Thread by @relatableafmd

A thread about things I wish other specialties knew re: calling surgical consults. Obvious disclaimer this is based on my experience/my institution, YMMV. Other thoughts welcome, defending consult-callers will be met with 🙄 because this isn’t to bash them just discuss pitfalls

#1 We staff our consults with seniors and attendings. That means there is truly a difference between a curbside and a consult. If you “curbside” me then put “surgery following” in your note I am going to be mad and I am going to make you change your note.

#2 Whenever you call it, we will come. That means if you realize at 3 am that nobody ever called the non-urgent surgery consult so you page it out to be helpful... I am coming to see that patient at 3 am. And waking up my attending to tell them about it.

#3 We need the formal imaging. Even if you’ve convinced yourself of the diagnosis by bedside ultrasound, if we do an unnecessary surgery that’s on us, so we need a picture to point to

#4 When getting CTs, if you’re looking for a problem with the luminal bowel, give PO contrast. If you’re looking for any inflammatory process, give IV contrast. Exceptions include renal dysfunction, kids, and portal venous pathology where you need specifically timed protocols

#5 I will forgive you anything else if you start the call by telling me what the diagnosis is and how you know. “Appendicitis confirmed on CT” saves me a lot of time as does “intussceception with no evidence and negative imaging but idk I’m just like really convinced”

#6 Please do not specifically tell the patient they need surgery. There are a million ways to frame this that don’t steal our credibility when we try to tell the patient that no, in fact, they do not need surgery.

#7 I’m aware that I have access to the same chart you do, but sometimes I’m returning the page from my cell as I walk between buildings. If I ask a lot of Qs it’s usually to either clarify what the consult is for or to triage the urgency of seeing this patient, not to be a dick

#8 If you’re calling a *new* consult about a physical exam finding ... you should physically examine the patient. When we both see the patient and discuss our impressions it feels collaborative; when you just have me see your patient it feels exploitative

#9 Our services don’t have caps. More consults = more work, straight up. The only potential benefit of calling us with an “easy” consult is to the patient, so if it’s not going to benefit the patient then I invite you to reconsider whether the consult is necessary.

10# If you page surgery, you might get a call back from an OR nurse because the resident is scrubbed. Having a 1-3 word non-comprehensive description of the consult saves headaches for everybody.

This has been my Top 10 Things I Wish You Knew About Calling A Surgery Consult.

#11 is that we’re always here to help, and if your patient needs a surgical evaluation then don’t hesitate to call us day or night 🤗

#TipsForNewDocs