We’ve all been there. Being on the receiving end of an unhappy consultant can be extremely frustrating and stressful, and it can be a major roadblock to appropriately communicating the needs of your patient. While you are sometimes just the victim of someone else’s issues, we can often do a better job to make these interactions go smoothly. The following is a suggested method for talking with your consultants.
1. Talk with your attending (or simply think about what you are going to say and why you are calling). If you are unclear as to why you are calling, talk it over and come up with a game plan.
2. Identify who you are, your level of training, and why you are calling: ”Hi this is Bob Stuntz, I’m one of the ED attendings. I’m calling you about a 50 year old male with diverticulitis complicated by microperforation and abscess.” This gets the consultants attention and lets them know who you are. Do not lose them by waffling about why you are calling. Avoid at all costs saying things to disparage your patient or your consult (e.g. “This is a soft admission,” I’m sorry about this one,” etc). Don’t lose your consultants trust and interest right off the bat.
3. Use a concise SBAR Format:
“Hi this is Dr. Stuntz, I’m one of the ED attendings. I’m calling you about a 50 year old male with diverticulitis complicated by microperforation and abscess.” (Situation). He has had 3 days of worsening LLQ abdominal pain, subjective fever, n/v, and now has pain with hitting bumps in the car. He has never had any surgery before, and has never had this before (Background). He was very tender on abdominal exam with guarding in the left lower quadrant, as well as some rebound tenderness. His HR was initially about 110/min, but with IVF and pain meds has come down to normal, and he is otherwise hemodynamically stable, afebrile, and more comfortable with IV dilaudid (Assessment). We got a CT showing descending and sigmoid diverticulitis with micro perforation and a small abscess. We have started him on Levaquin and Flagyl IV, and would like you to come evaluate him for hospitalization and further care (Recommendation).
4. Ask them if they have any questions, and if there is anything else they would like you to do. This gets them on your side and shows you value their opinion and want to work as a team to optimally care for the patient.
5. Be nice, and say thank you. Kindergarten rules apply. If you want people to be polite with you, you have to do the same back.
Dealing with difficult consultants and a more in depth discussion of this topic are to come in future posts, as well as our first podcast (expect that around the time interns begin to show up!)