Monday, February 12, 2007

10 Commandments of Consultation

I likely won't be posting again until next week after AAHPM. A lighter topic until then....

Archives of Internal Medicine has released a study about a subject near and dear to many of us: the role of the consultant. They posit the study as an update of the famous 1983 article about the 10 commandments of consultation.

The current study is from a survey of academic internists, family medicine docs, & general, orthopedic, and ob-gyn surgeons about what they want from consultants. The findings are illustrative but not, I guess, surprising. In general: surgeons (particularly orthopedic surgeons) were much more likely than family docs/internists to want a "co-management" model from their consultants--much more likely to say that it was ok for the consultants to write orders and to not restrict themselves to a narrowly defined question. 60% of surgeons wanted co-management whereas less than a quarter of non-surgeons did. Everyone wanted verbal communication from the consultant about her/his recs.

They go on to update the 1983 commandments. E.g. "thou shalt not covet thy neighbors turf" has been modified to "thou may negotiate joint title to thy neighbor's turf. The first commandment, which I strongly endorse and am glad they kept it as the first (although the wording is a little weird) is "determine your customer." That is, know thy consultee. This is much more important than the differences between orthopods and internists. Everyone wants something different from you....

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