For emergency physicians, consultations are an integral part of our specialty. Whether to provide hospitalization, provide assistance with challenging procedures, obtain follow-up appointments, or provide specialty-specific opinions, consultants are involved in 20 percent to 60 percent of all emergency department visits—and that number is growing annually.1,2 Surprisingly, formal training during emergency medicine residency to communicate with consultants is varied and can be sparse. As a result, poor communication occurs in 14 percent to 24 percent of inpatient consultations and leads to increased cost to patients and health systems, decreased patient experience of care, and suboptimal patient care.3,4
There is recognition and an effort in the medical community to ameliorate the situation through effective communication.5,6 However, there are still difficulties with consultants that may not be addressed easily by these systems. An audit of a London hospital identified “personality clashes” as key causes of conflict during consultation.7 Conversely, establishing a personal relationship with a consultant is found to mitigate conflict.8
The focus of this article is twofold. First, general etiquette is the cornerstone of a great relationship and can set the stage for a fruitful discussion with a consultant. Second, while there may always be difficult consultants, it is wise for emergency physicians to communicate in a way to not only advocate for their patients but to actively promote healthy working relationships.5 These strategies detailed in Dale Carnegie’s 1936 classic, How to Win Friends and Influence People, will provide the framework for the following discussion.9
Mind Your Manners
Don’t criticize or complain but understand first. It is often easy to find fault in consultants when they are slow to see the patient or ask for an add-on test prior to a bedside evaluation. Before jumping to conclusions, it is important to understand the consultants’ viewpoint. There may be legitimate or unforeseen reasons for their delays or actions that are beyond their control or are in the best interest of the patient. For example, a consultant could be determining what suture, split, scope, or other materials to bring based on that additional workup. Upon further understanding, materials could be made readily available in the emergency department. Complaining and criticizing before understanding destroys the possibility of working together.
Give honest and sincere appreciation. Consultants provide follow-up to patients, assist (as needed) with ED procedures, provide longitudinal care in the hospital, and offer specialty opinions. Saying “Thank you” or “I appreciate it” demonstrates a respect and appreciation for their work and dedication to patients. This is not intended to flatter consultants but to show genuine gratitude. There are also other subtle ways to show appreciation. For example, following up with an general surgery consultant about the outcome of an operation for an ED patient shows recognition of the craft. If a patient’s primary care physician has already provided a thorough outpatient work-up for a chronic complaint, mention it. This effort makes care delivery more efficient and effective.