Assistance in management of chronic medical issues (occasionally in a comanagement model) and preoperative evaluations are two of the most common reasons for inpatient medicine consults. 

Taking the Consult

• Logistical information to obtain
  • Referring Service
  • Referring Attending
  • Consult Question
  • Urgency of the consult
  • Contact information for recommendations
  • Recommendations only vs greater involvement including order writing
• “Curbside” questions
  • Always offer to do a formal consult - usually better for patient care
  • Only appropriate for simple, straightforward questions

Writing the Note

• Formulate specific and concise recommendations in the consult note
• Provide an action plan: “if ____, then ____” statements
• Avoid general statements (e.g. “fluid restrict”, “avoid hypertension”)
• Include your preferred contact method and information

Communication

• Always call the referring team and communicate recommendations
• Contact primary team at least daily, but as frequently as needed for patient’s condition
• Communicate the urgency of recommendations
• Avoid broad statements without intrinsic value (e.g. “cleared for surgery”, “okay for anesthesia”)
• Tell the primary team what you have communicated to the patient/family
• If other issues that may require consultation arise, ask the primary team if they would appreciate input
• Follow up:
  • When signing off, ensure appropriate follow up for medical issues
  • Contacting PCP for a consult patient can be helpful and sometimes required for safe transitions of care

Stephen M. Salerno; Frank P. Hurst; Stephanie Halvorson; Donna L. Mercado Principles of Effective Consultation: An Update for the 21st-Century Consultant. Arch Intern Med 2007;167(3):271-275.

Wang E, Moreland C, Shoffeitt M, Leykum L. Who Consults Us and Why? An Evaluation of Medicine Consult/Comanagement Services at Academic Medical Centers. J Hosp Med 2018.