Calling consults...

[ForeignBody]

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Now that I am a resident (soon to be fellow) there are essentially three things that I look for when I choose who I am going to call to consult:

1. Are you an ass? If yes, and if I have the choice of who to call (sometimes the attending will tell you who to consult), you will never be called. If you are pleasant on the phone, you are highly likely to be called.

2. Do you teach anything? If yes, then you are more likely to be called.

3. Are you easily reachable by phone (cellphone preferable, texting makes you like a god) or pager? We all like waiting by the phone for 30 minutes for your call back, um yeah.


I was curious how other people at other programs view calling consults...

 

[Orange Man]

Now that I am a resident (soon to be fellow) there are essentially three things that I look for when I choose who I am going to call to consult:

1. Are you an ass? If yes, and if I have the choice of who to call (sometimes the attending will tell you who to consult), you will never be called. If you are pleasant on the phone, you are highly likely to be called.

2. Do you teach anything? If yes, then you are more likely to be called.

3. Are you easily reachable by phone (cellphone preferable, texting makes you like a god) or pager? We all like waiting by the phone for 30 minutes for your call back, um yeah.


I was curious how other people at other programs view calling consults...

What? I'm confused.

If I feel my patient needs an I.D. consult, I call I.D.. If I feel they need an ortho consult. I call ortho. I could less care who the person is or what their personality is. I think most people know that one person is on call for a certain service, so you can't be picky.

If the patient needs the consult, that person is coming to see them....

 

[jdh71]

What? I'm confused.

If I feel my patient needs an I.D. consult, I call I.D.. If I feel they need an ortho consult. I call ortho. I could less care who the person is or what their personality is. I think most people know that one person is on call for a certain service, so you can't be picky.

If the patient needs the consult, that person is coming to see them....

I agree. I don't understand.

 

[flipmd]

Now that I am a resident (soon to be fellow) there are essentially three things that I look for when I choose who I am going to call to consult:

1. Are you an ass? If yes, and if I have the choice of who to call (sometimes the attending will tell you who to consult), you will never be called. If you are pleasant on the phone, you are highly likely to be called.

2. Do you teach anything? If yes, then you are more likely to be called.

3. Are you easily reachable by phone (cellphone preferable, texting makes you like a god) or pager? We all like waiting by the phone for 30 minutes for your call back, um yeah.


I was curious how other people at other programs view calling consults...

This thought process works in private practice, where consultants don't earn if they don't get consulted. But in residency, you don't really have much of a choice who to call. How you call, however, makes a difference. If you were an ass when I called you for a consult before, I won't think twice next time to call you at 4:45pm (or at 6:45am if I'm in the ER) for a new consult rather than waiting the next morning - and I'm not going to take "can you call me back when the CT is officially READ (ie. in 15 minutes when someone else is in)" as an answer.

 

[atsai3]

Now that I am a resident (soon to be fellow) there are essentially three things that I look for when I choose who I am going to call to consult:

1. Are you an ass? If yes, and if I have the choice of who to call (sometimes the attending will tell you who to consult), you will never be called. If you are pleasant on the phone, you are highly likely to be called.

2. Do you teach anything? If yes, then you are more likely to be called.

3. Are you easily reachable by phone (cellphone preferable, texting makes you like a god) or pager? We all like waiting by the phone for 30 minutes for your call back, um yeah.


I was curious how other people at other programs view calling consults...

You sound more like a medical student than a resident. Unfortunately for you, during residency you have very little control over who you call within a specialty. There is 1 ID pager, 1 cards pager, 1 psych pager, etc. It's not like you can decide for yourself, "hmm, I liked ortho resident A better than ortho resident B. I think I will ask ortho resident A to provide a consulting opinion on my patient".

I suppose you do have some control over whether to call ortho vs. psych. But again, the point of your rant is unclear. If your patient needs a scope, then you pick up the phone and call GI. It's not like you can decide for yourself, "hmmm, the GI fellows are always a**holes on the phone, but I've had pretty good experiences with ortho. I think I'll call ortho instead".

-AT.

 

[ForeignBody]

I see. I guess you all have entirely different systems than I do. Which would make sense since none of you get what I am talking about.

I do get to decide who I call about 75% of the time. There is no cards fellow with a pager, etc., so if attending says call Dr. so and so, I call them. Otherwise I am free to call whoever I want.

So i guess, forget what i said since it applies to no one else.

 

[Friendly]

I see. I guess you all have entirely different systems than I do. Which would make sense since none of you get what I am talking about.

I do get to decide who I call about 75% of the time. There is no cards fellow with a pager, etc., so if attending says call Dr. so and so, I call them. Otherwise I am free to call whoever I want.

So i guess, forget what i said since it applies to no one else.

