“What would you like us to do?”

This is probably the best question that can be asked surrounding a new consult. I’ve been asked it when calling consults and I’ve asked it myself when receiving consult requests. It sometimes sounds aggressive and even jerky, but it’s not. It’s seeking a moment of clarification. Looking to define why exactly the consult is needed.

Consults are not benign. Like everything else we do, there are consequences as well as benefits to asking for a consult. You’re adding to someone’s workload, however large or small the request. We often think, “it’s a minor issue, won’t be any trouble for them.” But even a “minor” issue requires a consultant to review a patient’s record, see the patient, make recommendations, write a note. There’s really no such thing as an inconsequential consult.

In addition to the effect on the consultant, there’s the added burden on the patient. “How could a consult burden or be detrimental to the patient?” you may ask. “Too many cooks…” is the phrase that comes to mind. The more teams that are involved, the more complicated things become. Again, there’s really no such thing as an inconsequential consult.

All of these downsides are perfectly acceptable if the consult is needed. But often, it isn’t. We often consult a specialist for something that we don’t really need a specialist for. Sometimes it’s a knee jerk reaction to a problem. “New AKI, consult renal.” “New afib? Better call cards.” But the fact is, many times the primary team, especially an ICU team, is perfectly capable of handling these issues.

I know an attending who likes to break her specialty into “101” and “401.” The basics and the upper level stuff. 101 is the bread and butter that an ICU team should be able to manage. 401 is the higher level stuff where you need a consultant.

“What do you want us to do?” is the question that clarifies that. It prevents the knee jerk reaction and forces you to stop and think, “do I really need this consult?” If the answer is “yes,” by all means, call it. Because the flip side of that coin is just as bad (if not worse).

Waiting until it’s too late for the consultant to be of any help is bad for the patient and the consultant. This is my approach to, “should I transfer a patient to the ICU?” If there’s any doubt, call. I’d rather go look at a dozen patients who are safe to stay on the ward than have to admit a patient who is crashing and likely beyond saving because the service was afraid to call.

So, I guess what I’m saying is, err on the side of caution, but always ask yourself, “what would I like for them to do?”

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