Physician Preferences for Elements of Effective Consultations
Effective communication is vital for optimal medical consultation, but there is little current information about physician preferences for effective consultation.
We invited physicians with at least one post-graduate year of experience at four Minnesota teaching hospitals to complete a 16-question Internet questionnaire about inpatient consultations.
E-mail requests were received by an estimated 651 physicians. Questionnaires were completed by 323 (50%). Of these, 54% had completed training >5 years before, 17% had completed training <5 years before, and 30% were residents or fellows. Three elements were considered essential in consultation requests by most respondents: the specific question to be addressed (94%), whom to call with the response (68%), and consultation urgency (66%). In the consultation note, 71% of subjects placed high importance on simple, concise recommendations and 64% on the rationale behind them, while only 7% placed high importance on citing references. Most (69%) preferred that assessments and recommendations be written in bulleted or numbered format. A plurality (48%) preferred that assessments and recommendations be separated. Most placed high value on recommendations regarding drug therapy that specify dose (80%), duration (80%), and generic medication name (62%). Requesters placed greater importance than consultants (87% vs. 65%, respectively, P = 0.004) on recommendations that included duration of therapy. The majority (63%) stated that telephone requests were needed for emergent or urgent consultations. Those who usually requested consultations were more likely than those who usually responded to consultation requests to prefer telephone requests for routine consultations (43% vs. 20%, P < 0.001).
Physicians agreed on many essential elements for effective consultations. These results should guide efforts to improve communication in the consultation process and design electronic medical record systems.
KEY WORDSreferral and consultation graduate medical education health care surveys interprofessional relations
The authors wish to thank Drs. Cristina Baker and Michael Aylward for conceptual discussions. DRB is supported by the National Institute of Allergy and Infectious Diseases (T32AI055433; L30AI066779; K12RR023247). Parts of the material were presented at the Infectious Diseases Society of America Annual Meeting, San Diego, CA, October 5, 2007.
All authors meet authorship criteria and have no financial conflicts of interest. GAF is a federal employee.
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