Try to greet consultants. The emergency department is familiar to its emergency medicine staff but not necessarily to consultants. The emergency department provides access to equipment, supplies, and personnel. Emergency physicians should see themselves as hosts and see consultants as guests. For guests, a quick welcome or introduction can go a long way. Making an effort to meet your consultants when they arrive or leave the emergency department can foster a good relationship for future consultations and mitigate potential conflict.^8,10 Imagine yourself visiting the medical floors for assistance with a difficult intubation without anyone to help orientate you to where the patient is or what equipment/personnel are available.

Talk in terms of the consultant’s language. Every specialty, by nature, has its focus and medical terminology. Honing an understanding of the consultants’ specialty can facilitate strong communication. When discussing an eye complaint, visual acuity, pupillary size, and intraocular pressures are the vital signs of ophthalmology. Obstetricians start conversations in terms of Gs (gravida), Ps (parity), and LMPs (last menstrual period). Engaging consultants on their terms helps both you and the consultants provide timely and coordinated efforts for the patient.

The Difficult Consultant

Begin friendly. Some consultants have a reputation for being more difficult. Regardless of a consultant’s initial demeanor or any previous encounters, every conversation should begin with a welcoming tone. It will help set a stage for a solution that makes everyone is happy and can help “disarm” the most disgruntled of souls.

Avoid arguments, if possible. Arguing may yield a quick win for an admission, but it will never win a consultant’s good will. The next time that consultant is called, there will be further difficulty. Remember that every consultation is about two relationships: the relationship you have with the patient and the one you have with the consultant. The patient should always come first, but our relationships with consultants often outlast those we have with our patients. Providers don’t have to agree on every aspect of a patient’s care, but by demonstrating professional conduct, you can foster the same in others.

Dramatize the presentation. Showmanship is a skill worth practicing to help better sell your thoughts. To convince a consultant to come evaluate a patient, focus on the more serious details of the patient’s case. If the patient has significant labs or imaging abnormalities that may be of interest to your consultant, stress those points. If the patient physically looks unwell but that is otherwise not reflected in the diagnostic evaluation, describe the patient. For example, in a previously healthy patient with pneumonia, you could say, “The patient presented diaphoretic, febrile with bouts of severe rigors, needing the assistance of two staff members just to help her walk into the emergency department.”