Tuesday, July 19, 2005

Answering (and writing) consults

I remember the best education I received about writing and answering consults. I was a fourth year med student, doing a rotation in the Surgery Department at the Naval Hospital in Bethesda. I was on a vascular service and received a consult from an internist on a patient with suspected peripheral vascular disease. He requested a specific test. I don't remember what it was, but it wasn't the right test for this patient. I did the right test and wrote up the consult. My resident and staff approved it and it was sent to the internist.

A few days later I received a message to call Colonel Internist, MD, USAF. Now I was just a measly Ensign, medical student, and was, of course, terrified.

However, he was very nice. He asked me why I hadn't done the test he requested. When I told him, he agreed that it was the wrong test, but suggested that, because he had asked a specific question about a specific test, that I should have answered the question. I should have explained why I wasn't doing the test he ordered and why the test I did was preferable.

He went on to spend a fair bit of time with me about the need to ask specific questions of consultants and the need to give specific answers when I was the consultant.

A very useful interaction.