| Principles of effective consultation: an update for the 21st-century consultant. | |
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MedLine Citation:
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PMID: 17296883 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Little information in the literature exists to guide consult interactions between different medical specialties. METHODS: A total of 323 general internists, family medicine physicians, general surgeons, orthopedic surgeons, and obstetricians/gynecologists (OB/GYNs) from 3 academic medical centers completed a survey addressing their ideal relationship with consultants. Differences between surgeons and nonsurgeons were calculated using logistic regression, adjusting for location and trainee status. Differences between different specialties of surgeons were calculated using analysis of variance with Scheffe post hoc analysis RESULTS: There was a 72% response rate. About half of respondents were surgeons and the rest were general internists and family medicine physicians. More nonsurgeons (69%) desired the consultant to focus on a narrow question than did surgeons (41%). Over half (59%) of family medicine physicians and internists preferred to retain order-writing authority on their patients compared with 37% of surgeons (P<.001). Of the surgeons preferring to retain authority, 70% believed it was appropriate for consultants to write orders after a verbal discussion. Orthopedic surgeons desired consultants to write orders and co-manage patients significantly more compared with general surgeons and OB/GYNs (P<.001). Only 29% of physicians thought literature references were useful in consultations. Most physicians (75%) desired direct verbal communication with the specialist providing the consultation. Most family physicians (78%) believed there was little need for general internal medicine input, preferring to consult medicine subspecialists directly. CONCLUSIONS: Specialty-dependent differences exist in consult preferences of physicians. These differences vary from the extremes of orthopedic surgeons desiring a comprehensive co-management approach with the consultant to general internists and family medicine physicians desiring to retain control over order writing and have a more focused consultant approach. |
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Authors:
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Stephen M Salerno; Frank P Hurst; Stephanie Halvorson; Donna L Mercado |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study |
Journal Detail:
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Title: Archives of internal medicine Volume: 167 ISSN: 0003-9926 ISO Abbreviation: Arch. Intern. Med. Publication Date: 2007 Feb |
Date Detail:
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Created Date: 2007-02-13 Completed Date: 2007-03-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0372440 Medline TA: Arch Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 271-5 Citation Subset: AIM; IM |
Affiliation:
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Department of Internal Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA. stephen.salerno@us.army.mil |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Attitude of Health Personnel* Family Practice* Health Care Surveys Humans Internal Medicine* Interprofessional Relations Referral and Consultation / organization & administration* Specialties, Surgical* United States |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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