title: Informal (Hallway) medical consultation in orthopedics-is it as common as it seems?
abstract: BACKGROUND
  Informal (hallway) medical consultation is an integral part of the physician's work. As musculoskeletal complaints are very common, orthopedic surgeons stand in the frontline of this practice. Many of these consultations are poorly, if at all, documented, thus imposing a potential medical danger to the patient and a medicolegal danger to the surgeon. We conducted this first study to examine whether this practice is common among the orthopedic surgeons in university hospital.
  
  
  METHODS
  In this prospective study, a 2-month record of informal consultations was kept. Six orthopedic surgeons-two joint reconstruction surgeons, one spine surgeon, two arthroscopy and sports medicine surgeons, and a shoulder surgeon participated. They recorded the details of the consulter, whether the consultation was for himself or somebody else, the major complaint, and whether it was a second opinion. All patients were advised to go to the formal orthopedic consultation and no advice or treatment was given. At the end of 2 months, each surgeon was asked to evaluate the percentage of cases he had failed to report.
  
  
  RESULTS
  During the 2-month period, 158 people asked for informal (hallway) consultations. 11 of them (7%) were physicians, 114 (72%) were other hospital personnel, 26 (17%) were unrelated to hospital, and 6 (4%) were treated patients' relatives. 93 (59%) of consultations were about the consulter himself and the rest were about a relative or a friend. 41 (26%) were requests for a second opinion. The estimated percentage of not reported cases was 10-40%; when the number of consultations was corrected for these figures, it reached 208 consultations in 2 months.
  
  
  CONCLUSIONS
  In this prospective study, six participating surgeons recorded 158 informal consultation requests in 2 months. If a correction is performed, it averages 0.6 consultations a day for a surgeon (or, if only workdays are counted-0.8 consultations a day). Orthopedic surgeons should be aware of this frequent habit and send these patients to a formal consultation.
authors.affiliation: Department of Orthopaedic Surgery, Hadassah-Hebrew University Medical Center, POB 23816, 91237, Jerusalem, Israel. kandel@hadassah.org.il.
authors.forename: Leonid
authors.initials: L
authors.lastname: Kandel
authors.affiliation: Department of Orthopaedic Surgery, Shaarei Zedek Medical Center, Jerusalem, Israel.
authors.forename: Yair
authors.initials: Y
authors.lastname: Barzilay
authors.affiliation: Department of Orthopaedic Surgery, Hadassah-Hebrew University Medical Center, POB 23816, 91237, Jerusalem, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Friedman
authors.affiliation: Department of Orthopaedic Surgery, Hadassah-Hebrew University Medical Center, POB 23816, 91237, Jerusalem, Israel.
authors.forename: Idan
authors.initials: I
authors.lastname: Ilsar
authors.affiliation: Department of Orthopaedic Surgery, Hadassah-Hebrew University Medical Center, POB 23816, 91237, Jerusalem, Israel.
authors.forename: Ori
authors.initials: O
authors.lastname: Safran
authors.affiliation: Department of Orthopaedic Surgery, Hadassah-Hebrew University Medical Center, POB 23816, 91237, Jerusalem, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Mattan
mesh_terms: D003695:Delivery of Health Care / Q000331:legislation & jurisprudence / Q000379:methods / Q000592:standards; D006801:Humans; D007557:Israel; D009140:Musculoskeletal Diseases / Q000175:diagnosis*; D009985:Orthopedics / Q000331:legislation & jurisprudence / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration*
keywords: Informal consultation