title: Principles of effective consultation: an update for the 21st-century consultant.
abstract: BACKGROUND
  Little information in the literature exists to guide consult interactions between different medical specialties.
  
  
  METHODS
  A total of 323 general internists, family medicine physicians, general surgeons, orthopedic surgeons, and obstetricians/gynecologists (OB/GYNs) from 3 academic medical centers completed a survey addressing their ideal relationship with consultants. Differences between surgeons and nonsurgeons were calculated using logistic regression, adjusting for location and trainee status. Differences between different specialties of surgeons were calculated using analysis of variance with Scheffe post hoc analysis
  
  
  RESULTS
  There was a 72% response rate. About half of respondents were surgeons and the rest were general internists and family medicine physicians. More nonsurgeons (69%) desired the consultant to focus on a narrow question than did surgeons (41%). Over half (59%) of family medicine physicians and internists preferred to retain order-writing authority on their patients compared with 37% of surgeons (P<.001). Of the surgeons preferring to retain authority, 70% believed it was appropriate for consultants to write orders after a verbal discussion. Orthopedic surgeons desired consultants to write orders and co-manage patients significantly more compared with general surgeons and OB/GYNs (P<.001). Only 29% of physicians thought literature references were useful in consultations. Most physicians (75%) desired direct verbal communication with the specialist providing the consultation. Most family physicians (78%) believed there was little need for general internal medicine input, preferring to consult medicine subspecialists directly.
  
  
  CONCLUSIONS
  Specialty-dependent differences exist in consult preferences of physicians. These differences vary from the extremes of orthopedic surgeons desiring a comprehensive co-management approach with the consultant to general internists and family medicine physicians desiring to retain control over order writing and have a more focused consultant approach.
authors.affiliation: Department of Internal Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA. stephen.salerno@us.army.mil
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Salerno
authors.forename: Frank P
authors.initials: FP
authors.lastname: Hurst
authors.forename: Stephanie
authors.initials: S
authors.lastname: Halvorson
authors.forename: Donna L
authors.initials: DL
authors.lastname: Mercado
mesh_terms: D001291:Attitude of Health Personnel; D005194:Family Practice; D019538:Health Care Surveys; D006801:Humans; D007388:Internal Medicine; D007400:Interprofessional Relations; D012017:Referral and Consultation / Q000458:organization & administration*; D013043:Specialties, Surgical; D014481:United States