Skip to main content

Advertisement

Log in

Physician Preferences for Elements of Effective Consultations

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Effective communication is vital for optimal medical consultation, but there is little current information about physician preferences for effective consultation.

Methods

We invited physicians with at least one post-graduate year of experience at four Minnesota teaching hospitals to complete a 16-question Internet questionnaire about inpatient consultations.

Results

E-mail requests were received by an estimated 651 physicians. Questionnaires were completed by 323 (50%). Of these, 54% had completed training >5 years before, 17% had completed training <5 years before, and 30% were residents or fellows. Three elements were considered essential in consultation requests by most respondents: the specific question to be addressed (94%), whom to call with the response (68%), and consultation urgency (66%). In the consultation note, 71% of subjects placed high importance on simple, concise recommendations and 64% on the rationale behind them, while only 7% placed high importance on citing references. Most (69%) preferred that assessments and recommendations be written in bulleted or numbered format. A plurality (48%) preferred that assessments and recommendations be separated. Most placed high value on recommendations regarding drug therapy that specify dose (80%), duration (80%), and generic medication name (62%). Requesters placed greater importance than consultants (87% vs. 65%, respectively, P = 0.004) on recommendations that included duration of therapy. The majority (63%) stated that telephone requests were needed for emergent or urgent consultations. Those who usually requested consultations were more likely than those who usually responded to consultation requests to prefer telephone requests for routine consultations (43% vs. 20%, P < 0.001).

Conclusions

Physicians agreed on many essential elements for effective consultations. These results should guide efforts to improve communication in the consultation process and design electronic medical record systems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Horwitz RI, Henes CG, Horwitz SM. Developing strategies for improving the diagnostic and management efficacy of medical consultations. J Chronic Dis. 1983;36:213–8.

    Article  CAS  PubMed  Google Scholar 

  2. Lee T, Pappius EM, Goldman L. Impact of inter-physician communication on the effectiveness of medical consultations. Am J Med. 1983;74:106–12.

    Article  CAS  PubMed  Google Scholar 

  3. Lo E, Rezai K, Evans AT, et al. Why don’t they listen? Adherence to recommendations of infectious disease consultations. Clin Infect Dis. 2004;38:1212–8.

    Article  PubMed  Google Scholar 

  4. Popkin MK, Mackenzie TB, Hall RC, Garrard J. Physicians’ concordance with consultants’ recommendations for psychotropic medication. Arch Gen Psychiatry. 1979;36:386–9.

    CAS  PubMed  Google Scholar 

  5. Salerno SM, Hurst FP, Halvorson S, Mercado DL. Principles of effective consultation: An update for the 21st-century consultant. Arch Intern Med. 2007;167:271–5.

    Article  PubMed  Google Scholar 

  6. Linzer M, Myerburg RJ, Kutner JS, et al. Exploring the generalist-subspecialist interface in internal medicine. Am J Med. 2006;119:528–37.

    Article  PubMed  Google Scholar 

  7. Goldman L, Lee T, Rudd P. Ten commandments for effective consultations. Arch Intern Med. 1983;143:1753–5.

    Article  CAS  PubMed  Google Scholar 

  8. Devor M, Renvall M, Ramsdell J. Practice patterns and the adequacy of residency training in consultation medicine. J Gen Intern Med. 1993;8:554–60.

    Article  CAS  PubMed  Google Scholar 

  9. Moore RA, Kammerer WS, McGlynn TJ, Trautlein JJ, Burnside JW. Consultations in internal medicine: A training program resource. J Med Educ. 1977;52:323–7.

    CAS  PubMed  Google Scholar 

  10. Sibert L, Lachkar A, Grise P, Charlin B, Lechevallier J, Weber J. Communication between consultants and referring physicians: A qualitative study to define learning and assessment objectives in a specialty residency program. Teach Learn Med. 2002;14:15–9.

    Article  PubMed  Google Scholar 

  11. Conley J, Jordan M, Ghali WA. Audit of the consultation process on general internal medicine services. Qual Saf Health Care. 2009;18:59–62.

    Article  CAS  PubMed  Google Scholar 

  12. Landrigan CP, Czeisler CA, Barger LK, et al. Effective implementation of work-hour limits and systemic improvements. Jt Comm J Qual Patient Saf. 2007;33:19–29.

    PubMed  Google Scholar 

  13. Hayrinen K, Saranto K, Nykanen P. Definition, structure, content, use and impacts of electronic health records: A review of the research literature. Int J Med Inform. 2008;77:291–304.

    Article  PubMed  Google Scholar 

  14. Haldis TA, Blankenship JC. Telephone reporting in the consultant-generalist relationship. J Eval Clin Pract. 2002;8:31–5.

    Article  PubMed  Google Scholar 

  15. Byrd JC, Moskowitz MA. Outpatient consultation: Interaction between the general internist and the specialist. J Gen Intern Med. 1987;2:93–8.

    Article  CAS  PubMed  Google Scholar 

  16. Saunders TC. Consultation-referral among physicians: Practice and process. J Fam Pract. 1978;6:123–8.

    CAS  PubMed  Google Scholar 

  17. Accreditation Council for Graduate Medical Education. Program requirements for residency education in internal medicine. Available at: http://www.acgme.org/acWebsite/downloads/RRC_progReq/140pr703_u704.pdf. Accessed September 11, 2009.

  18. Ballard WP, Gold JP, Charlson ME. Compliance with the recommendations of medical consultants. J Gen Intern Med. 1986;1:220–4.

    Article  CAS  PubMed  Google Scholar 

  19. Were MC, Abernathy G, Hui SL, Kempf C, Weiner M. Using computerized provider order entry and clinical decision support to improve referring physicians’ implementation of consultants’ medical recommendations. J Am Med Inform Assoc. 2009;16:196–202.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Drs. Cristina Baker and Michael Aylward for conceptual discussions. DRB is supported by the National Institute of Allergy and Infectious Diseases (T32AI055433; L30AI066779; K12RR023247). Parts of the material were presented at the Infectious Diseases Society of America Annual Meeting, San Diego, CA, October 5, 2007.

All authors meet authorship criteria and have no financial conflicts of interest. GAF is a federal employee.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gregory A. Filice MD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Appendix 1 (PDF 81 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Boulware, D.R., Dekarske, A.S. & Filice, G.A. Physician Preferences for Elements of Effective Consultations. J GEN INTERN MED 25, 25–30 (2010). https://doi.org/10.1007/s11606-009-1142-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-009-1142-2

KEY WORDS

Navigation