Win Friends & Influence People by Dale Carnegie
- How to Talk to Anyone by Leil Lowndes
📨 Subscribe to Sunday Morning Rounds: My weekly newsletter is filled with tips and resources to help you learn, grow, and become a better doctor. Click here to subscribe.
📱 Social media: Find me at @MedSchoolMoose on Instagram, TikTok, and YouTube to enjoy more of my content!