Tuesday, July 2, 2013

Dr. Orthochick: Thanks for the consult!

The trend in medicine is, at the end of your consult note you say something along the lines of "thank you very much for allowing me to participate in this extremely pleasant patient's care." The first time I read a consult note it was for a patient who was intubated, ventilated, and sedated, and I thought it was really nice of the consultant doc to realize that when the patient woke up, he was actually a nice guy. I didn't realize that it was just a formality.

There are some variations on the subject, my cardiac electrophysiology attending used to end with "thank you very much for allowing me to participate in the care of this very pleasant but very unfortunate patient," because all his patients had problems that were pretty much not compatible with any sort of quality of life. Some people write "Thank you for allowing us to participate in this patient's care," I guess that's what you do if the patient sucks.

Anyway, I usually do the extremely pleasant patient thing, regardless of whether or not the patient is a raging bitchaholic and regardless of how stupid the consult actually is. It's kind of a reflex. I do it right before I say "ok, thanks, once again this is Dr. Orthochick dictating a note on patient ____ for Dr. Attending."

I was with Dr. Angry last week and he told me to dictate a note on a new patient to the patient's primary doc. So I did the whole thing while he sat there and stared at me and then at the end I started with "thank you very much for--" and he totally grabbed the recorder away from me.

Dr. Angry: Don't say that! You don't have to thank the doctor for referring a patient to us. We want him to continue to make referrals but you don't have to say "thank you very much!" We're the ones who did him a favor! So why are you thanking him very much?

So he recorded the end as "thank you for your referral. Please contact me if I can be of any further assistance."

I gotta say, I'm not really seeing the big deal. I'm pretty sure the primary doc has figured out by now that I'm not thanking him because I actually care that he sent me a patient and the difference between "thank you" and "thank you very much" is pretty minimal. I mean, I think the primary doc knows that I'm just saying it as a formality. And Dr. Angry says his part as a formality, not because he actually wants the primary doc to contact him with questions.

In conclusion, if someone in medicine thanks you for your referral, it does not mean they're actually thanking you. And if they say the patient is "extremely pleasant" it can mean the patient is anything on a scale of angelic to dead to raging superdick. So really, don't read too much into the last line of a consult.

I was starting to get annoyed at Dr. Angry yesterday so I decided to get back at him by doing one of the things he really hates: I thanked the referring physician in my dictation.

I was dictating my note and at the end I turned off the recorder (Dr. Angry didn't notice) and said:

"Once again, thank you so very much for your kind referral of Ms. Smith. We really appreciate your sending her to us and we hope that we can continue to work with you to manage her care. We had such a lovely time meeting her and we want to thank you again for giving us that opportunity. Have a great day. We did, because we had the pleasure of--"

At that point, Dr. Angry grabbed the recorder out of my hands and started rewinding it.

Me: I didn't actually record that. I was just doing it to piss you off.

Dr. Angry: Well, it worked.


  1. A we would get along so well.

  2. I group the "thank you very much for this very interesting consult" line in the same category as "I'd be happy to (insert extremely inconvenient and unnecessary task your attending just made you ask the consultant to do)".

  3. Jess - you *are* still planning on writing for The Onion at some point, yes?

    your film buddy from the last decade

  4. I just laughed really hard reading this post. The line thanking the physician "for allowing me to participate in this patient's care" always rubs me the wrong way. Seriously though, your trick on Dr. Angry was fantastic. I could never have kept a straight-face to do that.

  5. I would fail as a consult. I can't stand empty platitudes and this is the kind of statement that drives me insane. I would end it the way Dr. Angry did. I agree with 11.36 anon, the trick was fantastic.

  6. Haha! Great idea! Will have to keep it in mind for future....