The fundamentals of a passive aggressive consult note
Consult to: Bob Johnson, MD, FACS, Director of Microvascular Reconstructive Surgery, Professor of Head and Neck Oncologic Surgery [note the ridiculous title, making sure the consulting ED NP knows just who they are bothering with this]
Resaon for Consult: "Vertigo" [putting the chief complaint in quotes is very important, both for Medicare billing and to cast doubt on whether the patient ever had vertigo]
HPI: Ms. Smith is a very pleasant [the more pleasant they are, the more bull**** the c/s] 92-year-old female who had an episode of syncope after standing up at an outdoor church picnic in July heat. She said she felt lightheaded when she stood, then had loss of consciousness. She denies vertigo [very important to state that the patient denies the chief complaint], hearing loss, tinnitus, otalgia, otorrhea. No headaches. Reports no prior history of vertigo. No history of otologic trauma or surgery. [Make your pertinent negatives very long to make it clear that you asked all the questions they didn't]
...
Assessment and Plan
92yo female with "vertigo" [quotes again]
- No evidence of vertigo
- If patient having recurrent syncope, can consider audiogram, electronystagmogram, and electrocochleography to rule out otolithic crisis of Tumarkin in setting of Meniere's disease [Make a ridiculous recommendation that will add nothing to patient care]
- Patient may follow up with Dr. Johnson if she desires [make it clear you don't give a **** if you ever see the patient again, but don't include this statement if patient is crazy]
Seen and discussed with attending physician, Dr. Johnson.
Thank you very much for this interesting consult.
VisionaryTics MD PGY2 State U Otolaryngology [do not include personal or service pager]
We will sign off. [end with the stinger]
