Christopher Swyers, DO, PGY-3

One of the most important jobs of an emergency physician is realizing when he or she needs help. Whether it’s simply ensuring good follow up, getting a patient to surgery, or getting a sub-specialist’s expertise, calling a consult is a critical skill. Experience is often the best teacher, and while trial and error can hone a physician’s skill, knowing when to call and how to structure your conversation can increase your efficiency and get the patient the care he or she needs.

Here are some important things to consider when calling a consult, based on one resident’s experience:

  1. Know your audience: This idea is easier said than done, especially at a new or unfamiliar facility. Some general ideas apply across the board, though. First, consult calls may vary in information, length, and content based on the type of consultant. An orthopedics consult, for example, may be more focused on fracture patterns, neurovascular status, etc., while a consult to admit a patient may have more detail on history, physical findings, and the like. As you develop a working relationship with consultants, nuances of their practice patterns will become more obvious.
  2. Know your patient: This point is seemingly obvious, but bears repeating. Being able to summarize your patient’s chief complaint, pertinent findings, and course of care is critical to having a productive discussion with your consultant. This includes noting trends (i.e. trends in lab values over time, changes in vital signs in the ED, new or changed medications noted in your history-taking).
  3. Don’t bury the lede: In journalism, “burying the lede” is the idea of obscuring one’s key point(s) in other, often extraneous, details. Leading off with a specific reason for consultation can lead to a more precise–and shorter–call.
  4. Practice before you preach: Consult calls can feel like something between a casual conversation and an academic discussion. Practicing with a attending physician or a colleague prior to placing the call can help with any pre-call jitters. It also gives an opportunity for peer review and attending feedback.
  5. Consider a system: Consults are as much an art as a science; but there are multiple systems (SBAR, the 5C method [1]) for more effective and concise communication. If you’re having trouble, consider using one of these systems.