Fascinating discussion prompted by this tweet regarding consultation practices! 👇👇👇
Here are my own thoughts on this question:
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Here are my own thoughts on this question:
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It's great if there is a specific question for consultants to answer from a primary service.
However, that is not always necessary, and in some instances can discourage appropriate consultation if there is unnecessary emphasis on, "What is the specific question?"
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However, that is not always necessary, and in some instances can discourage appropriate consultation if there is unnecessary emphasis on, "What is the specific question?"
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In some cases, the specific ? asked might not be the correct one. Or there are additional ?'s that should be explored.
If a consultant finds these extra ?'s, it is better for patient care to address them rather than narrowly focusing only on what was specifically asked.
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If a consultant finds these extra ?'s, it is better for patient care to address them rather than narrowly focusing only on what was specifically asked.
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Sometimes a feeling of clinical unease should be enough to prompt a consultation, even if there is not a specific question.
Perhaps the request is, We are doing all these things. Anything additional that should be done in this situation?
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Perhaps the request is, We are doing all these things. Anything additional that should be done in this situation?
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Certain clinical situations don't really require a specific ? to be asked.
Sometimes it's about co-management, as my friend @InchausteguiC has pointed out.
Exs of such Dx's include: S. aureus bacteremia, prosthetic joint infxn, pts with solid-organ transplants, AKI, etc.
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Sometimes it's about co-management, as my friend @InchausteguiC has pointed out.
Exs of such Dx's include: S. aureus bacteremia, prosthetic joint infxn, pts with solid-organ transplants, AKI, etc.
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From the consultant side, immediately agreeing to see the pt helps to diffuse any hesitation the caller might have.
This has been pointed out by my friend @Cortes_Penfield.
Further clarity can be sought w/o any doubt abt the pt receiving the consultant's care.
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This has been pointed out by my friend @Cortes_Penfield.
Further clarity can be sought w/o any doubt abt the pt receiving the consultant's care.
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In fairness to primary teams, they also have a really tough job!
If they call too early, they sometimes receive neg reinforcement for calling too early.
Or they are told it's a condition that doesn't require specialty care.
This is typically unhelpful.
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If they call too early, they sometimes receive neg reinforcement for calling too early.
Or they are told it's a condition that doesn't require specialty care.
This is typically unhelpful.
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Conversely, if they call too late, they may also be criticized for not calling early enough.
The Goldilocks time to call is difficult, and probably also varies from specialty to specialty or even attending to attending.
That is a tricky position for them!
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The Goldilocks time to call is difficult, and probably also varies from specialty to specialty or even attending to attending.
That is a tricky position for them!
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How to balance the need for good education with early engagement of specialty care, length of stay for the patient, and a good transition to the outpatient setting?
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Don't have the perfect answer, but my sense is education and intellectual rigor can occur for the primary team at the same time that specialty care is engaged early (as appropriate) to ensure the pt gets a comprehensive evaluation and a solid transition to the outpt setting.
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In sum, over time, I've landed on the following concepts:
- Great to have a specific clinical question when calling a consult but not always required
- Some consults are clearly for comanagement, which is best for certain diagnoses
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- Great to have a specific clinical question when calling a consult but not always required
- Some consults are clearly for comanagement, which is best for certain diagnoses
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- Clinical unease or uncertainty is okay as a reason to request a consult
- Primary teams have a tough job in trying to time consults just right! Better to cut them some slack.
- Consultants can help by always prioritizing pt care and providing useful education.
Fin/
- Primary teams have a tough job in trying to time consults just right! Better to cut them some slack.
- Consultants can help by always prioritizing pt care and providing useful education.
Fin/
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