Life as a Fellow: Becoming an Excellent Consultant
By: Melissa MacDonald, MD
July 10, 2020
As you transition from residency to fellowship, you have the opportunity to take on a new role as the first-call or leader of the inpatient consulting team. This can be both an exciting and a stressful role, but taking the time to learn how to be an effective inpatient consultant can also help improve your skills as an outpatient consultant and prepare you for your future career. If you are like me, then you may be nervous with the transition to the fellow role as a consultant, because you may perceive that the primary team is suddenly expecting you to be an expert in pulmonary and critical care medicine. Obviously, this is not the case because you have 3 years of fellowship and then the rest of your career to continue to learn and expand your expertise. These are just a few of the tips I have learned over my training that I hope can help you adjust to becoming a great consultant for your colleagues.
Be Kind
I’m confident we all can recall being the timid, third-year medical student who was asked to call a consultant for the first time. I remember how nerve-wracking that experience was, especially when I had a rude consultant on the other end of the line. Try to always keep that in mind when you return a page or call. I know it can be frustrating not to receive a clear history or question from the primary service, especially when you are busy with a high census, procedures, or need to rush to the clinic. However, don’t let your annoyance shine through and, instead, see this as a new opportunity for teaching, especially for students. By always being kind and courteous, you will become respected by your colleagues, and your actions will have a positive impact on the trainees early in their career paths.
Clarify the Question or Concern and Give a Relevant Answer
When you are called for a consult, try to gently push the primary team for a clear question so that you can better direct your advice. This will help ensure that the team finds your consult useful for patient care and will be educational for them in the care of future patients as well. It is also helpful to know the exact question when you are framing your evaluation of the patient and your discussions with your attending. In return, clearly explain your reasoning for your recommendations, either in writing or in person to the primary team.
Clear Communication Is Key
Do not simply write a note with your recommendations, but instead close the loop by providing either face-to-face or verbal communication with the primary team. In the outpatient world, it can also be helpful to send an in-basket message or to directly call the referring provider to help coordinate care of the patient, specifically for those patients with complex medical histories or treatment plans.
Avoid Anchoring
Remember to keep your differential diagnosis broad and avoid anchoring to either your first diagnosis or the primary team’s presumed diagnosis for the patient. As a consultant, you have the opportunity to review the patient’s history with fresh eyes and you may discover something new about the patient.
Think Ahead
When you are evaluating a patient for a consult, try to think a few steps ahead. What will be needed from our team to help prepare the patient for discharge? Should we see the patient in follow-up care as an outpatient? Will we arrange that, or do we expect the primary team to do so?
Remember That a Consult Is Often a Call for Help
I am sure we have all had consults for cases that we thought were straightforward or unnecessary. We have also had consults for cases in which the primary team cannot easily state its underlying question. Remember that this is typically not a sign of laziness on the part of the primary team but is often a call for help. Perhaps the patient or family is challenging and the primary provider needs an additional layer of support or it may be an issue that the team members have become less comfortable with over their careers as they themselves have become more specialized. Take advantage of these calls to build rapport with your colleagues by kindly helping and providing them with support rather than getting annoyed with what may seem like a frustrating consult. In the future, you may need help with something in their area of expertise and they’ll be willing to return the favor.
Melissa MacDonald, MD, is a graduate of The Ohio State University College of Medicine. She completed an internal medicine residency at the University of Wisconsin, where she is also completing her pulmonary and critical care medicine fellowship.