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So I'm relatively new to the non-academic world and have been a bit surprised by how consults are treated. In my job, we carry the pager about once a week which means we do orders for admits and cover consults as they arise on top of whatever our regular work load would be. Consults are relatively rare, but I feel like when they do pop up, there's an expectation that we can provide meaningful consults in really little amounts of time.
Case in point -- I received a consult request from the ED today later in the afternoon regarding a man with dementia and behavioral disturbances who appeared to be pretty much at baseline. His facility was requesting a psychiatric consultation with recommendations for PRNs prior to him returning to his facility. Of note, this guy already has a psychiatrist. So my thought is that to actually do a quality consult that would provide value to a geriatric patient with dementia, multiple medical concerns and behavioral disturbances would honestly take 2 to 3 hours including interviewing the patient, his doctor, care givers, reviewing the (quite extensive) chart and lastly writing your note. That was not remotely feasible for my work flow for the day, and I wound up briefly talking to this guy, reviewing his MAR for totally inappropriate stuff (which btw wasn't there) and doing a quick chart review for obvious things. That took an hour and provided I thought about zero value.
I feel pretty comfortable doing admissions more quickly because you have more time with people and can figure out things as you go along. These one time consults, though, with patients where you won't do follow up are hard. Am I being entirely unreasonable in thinking it's unrealistic to expect psychiatric consults in short periods of time?
Case in point -- I received a consult request from the ED today later in the afternoon regarding a man with dementia and behavioral disturbances who appeared to be pretty much at baseline. His facility was requesting a psychiatric consultation with recommendations for PRNs prior to him returning to his facility. Of note, this guy already has a psychiatrist. So my thought is that to actually do a quality consult that would provide value to a geriatric patient with dementia, multiple medical concerns and behavioral disturbances would honestly take 2 to 3 hours including interviewing the patient, his doctor, care givers, reviewing the (quite extensive) chart and lastly writing your note. That was not remotely feasible for my work flow for the day, and I wound up briefly talking to this guy, reviewing his MAR for totally inappropriate stuff (which btw wasn't there) and doing a quick chart review for obvious things. That took an hour and provided I thought about zero value.
I feel pretty comfortable doing admissions more quickly because you have more time with people and can figure out things as you go along. These one time consults, though, with patients where you won't do follow up are hard. Am I being entirely unreasonable in thinking it's unrealistic to expect psychiatric consults in short periods of time?