The relationship between the attending physician and the consultant has never been perfectly clear. It varies with different people's expectations and certainly from hospital to hospital. The concept of comanagement has, in many settings, taken it from unclear to nebulous.
Dr. Brad Flansbaum, blogging at The Hospitalist Leader, pointed me to this article illustrative of how the collaboration can go wrong. The article is so poorly written, as Dr. Flansbaum points out, that it's difficult to know what really happened, but perhaps there are some lessons.
Important questions are raised. When is it appropriate to order a consult? To what extent should the rules for comanagememt be hammered out in advance and what are the key issues?
For my twelve year hospitalist career I've worked in only one program although I've seen different styles. Some hospitalists consult liberally, others sparingly. Either style can go to the extreme, to a fault. I've heard of hospitalists who consult for every deranged organ system, others who hunker down and feel they can handle anything. Some consults are for a legitimate clinical question. Others are for a procedure. Many are CYA---sometimes with good reason. After all, if there is a bad outcome, the specialty talent was available and you didn't utilize it, then what?
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