Dr. Nagamine also recommends considering the seriousness of the patient’s condition. Patients rarely die from a rash but can if you’re wrong about chest pain, for example.
“You need to ask yourself, ‘What’s the complexity of the case and the downside of being wrong and what, exactly [is my colleague] asking me?’ ” she says.
Ask specific questions: “Think very carefully about whether the situation is appropriate for a curbside consultation,” Dr. Nagamine cautions. “Ask probing questions that assure you that the correct and complete information was gathered. What is the quality of the information you’re being given?” If you don’t have complete faith in the ability of the physician asking you for a consult, it’s best to see the patient, she says.
Consider facts not given: Diamond recommends the hospitalists consider the facts not given before deciding to give advice in a curbside consultation. The physician asking for the consult is going to give the information he feels is important at the time. He may have left out or discounted important facts about the patient’s history. Ask “What am I not getting here?” she recommends.
Don’t hesitate to ask to see the patient: Dr. Nagamine urges hospitalists not to refrain from asking to see the patient involved. “Many times I feel like the other physician really wants me to see the patient but doesn’t want to bother me. I find they are relieved when I suggest that I see the patient,” she says. “Other times hospitalists don’t like to admit they are in over their heads and ask for help. In many cases when I see the patient I’m glad I did.”
Document the conversation: The Doctors Company recommends hospitalists document curbside consultations. “Keep a brief record of it in a memo to yourself, “ Diamond says. However, that can be a Catch-22. “If you end up in court you have to supply all the information you have. So we say that if it gets to the point that you feel like you need to document a curbside consult, you need to bump it up to a formal consultation.”
Know your responsibilities to the hospital: For those hospitalists who work at more than one hospital, Diamond recommends you make sure you are following hospital protocol and not doing more than the hospital expects from you. Some hospitalists think it’s their responsibility to take a curbside consult from a facility’s hospitalists, and it may not be the case. All hospitals don’t have the same expectations of hospitalists, she says.
Dr. Nagamine thinks the stakes are higher for hospitalists taking curbside consultations because hospitalized patients are usually sicker than in an office setting. So the hospitalist may need to be even more cautious. TH
Barbara Dillard is a medical journalist based in Chicago.
- Manian FA. Curbside consultations: a closer look at a common practice. JAMA. 1996;275(22):145-147.
- Perley CM. Physician use of the curbside consultation to address information needs. J Med Libr Assoc. 2006 April;94(2);137-144.
- Pearson SD, Moreno R, Trnka Y. Informal consultations provided to general internists by the gastroenterology department of an HMO. J Gen Intern Med. 1998 July;13(7):435-438.