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INTRODUCTION

Effective health care requires teams of generalists and specialists with complementary expertise. Many clinical conditions require the input of more than one clinical provider, either because the diagnosis and recommended treatment is uncertain or because a patient may have multiple diseases that may be best managed by involving multiple specialists.

To consult is to seek advice from someone with expertise in a particular area, whereas consultation refers to the meeting or comparable outcome arising from that request. Medical consultation takes several forms. Its most traditional forms include in-hospital consultation in which physicians provide recommendations or perform procedures for a hospitalized patient, and out-patient consultations, in which patients are seen in the office setting. More contemporary forms of consultation include e-consultations, telemedicine evaluations (see “Consultation Involving Telemedicine,” below), and remote medical second opinions. In these forms, the consultant may not actually see the patient but, nonetheless, assumes the responsibility of evaluating the patient’s clinical condition, assessing and analyzing pertinent clinical data, and offering a synthesis and appropriate recommendations.

While forms of medical consultation evolve, basic responsibilities associated with medical consultation endure. These responsibilities can be divided into those that fall to the requesting physician or non-physician practitioner; the consultant, who provides the consultation; and the health system, hospital, or organization that must support this important medical encounter (Table 465-1).

TABLE 465-1Stakeholder Responsibilities in the Medical Consultation Process

RESPONSIBILITIES OF THE REQUESTING PRACTITIONER

Before requesting a consultation, the provider should ensure that the patient endorses the purpose of the consultation, understands the role of the consultant, and anticipates the likely outcomes of the encounter. Further responsibilities of the requesting practitioner include being specific and communicating clearly the reason for the consultation. Vague messages such as, “Please evaluate” are not as helpful as more specific inquiries such as, “What is the cause of the declining kidney function?” or, “How should this asymptomatic pulmonary nodule be evaluated?” To the extent possible, the requesting practitioner should provide the relevant clinical information, summarized as succinctly as possible. Urgency should be clearly conveyed, typically with a phone call or other direct communication.

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