Friday, July 29, 2011

The 5 Different Kinds of Consults

Wanted to make a cartoon out of this, but just couldn't make it work. So here it is, in boring prose:

The Five Different Kinds of Consults

1. The "Out the Door" Consult
"I've got a consult for you. We're trying to figure out how to manage this patient's meds while they're in the hospital."
"But you need to see them in the next ten minutes because they're about to go home."

2. The "Afterthought" Consult
"So I've got this patient... he's pretty sick..."
"It's five o'clock. Is it OK to see him tomorrow morning?"
"No, he needs to be seen now. He's sick."
"So why did you wait till 5 to call? Never mind, what's his MR number?"

3. The "Just Because You're Here" Consult
You sit down to eat your lunch...
Someone at table: "So what service are you on now?"
You: "_____ Consult."
Someone: "Oh really? Hey, I have a consult for you..."
You: "No, you don't."

4. The "I've Blessed You With a Consult" Consult
"So I've got a really interesting patient for you..."
"Uh.. thanks?"

5. The "Least Important Consult Ever" Consult
"So I've got this patient. He's septic with pneumonia and he's been intubated. His oxygen sats are in the 70s and he's got pus filling his pleural space. He's also got heart failure."
"What's the consult for?"
"I think he has osteoarthritis is his knee."


  1. When I was a chief resident on the gyn-onc service, a pt known to us with endometrial cancer (whose presenting symptom was vaginal bleeding) was in an MVA prior to her hysterectomy. Fractured her pelvis.

    Ortho consulted us for vaginal bleeding, expecting us to do a pelvic exam on a woman who had orders not to move her hips after they had stabilized them.


    Quickest consult EVER!

  2. I like the "I've Blessed You With a Consult" the best.... cuz yanno, I can't imagine you'd be busy with a million other things.

  3. I lol'ed at the last one! I love those people who get distracted by the little things.

  4. The last one is all too familiar! It always struck me as a huge waste of time to add yet another consultant (who must summarize the entire history of the present illness and include every section of a standard consultant's report) only to add a few sentences about an issue that should be addressed outside of the acute care setting.

  5. No room for the dreaded "Social Admit/Failure to Cope"?

  6. You forgot the "deranged family is demanding a consult for no apparent reason" consult.

  7. I think I originally wrote this when I was on a medicine consult service. I have a whole other list for PM&R consults:

  8. GOD, why do people from medical specialties always nag us orthopaedists because their 100 y/o pre-corpse has osteoarthritis??