OB Guideline 4: Consultation

Consultation occurs between two professionals who are both licensed and credentialed to provide patient care. One (the“requesting clinician”) requests an opinion from the other(the “consultant”). The requesting clinician considers the recommendations of the consultant and decides whether or not to follow them based on their clinical judgment.

All clinicians are encouraged to seek additional medical advice whenever they have concern about a diagnosis or course of treatment. Consultation is essential when the experience,expertise, or comfort level of the attending clinician is exceeded. Once the limits of a clinician’s privileges are exceeded, care must be transferred.

Consultations may be formal or informal.

A formal consultation occurs when an opinion about a specific circumstance is requested. The requesting clinician is responsible for documenting the request.

1. If the consultation is in person, the consultant shall personally evaluate the patient including a physical examination, where appropriate, and a written note will be placed in the hospital record.
2. If a telephone consultation is obtained, both parties should be clear that this is a formal consultation and that a summary of the discussion and the consultant’s name will be entered into the medical record.
3. If the final management plan differs from the consultant’s recommendation, then the responsible requesting clinician should document their rationale for choosing a different course of action.

When a consultation occurs, clear documentation should be made in the patient’s medical record defining the nature of the consultation and indicating whether it is a) a one-time consult,b) care that will now continue jointly, or c) a transfer of care.

An informal consultation (curbside consult) occurs when the discussion between clinicians lacks details specific to one patient. An informal consultant is not named in the record. When these consultations occur, both parties should be clear that the discussion is not intended to constitute individual patient care, and does not create a clinician/patient relationship.

Absent a formal consultation, avoid entering limited statements such as “physician aware.” Such wording may imply that the indicated physician has knowledge of the case when they do not.