- Thou shalt know why thou art consulting a service, lest the discussion with the consult become a game of 20 questions.
- Thou shalt know thy patient, lest you admit that thou hast not seen the imaging or read through the last consultant's note.
- Thou shalt have done a basic workup to aid in commandment #2.
- Bonus: Thou shalt not feed a patient if thou hast consulted surgery with requests for an emergent intervention.
I broke 1 and 2 today. We had a patient with PVD who had a new wound. My attending said, "consult vascular". I did. The vascular resident (full disclosure: really smart guy who knows me and who I respect) asked *why* I was consulting them, i.e., what was I hoping vascular would do. I paused. A guy with PVD and a wound is as common as an anesthesiologist wearing a Hawaiian shirt on rounds. I knew this wasn't a surgical candidate. Wound care was on board. Why was I calling vascular? Then the resident asked me how his peripheral pulses were. Lots of stammering on my end. Of course I should have known that. Big difference between someone who has intact pulses vs. a guy who has no DP even on doppler.
The actual question was what workup we should do to see how bad this guy's leg was and whether vascular surgery thought we should do anything besides mere wound care, whether he should be followed outpatient, etc. Different question, more specific.
The consult resident can get 20+ requests a day. Everyone benefits when we know why we're doing something and have done enough basic legwork to give a concrete answer. As for #4, if you want gen surg to take out a guy's gallbladder, look at the US yourself and don't have him chowing down on a hamburger when we visit.
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