Communicating with Consultants

As ED physicians we are tasked with knowing as much as possible about anything that could come through the emergency room's entrance. However, there are times when we must reach out for help from other doctors. Whether it is to admit a patient, have a specialist perform a procedure, or to solicit medical advice, we frequently reach out to a wide range of physicians to help us treat our patients. Dr. Dave Ledrick kicked off this year's #EMConf with a lecture about speaking with our consultants. Here are some takeaway points from his lecture:

• Being right isn't enough; to get ahead, you've got to get along.

• Get to know your consultants and establish long term relationships to earn their trust and respect.

• Before you call, know exactly WHY you're calling; talk to your attending if you are unsure.

• Have your ducks in a row: be ready with any necessary information easily accessible (lab values, imaging results, old notes/workups etc.).

• Avoid telephone delays; try to stay close by the phone while you're expecting a call.

• When you have the consultant on the phone, make sure to do the following:

- Introduce yourself (everyone has a different way of doing this; find what works best for you)

- Tell them what hospital you are at

- Clarify that they really are covering the specialty you need

- Tell them which ED attending you are working with (your attending's name may be familiar to them)

• Lay out the expectations: tell your consultant UP FRONT what you want from them (admission, procedure, follow-up, history, etc.):

- Ex. 1: "I have a 48 year old male with an acute anterior MI that needs to go to the cath lab. About 45 minutes ago, he started having chest pain that radiated down both arms..."

- Ex. 2: "I have a 12 year old female with CT confirmed appendicitis that needs to have her appendix removed. She has had on and off right lower quadrant pain over the past..."

• Be artful on overnight phone calls: if clinically appropriate, consider making low priority calls at the end of your shift (ex. after 6:30am).

• There is a fine line between being a patient advocate and stretching the truth. Be honest with your consultants (Ex. if it is a social admit, say so).

• Be active in medical staff affairs: join interdepartmental committees, participate on policy-making, attend hospital-wide social events, etc.

• Watch your ego, admit when you're wrong, and know when to back down.