anyone else have this problem?

[cali-ob]

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So, I'm post call this am. I admitted 5 patients last night, 3 of which were soft "social admits".
On two of the patients, my attending tells me this morning to consult Neuro. I feel that this is completely unwarrented, we don't have a "valid" question to ask, and that the Neurologist is going to be completely annoyned. I also feel that this can and should be handled out patient. I voice this concern, respectfully, but my concerns are dismissed.
So I call the consult......The attending (neuro) yells and is annoyed. This should be handled out patient! This is at the back of his list! Did my attending see the patient?? I am with him, but what am I to do as the intern? Now I look like the dumb one (and by default my specialty as a whole at this institution) when in fact I knew this wasn't a valid consult!
This happens not only with neuro, but sometimes with cards, etc. I HATE it, cause I end up taking the brunt of the rants and raves from consultants.
Anyone else with this issue?😡
I'm not talking about a valid consult where the consultant is just being rude...but rather truly unwarrented consults that your attending forces you to call.

 

[AlternateSome1]

Whenever I call an unwarranted consult, I choose the plan that I would want first and offer that to the consultant. Sometimes they will agree but see the patient in brief and write it, sometimes they will agree and just call the attending to let them know it can be done as an outpatient, and sometimes they just see the pt with a little bit of their anger diffused since you didn't just shotgun consult, "gee..this pt has chf, peripheral neuropathy, and diabetes...better call cards, neuro, and endo!" You are the low man on the totem pole right now, so just suck it up. In 3+ years you can consult the hell out of that idiot who yelled at you. 😉

 

[hippiedoc13]

OP, I totally feel your pain. Happens to me all the time too. What I really hate is when I get chastised by my own attending ("Why haven't you already called a xxx consult?? They should be on board!" Ummm...we have no valid consult question...) and THEN I (reluctantly) call the consultant with this BS consult and get told-off by the consultant ("This is an unnecessary consult! And furthermore why are you calling me on a weekend, it's not urgent!!"). I have definitely had a few days as the intern when I feel like I am being yelled at from all sides, and can do nothing right. Sigh.

 

[Winged Scapula]

It happens to EVERY intern/resident. We've all been through it.

And now as an attending I find myself on the end of annoying inappropriate consults.

What I always did was tell the consultant, "I am sorry. Attending X is the one requesting the consult. His/her reasoning is X and he/she is on call today if you would like to discuss it with them."

I suppose the above coul backfire if your attending got called and then got mad at you, but in my several years of residency calling embarassing consults, I never found it a problem.

 

[gutonc]

Yup...it's just the price of doing business. If you're in a large academic center where all of the consults will be done by other house staff it's not as horrible since at some point everyone will be both on the giving and receiving end of these. If you're somewhere that only has 1 or 2 residencies (Like FM) and all of the consultants are PP attendings then it's a little bit more of a problem.

I have called (and been called for) more than my fair share of MAMMDI (My Attending Made Me Do It) consults. In the academic setting, it's just something you get used to.

 

[cali-ob]

I like your method winged, and that is essentially what I do/did. I "pass the buck" so to speak to the responsible party and let them take it up with them...which they never do of course.
On another note, I did see the neurologist 30 minutes after he yelled about my patient being at the bottom of his list etc. seeing my patient. So I decided to go up to him and introduce myself and thank him for coming.
And you know what....? He was SO very polite and even seemed a little scared of me! He said he was GLAD to help, and told me I did the right thing adjusting the patient's meds etc etc. Funny. People aren't so bold in person.

 

[minstral]

I also add to a consult converstaion, if there seems to be trrepidation by the consulted, the line:
"This is what my staff has asked me to do"

 

[dragonfly99]

All the advice mentioned above is good, except I don't think I'd recommend an intern to do what Winged Scapula is suggesting above...some attendings might get pretty ticked off and it could come back to haunt you. Some would take it well, but some will have zero tolerance for being "called out" by their intern...in their mind your job is to do whatever they want, whenever they want, and you damn well better not be complaining about it.
In this situation, I just usually would say at the time I called the consult, "Sorry, I know it's kind of a soft consult, but the attending was very concerned about 'X' and wants it checked out in house..."

And yes, you will get yelled at about a lot of stupid crap that isn't your fault when you are an intern, along with a smaller amount of stupid crap that probably is. This gets less and less bad as you go up the food chain.
Yes, OB/Gyn often calls cardiology consults, but I try never to sound annoyed when other services call consults...if they thought they could handle things alone, they would be doing so, and besides, most of the time it wasn't the intern or resident who decided they needed a consult, it was the attending...

Also, attendings often feel the need to "cover their a--" liability-wise in our present medicolegal environment, which probably leads to a lot of unnecessary consults.