Surgeons, I’m sure you’ve had an experience something like this at some point:
You happen to be wandering through the emergency department and one of your Emergency Medicine colleagues approaches you and says, “Hey, I ‘ve got this patient I’m seeing that I just want to run by you…”
How should you deal with this? They want a quick tidbit of information to help them decide what to do with the patient. Can they send them home, or should they “formally” consult you?
It’s important to look at the pros and cons of this practice. First the pros:
- It’s direct. You’re right there. No phone calls, no paging.
- It’s quick. Just a quick description of the problem, and a prompt answer. Then everyone can get on with their business.
But then there are the cons:
- Situational accuracy. The consultee has not seen the patient, so the information they have been given was filtered through the consulter. Any number of cognitive biases are possible, so the real story may not be exactly as it seems.
- Interpretation of the recommendation. Other cognitive biases are also possible as the consulter acts on and implements the recommendations of the consulter. Have they really been followed?
- Lack of documentation. This is the biggest problem with a curbside consult. The consultee may act without documenting the source of the recommendation. Or, they may document that they spoke with Dr. Consultee. In either case, one or the other may be hung out to dry, so to speak.
Consider what happens if there is a complication in the care of that patient. There is no way to really determine what was said during that conversation a week or two years later. It boils down to recollections and may end up as a he said … she said situation. And in the worst case scenario, if such a case were to enter the medicolegal arena, there is no official record that any recommendation was made or followed. It’s a very easy case for the plaintiff’s attorney to prevail.
Those of you who have been following me for some time may be familiar with my Laws of Trauma. Originally, there were ten.
But the curbside consult leads to my new Eleventh Law of Trauma:
“Work not documented is work not done“
Bottom line: There is no such thing as a curbside consult! The consultee should say, “I’d better take a look at this patient, why don’t you officially consult me?”
In doing this, the consulter gets to use their own clinical and cognitive skills, and thus render a real opinion based on first hand experience. The consultee gets the most accurate recommendations possible, and they are noted in the record so there is no room for misinterpretation. And finally, there is good documentation from both that will stand up in a court of law if needed.