Effectively working with consultants

Definition

1. “The chief function of a consultant is to make a rectal examination that you have omitted.” Sir William Osler.

2. More practically, it is a service type provided by a physician whose opinion or advice regarding evaluation or management of a specific problem is requested by another physician.

Six Tenets of Dale Carnegie "How to Win Friends and Influence People

1. Become genuinely interested in other people.


2. Be a good listener.


3. Encourage people to talk about themselves.


4. Make the other person feel important and do it sincerely.


5. Show respect for the other person’s opinions. Don’t say “You’re wrong”.

6. Begin in a friendly way and try honestly to see things from the other’s view.


7. Keep your friends close and your enemies closer (Don Corleone, The Godfather)

Skills for success

1. Organizational skills: Focused. Concise. Prompt. Prepared.

2. Interpersonal/Comm Skills: Polite. Be willing to help. Clear communication

3. Medical knowledge: Accurate. Investigating the problem. Owning the patient.

4. Conflict resolution: Concession. Compromise. Negotiation.

The "5 C's" of ED Consults

1. Contact: Full name. Rank and service. Identify supervisor

2. Communicate: Concise story. Clearly speaking. Clarify issues. Be patient.

3. Core question: Specify the need for the consultant.

4. Collaboration: result of the discussion.

5. Closing the loop: Ensure both parties on same page, update with any changes.

Peer to Peer

When making contact, introduce yourself as “Dr. Smith (not Bill), the EM resident”. You earned your title, so use it. Calling yourself "Bill" the ED resident and addressing the consultant as "Dr. Jones" immediately puts you in a subservient position for the rest of the conversation. For peers, e.g. resident to resident, using first names is acceptable.

Communicate/Core Questions

1. Give the diagnosis first and why you are consulting them, e.g. for an admission or a consult.

2. Know your goal before you call them and then state it clearly to them. Don’t say “what do you want us to do?”

Conflict Resolution

1. Do not criticize or question the other physician in front of the patient/family

2. Always maintain professional standards regardless of their behavior

Different Spin and Summary from allbleedingstops.blogspot.com

1. Never call without first knowing exactly what it is that you want. Know in advance what the desired outcome of the conversation will be.

2. Be direct when presenting on the phone. Don’t make them wonder.

3. Make a compelling sales pitch. ust make the sale and convince them as succinctly as possible. Three sentences is as long as this should take.

4. Never lie. They will find out. One can begin the conversation with “I am sorry but this is a social admission, and it is necessary because…”

5. Start with the case FOR your diagnosis and plan, then acknowledge countervailing facts. If they detect uncertainty, they will pounce and you are lost.

6. Anticipate and pre-empt obstacles. Figure out the roadblocks, address them, and have an answer for the objection before it is even uttered.

7. Be reasonable. Listen to them.

8. Close the deal. Once you and the consultant have agreed upon a plan, be very concrete in defining the next step. “I will admit them to telemetry."

9. Be pleasant. Get to know their names, chat and joke as the situation and time of day allow. Social niceties lubricate and facilitate these interactions.

10. Become involved in your hospital medical staff. The better your consultants know you, the more credibility and trust you will accrue.

References

1. Consultation in the emergency department: a qualitative analysis and review.J Emerg Med. 2012 Jun;42(6):704-11. doi: 10.1016/j.jemermed.2011.01.025. Epub 2011 May 26

2. EMRAP Episode #144

3. http://allbleedingstops.blogspot.com/2007/04