So this (above) is not how 99% of U.S. internal medicine programs work. If my patient's care requires the input of a consultant and I call a consult, they're coming......

 

[jdh71]

I see. I guess you all have entirely different systems than I do. Which would make sense since none of you get what I am talking about.

I do get to decide who I call about 75% of the time. There is no cards fellow with a pager, etc., so if attending says call Dr. so and so, I call them. Otherwise I am free to call whoever I want.

So i guess, forget what i said since it applies to no one else.

I don't know about 99% but most of us train at places where there is a consulting teaching service for all the sub specialities. We talk to either the fellow or the resident on that service. We don't choose who to consult. We simply consult "GI" or "endo" or "ID" and whoever is on that service, resident, fellow, attending takes the consult.

 

[VJWDO]

I do understand what you are talking about. At my program we are at a community hospital for some of our rotations and we have the choice of various groups to call. I can avoid calling docs that have been an ass to me in the past. Consultants are very nice to you when you call because it means money to them. At our VA though we call "endo" or "cards" or "GI". I completely agree that the points brought up in the OP's post are valid and cross my mind frequently.

 

[drfunktacular]

I think the OP's original point is important to consider, though it does apply to most people only once they're in practice. As I was once told, "in residency more consults means more work, but in practice more consults means more money." One of my surgery attendings when I was a med student used to say that no matter how stupid a call/consult is, no matter what time of day/night, if you want to be a good doctor your answer should always be "I'm happy to help."

Residents/fellows bitch and moan about every single little piece of work because they don't see what's in it for them, whereas in practice everyone is "happy to help."

For those of us who are in training I do think this is worth keeping in mind, because your colleagues in other departments really will appreciate having a nice helpful voice on the other end of the phone when they are stuck and need help, and you will be preparing your skills as a happy helpful consultant for when you go into the real world.

Also, I'm sure anyone who has worked on a consult service has had the experience of getting a "stupid" consult, only to wonder aloud when you arrive "what are they DOING to this poor patient??" In those cases (particularly as a medical consultant) I think you really can make a difference in patient care even outside endo/GI/cards/pulm/rheum/your specialty by politely raising the issue of "have you guys considered X/Y/Z?"

 

[DrWBD]

I see. I guess you all have entirely different systems than I do. Which would make sense since none of you get what I am talking about.

I do get to decide who I call about 75% of the time. There is no cards fellow with a pager, etc., so if attending says call Dr. so and so, I call them. Otherwise I am free to call whoever I want.

So i guess, forget what i said since it applies to no one else.

I know exactly what you are talking about. As others have mentioned, it depends on where you train.

As a resident, I was in a university hospital with where "house" was the only game in town, for the most part. So, you paged the fellow or resident on call for consults. Some of them were, at baseline, terribly abrasive and miserable people during during normal working hours, so you can imagine what they were like at night or on the weekends. Even when you were calling with a perfectly reasonable consult request these people had a way of making you feel like an idiot for calling them.

After residency, I worked elsewhere in a large community hospital that also had residency and fellowship programs but also had a substantial number of "private" attendings in various specialties. The housestaff there would often coax the admitting attending into calling the specialists they knew would not give them a hard time on the phone, i.e. the "thank you for the interesting consult" folks. Sometimes that would be the residents/fellows, sometimes the private attendings.

Looking back I'm not sure which system was better. While it is nice to not get yelled at on the phone by a cranky resident or fellow (or attending), the other extreme is that you don't learn how to be judicious with consults if they are super easy to call. Part of the "unofficial curriculum" in a medicine residency is to develop the ability to handle stuff without consultation as opposed to having every aspect of a patient's care managed by a specialist in the hospital.

 

[DrWBD]

I think the OP's original point is important to consider, though it does apply to most people only once they're in practice. As I was once told, "in residency more consults means more work, but in practice more consults means more money." One of my surgery attendings when I was a med student used to say that no matter how stupid a call/consult is, no matter what time of day/night, if you want to be a good doctor your answer should always be "I'm happy to help."

Residents/fellows bitch and moan about every single little piece of work because they don't see what's in it for them, whereas in practice everyone is "happy to help."

For those of us who are in training I do think this is worth keeping in mind, because your colleagues in other departments really will appreciate having a nice helpful voice on the other end of the phone when they are stuck and need help, and you will be preparing your skills as a happy helpful consultant for when you go into the real world.

Also, I'm sure anyone who has worked on a consult service has had the experience of getting a "stupid" consult, only to wonder aloud when you arrive "what are they DOING to this poor patient??" In those cases (particularly as a medical consultant) I think you really can make a difference in patient care even outside endo/GI/cards/pulm/rheum/your specialty by politely raising the issue of "have you guys considered X/Y/Z?"

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