What do Medical Consultants Do?

I am a gastroenterologist.  Like most medical specialists, most of the patients I see are referred to me by other medical professionals.  In this role, I am serving as a consultant.  Similarly, when a specialist is asked to see a hospitalized patient by the attending physician, the requested doctor will be serving in a consultant role.

Consultants are recruited when the medical team or an individual practitioner feels that additional knowledge and experience is necessary.  Consider three hypothetical scenarios.

A patient has not responded to a standard course of antibiotics.  The attending physician asks an infectious disease physician to make recommendations.

A primary care physician is uncertain if the abnormal chest x-ray is heart failure or pneumonia.  The doctor calls in a cardiologist to assist.

A patient with colitis comes to an emergency room with worsening diarrhea after starting a new medicine.  The ER physician is uncertain if the patient’s diarrhea is a side-effect of medication or is a worsening of the underlying illness.  A gastroenterologist is consulted to evaluate the situation.

Not sure what this rash is.  Let's have a dermatologist consult on the case.

The consultant’s role is to offer recommendations to the patient and to the referring physician - not to take over the case which often occurs. The consultant's role is advisory.  For example, a surgical consultant may advise an operation, but the patient’s doctor of many years and the patient may have good reasons to prefer a conservative approach. Obviously, there should be robust communication among the consultant, the patient and relevant members of the care team.  In theory, the doctor in charge, not the consultant, synthesizes the advice from one or more consultants and then makes recommendations to the patient, who has the ultimate authority.  

Consultants like me prefer when our opinion is sought on a specific medical question.  Not only does this allow us to focus more narrowly, but it also indicates that the referring physician has given thought to the medical situation.  Consider these 2 hypothetical consultation requests.

Please see my patient who has had repeated attacks of upper abdominal pain with vomiting.  The symptoms persisted despite taking medication for ulcers.  Labs and a CAT scan from a recent ER visit were normal.   Even though a gallbladder test was negative, I still wonder if the gallbladder is the culprit. 

OR

See patient with stomach pain.

There are instances when a patient referred to me doesn’t know the reason why.  And there have been times when the chart does not enlighten me on why a consult is being requested.

Throughout my career, nursing home residents have been brought to my office accompanied by aides who does not know them and bring paperwork that does not specify a reason for the visit.  Not medicine's finest hour.

In a perfect world, which is not our world, all medical consultation requests would be sufficiently detailed.  I’m not faulting my referring colleagues for how consultations are issued.  Physicians are incredibly overworked and overstretched.  And their burdens are mounting.  Typical days are filled with patient visits, phone calls, portal messages, ‘paperwork’ on the computer, refills, covering for vacationing colleagues, worry over sick patients, adding on patients to the schedule, seemingly endless e-mails and running behind in the office.  Is it any wonder why their consult request communications might be abbreviated?  

Doctors need our own consultants to decompress us and stave off burn out.  Does such a professional exist?