Why do people consult without doing the basic work? I mean, you call in the experts when you don't know what's going on. You shouldn't need to call in the experts to hold your hand through the basic steps. We all go through medical school. We all know the basic stuff. You know, if you consult a cardiology service and you don't do an EKG, you should be shot. I don't feel guilty at all paging the shit out of these surgery residents. They consult my service without telling us why, without telling us what surgery they're going to do, without telling us when they're taking the patient to surgery, without telling us anything. Two consults I did today were consults on empty charts. What's the point of that? I have to do all the work. I'm doing THEIR work. It's aggravating.
When I was on vascular surgery and we were consulted by medicine services, we'd come by and there would be blood cultures ordered, chest x-rays shot, and all the appropriate labwork done. Now that I'm on a medicine service being consulted by everyone else, it's appalling how shoddy the consults are. You know, I was consulted yesterday basically for a 'Please find the old records and read them.' We did nothing except request old charts. I guess Friday is always a bad day in the hospital. Oh well.
The thing is though that consultation is a request to another physician formally to help with the treatment of a complicated patient. It's admitting that you need some assistance. That is the purpose of consultation. It's not to offload work. It's not to have someone else doing the stuff you don't want to do. It's not to have someone pat you on the back. I get frustrated when people write for consults and they don't want a consult. They want to have someone else do the work, or they want someone to congratulate them. I am interested in neither. Having done several consultation services, I've come to the conclusion that the ideal consult is one where the work is already done. It's not that I'm lazy. It's that it's flat out rude to make someone redo all the work that's already been done (or do all the work that should've already been done). It's rude to consult someone and make that person reinvent the wheel just to figure out what's going on.
One of my friends is a resident. When I was on vascular, he was on the heme/onc medicine service, and he consulted us over a possibly infected port that we'd put in. I go down to do the consult, and he's already done a chest x-ray, blood cultures, wound cultures, CBC and BMP. All my attending had to decide was if he wanted it out, and when and where to do it. Of course, it would come out. That's what a consult should be. I told my friend that the consult I did with him was the perfect consult, the ideal way a consultation service and an admitting service should interact. It shouldn't be going up to the floor, finding a chart with a sloppy and scant H+P with no old charts and nothing else in the chart except nursing notes. Half the time, I find myself asking why we were consulted. There's no reason provided.
I really enjoy working with students. But I do get frustrated by people who are gifted with a big ole brain, and refuse to use it. You know, one of my surgery attendings put it to me. I told him I didn't know the answer to his question, and he refused to accept that. "No, you're smarter than that. You don't get off that easy." and he grilled me, and I got the answer, and it was the best learning experience I've ever had. And it was because he made me rise up to another level. And I'm not really asking anyone to even do that.