- Engaging consultants is a common practice in medicine that is often taken for granted.
- Surgeon-consultant interactions can be unproductive if not correctly managed.
- Learn how to deploy a strategy for intentionally working with consultants to achieve the highest quality of care.
In the increasingly complex world of medicine, it is difficult to maintain a high level of expertise in every disease process. Engaging consultants who have expertise in other areas, both in the ambulatory and inpatient settings, is a common practice that is often taken for granted. These interactions can be unproductive if not correctly managed, leading to delayed or ineffective patient care with mutual frustration. Deploying a strategy to intentionally work with consultants will have countless benefits for both patients and physicians.
“No Man Is an Island”
Communication is the key to building and maintaining any relationship and is especially crucial when patient lives and outcomes are at stake. Often, requests to assist with clinical problems are sent through computer-generated orders or the least experienced member of the clinical team given the common time constraints. Consultants must then decipher the clinical need and hopefully reach out for more information if the initial request lacks clarity. If neither of these occur, it is possible that the wrong clinical problem is addressed resulting in the need to backtrack and revise the process. Developing more direct lines of communication can take less time than anticipated and can be as simple as sending a brief message or text with exponential benefits.
Building relationships with consultants is essential to working together effectively, elevating clinical requests from a more transactional nature to a collaborative one. Additionally, having good personal relationships at work is linked to more workplace satisfaction, an important consideration with increasing burnout rates. This is more difficult in the hybrid virtual/in-person era, but it can be worthwhile to make the effort to find non-clinical areas of shared interests as socializing outside of a work setting can also lead to improved camaraderie.
Know the Landscape
When entering a new institution there will inevitably be differences in the scope of practice and local expertise. Your idea of what constitutes an optimal standard of care may differ from that of your consultants and even your partners. There will be some areas where implementing your vision is relatively straightforward, especially when initiating a new program. Other aspects will require finesse and flexibility to determine where there is either a real need for change or where adapting would lead to a better relationship without compromising patient care.
When the Going Gets Tough: Managing Difficult Interactions
Inevitably, disagreements will arise. These can range from differences in opinion over relatively minor elements to disparate views regarding major treatment decisions. The first step is to look inward and assess your role in creating the disagreement. Are you making incorrect assumptions? Have you been clear in your communication? Re-establish any broken communication lines and ensure that this is not a misunderstanding that can be resolved by getting all the facts and engaging in open dialogue. Be honest about whether this reflects a need to be in the right or truly working for the patient’s best interest. Would the clinical outcome be adversely affected? When both parties are in more intransigent positions, be mindful of creating a lose-lose situation where you either cede ground and maintain the relationship or push for what you think is right and diminish the relationship. Instead, try to find a solution that achieves an outcome that is right for the patient, and maintains the relationship despite the difficult conversations and decisions that this may require. Unfortunately, there may be instances where this is not feasible, and to do what is best for the patient the situation needs to be escalated. Reach out to your partners and leaders in your group for advice and support before going to your consultant’s superiors. Lastly, maintain professionalism through the disagreement. Communicate directly instead of through surrogates and do not use the medical record to adjudicate the problem.
All for One: Team-Based Care
Conflict is inevitable, and in some instances can be beneficial to patient care. But more commonly, collaboration yields better outcomes. Competition for either patients or resources can inhibit collaboration, amplified by incentives that do not align. Disease-based teams can be useful to create shared goals and better foster collaboration. Engage your leadership to create systems to better align incentives and reduce the potential for conflicts of interest to negatively affect clinical decisions.
Ultimately, working with consultants is a balancing act between leadership and collaboration. Despite the potential pitfalls these relationships can have immense benefits for patients and be tremendously rewarding for all involved.