ACADEMIC AFFAIRS COMMITTEE
Dealing with Challenging Consultants Mary Claire O’Brien, MD FAAEM
Up front, verify you have the correct service and the appropriate person. Do this before you launch into
EM Attending
long-winded details about the case. “Hi, thanks for answering my page. The web schedule says Orthopedics is on call for Hand this week. Are you the right person to speak to about an ED consult?”
Help!
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Be appreciative. “Thank you for coming to see the patient. Let me know if I can do anything to help you.”
ear EM Attending,
The senior residents from a particular consult service insist on “stacking” their telephone calls to their on-call attendings, who do not like to be interrupted during the day or woken up at night. This is outrageous! It causes long delays in admission. To add insult to injury, the families are all barking at me—and so are you! Help! Signed,| Beleaguered Emergency Medicine Resident
Be helpful. If the consultant’s requests are reasonable—even if they
are not part of your “EM work-up”—do what you can to make their life easier. “Of course. I will be glad to order an extra set of blood cultures (or an iron panel or a sedimentation rate).” “Hey, I put the plastics tray and the lidocaine at the bedside. What else do you need?” “Can we get the family from the waiting room for you?” “If you’re hungry, there’s cake in the back.” What goes around, comes around. Develop rhinoceros skin. Don’t take umbrage when a consul-
tant disagrees with you or points out a mistake. A tough hide is essential for the long-term practice of emergency medicine. Say, “Thank you. That’s helpful.” Remember, the “Ologist” should know more “Ology” than you do. If she did not—she wouldn’t be an “Ologist!” Nurture curiosity— you might learn something. Develop standardized language.
Dear Beleaguered, Been there, understand that. Here are some suggestions for fostering goodwill among nations while you expedite the consultation process. Don’t say, “Sorry to bother you.” The consultant is on call,
and part of that responsibility includes answering pages, speaking with you on the phone, and seeing patients in the ED when formally requested. To apologize at the beginning of your interaction suggests that EM is “at fault” somehow for “bothering” them. Patient care is not an interruption of the consultant’s job. It *is* their job.
“What are your thoughts on how best to handle this?” “I’m not comfortable with that plan. My concerns are…” “How would you suggest we resolve our differences? I know we both want to do the right thing for the patient.” Be genuinely open to persuasion.
“I am open to persuasion, but am not yet persuaded.” “Help me understand why yours is a better plan for the patient.” Do not be defensive. Being defensive indicates that you are on
Consultant pushback: He can’t have appendicitis, his white count is normal.
the opposite side from the consultant. You are not! You are both on the same side, trying to do the right thing for the patient. It is possible to disagree courteously about what the “right” thing is. >>
Calm EM response: Actually, only 80% of patients with surgically proven appendicitis have leukocytosis. Leukocytosis is only 80% sensitive and 55% specific.
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COMMON SENSE JULY/AUGUST 2023