Everyone has been there. You’re making rounds in the hospital and another physician taps you on the shoulder and says, “Can I ask you something?” He then gives the details and diagnosis of a patient’s condition and asks, “What would you suggest?”
Or maybe you stop the cardiologist in the hall to run your planned treatment of a particularly perplexing case by him.
These encounters—called curbside consultations—happen everywhere: hallways, cocktail parties, weddings, parking lots, and, increasingly, on the Internet.
As hospitalists increase their presence, they expose themselves to more curbside consultations—and the risks they entail. The practice is fraught with minefields that can turn the best of intentions into a potential medical and legal nightmare.
The term curbside consults implies opportunity—and hospitalists are most available to other hospitalists as they work in the hospital. In return, hospitalists have a greater opportunity to ask questions of other specialists without even picking up a telephone. A combination of geography and opportunity puts hospitalists at increasingly greater risk.
“We’re so accessible to other doctors in the hospital,” says Janet Nagamine, MD, chair of SHM’s Hospital Quality and Patient Safety committee and a hospitalist at Kaiser Permanente Santa Clara Medical Center in California. “I think we get more requests for informal consultations because we are there. It’s so easy for another physician to tap you on the shoulder and ask what you think about a patient’s condition or treatment. I am more frequently the giver of information than the receiver because it is so easy for a physician to tap me on the shoulder and ask my opinion.”
Proximity also presents an increased opportunity for hospitalists to seek a curbside consult from another physician in the hall. “I think hospitalists are more likely to ask for help from specialists they see in the hospital because hospitalists are generalists and can see a wide variety of conditions in the hospital,” says Clifford Zwillich, MD, professor of medicine at the University of Colorado and a hospitalist at the Denver Veterans Affairs Medical Center.
—Janet Nagamine, MD, chair of SHM’s Hospital Quality and Patient Safety committee and hospitalist, Kaiser Permanente Santa Clara Medical Center (Calif.)
In an April 2006 study in the Journal of the Medical Library Association, hospitalists reported that they seek a curbside consultation for a variety of reasons. These include:
- Confirm what they already know;
- Get quick answers to a question;
- Continue their medical education;
- Determine if a formal consultation is called for;
- Negotiate an appropriate course of treatment for a particular patient;
- Spread the emotional risk during a difficult case;
- Create or sustain camaraderie with physician colleges;
- Find like thinkers among their physician colleagues;
- Monitor their own knowledge; and
- Obtain help to get out of a difficult situation.
Hospitalists who provide curbside consultations reported doing so to provide good patient care, fulfill professional obligations, serve doctors, and encourage formal referrals.
Another study reported that 70% of primary care hospitalists and 68% of subspecialists surveyed participated in at least one informal consult in the previous week.
Critics say an enormous number of hospitalists put themselves at risk and potentially jeopardize patient care by taking part in these consultations. These dangers seem to increase when the consultation veers from the general educational question to advice on treating a specific patient.