One of the day-to-day tasks of the junior doctor is to request the advice of another specialist team in the management of one or more of your patients. This takes place by way of a formal consultation or ‘consult’. Due to increasing sub-specialisation at tertiary hospitals, this can result in organising a consult for each system of the body!
Arranging a consult can be a daunting task for the junior doctor. It is often difficult to know how to prepare, and you may not know how to organise the information before calling. In addition to this, there is always a lurking fear of calling someone who doesn’t know you.
For the registrar receiving a call it is hard not to see consults as just “more work”. It is important to recognise that as a junior doctor, the response of the registrar on the phone has less to do with your specific request and more to do with adding more work to an already busy workload. Despite this, being able to provide a complete and considered consult request will enhance your reputation at the hospital. Remember that when you request a consult, you are calling as a representative of your consultant, who has requested the help of another consultant in the management of his or her patient. Being organised, polite and succinct reflects well on your consultant, and the same goes for the registrar on the other end of the phone.
Your more senior colleagues will be able to tell you that requesting a consult is a skill – and like any skill it improves with practice. With this in mind, here are 5 tips to make the process easier and less stressful!
The earlier a consult is made, the greater chance that that patient will be reviewed that day. Requesting consults is something that should be done in the morning if possible. Sometimes that won’t happen due to the timing of the ward round or urgency of the clinical problem. If your consult is particularly urgent, make sure you mention this to the registrar and explain why.
Each consult should be based on a clinical question that the team wants answered. This is the most important piece of information. You should be able to summarise the question in a concise sentence. For example:
• How can we improve the management of this patient’s heart failure?
• Does this patient have cholecystitis?
• Can you help us decide on the best discharge destination for this patient?
If you don’t know the question, ask your registrar before you call
It is helpful to write or type up the consult before you make the call to help organise your thoughts. Make sure you also have access to all relevant information whilst you are on the phone. This means having the progress notes and bedside chart in front of you, as well as their file or electronic medical record.
At a minimum, you will require the patient’s name, medical record number, bed number, reason for admission, and clinical question. Beyond this, you should anticipate what questions the registrar will ask. It is neither practical nor necessary to do a complete case presentation. It can be helpful to think through the categories of history, examination, investigations, treatment etc. and pick out the most relevant points.
Use ISBAR to help structure your request concisely. You should begin with a brief introduction such as, ‘My name is Belinda Jones and I am the gastroenterology intern. I am calling to request a cardiology consult for one of my patients who is known to Dr Wilcox. Are you the person I should be speaking to?’ Once you have located the correct registrar, you can proceed to provide all the required information as stated above. If you are simply calling for phone advice, state this in your introduction. Similarly, if you would like the other specialist care team to take over care of your patient, make sure you state this clearly and early in the request.
Often the registrar will require additional information to prioritise your patient and help offer informed management advice. The registrar may request additional investigations, GP correspondence or old clinic notes to help piece together the patient’s history and to help answer your clinical question. Help the registrar by adhering to their requests before they arrive so that you can ensure the best care for your patient.