1 Be prompt. Many times a referring clinician will consult a physician based on his or her availability. Clinicians are constantly under pressure from administrators to reduce inpatient length of stay, decide disposition or improve patient satisfaction measures. As such, being prompt to see a patient often trumps clinical prowess. Establish a timeframe: is the consult emergent, urgent or routine? All parties, including the patient, should know when to expect the consultant at the bedside.
2 Be available. A good consultant is always available for the clinicians he or she serves. While this may be difficult during a day filled with cases, always return pages, calls and messages as soon as possible. If you are working with PAs/NPs, residents and/or fellows, have them return communications and take a short message about the consult/inquiry when you are unable to do so. Clinicians should always have a clear and easy way to contact you (secure texting, floating consult pager, answering service, etc.) during off hours.
3 Be professional and respectful. Most clinicians do not possess the imaging, procedural and clinical skills of the modern interventional radiologist, but that doesn’t mean that they shouldn’t be treated with the utmost respect. Some of your knowledge that may seem basic (chest tube care, periprocedural anticoagulation, etc.) generally isn’t common knowledge in other specialties. Being condescending towards clinicians is a failsafe way to lose consults.
4 Round and be visible. Being seen on the floors, ICUs and outpatient setting by other clinicians builds rapport and often leads to new consults. Always carry a business card so clinicians have a quick and easy way to contact you if needed.
5 Write detailed initial consultations. While consultants are often asked about a specific issue, a good physician must be aware of the active issues and overall clinical picture. For example, in moribund patients, know the goals of care and recommended appropriate management. This is also important for billing and coding; make sure to provide adequate documentation (patient acuity, physical exam, review of symptoms, etc.) for appropriate billing.
6 Communicate effectively. If dictating a consult or report, make sure to copy: all physicians who are involved in the patient’s care (internist, gastroenterologist, oncologist, etc.). The initial consultation should be discussed verbally, which improves compliance and allows everyone to agree on the next plan of action and to provide a unified plan to the patient. Finally, it should be clear if the primary team or consultant will place orders after your recommendations.
7 Write follow-up notes. It is important to document your findings when reviewing medical records or imaging or when discussing a case with a referring physician. Doing so shows your referring physician that you are engaged and adding value to the case and is best accomplished by writing a note in the patient’s chart. Make brief, detailed plans that will be easy for the primary team to follow.
8 Talk the talk and stay updated. Convey your findings, evaluation and management in words that are easy to understand by the referring physician. An internist may not understand the enhancing characteristics of a hepatocellular carcinoma on MRI or the utility of an internal–external urinary stent. However, this would be easily understood by a gastroenterologist and urologist, respectively. Stay up to date with major journal articles on your area of practice that are published in nonradiology journals. Learn and use guidelines, protocols and scores that are commonly used by clinicians (CHA₂DS₂-VASc, SOFA, MELD, etc.).
9 Sign out. All good consulting services sign out to a covering physician during nights, weekends and/or holidays. A good sign-out is performed physician to physician, includes the names of patients on the service, active issues that may come up when the primary physician is not available and things the covering doctor should perform or monitor during the time of coverage.
10 Own the disease and go the extra mile. You must be up to date, active and involved in all facets of a disease process. This includes managing imaging follow-up, medications and minimally invasive treatment. Simply leaving recommendations to repeat imaging, obtaining old tests and records does not add value. If you feel this information is important, contact outside providers, subspecialists and/or imagining centers to obtain this information and help the patient. Set up a protocol that allows outside physicians to easily upload patient imaging media into your system.
