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Invited Commentary
September 2014

Medical Consultation for Surgical Cases in the Era of Value-Based Care

Author Affiliations
  • 1Division of Pulmonary Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston
JAMA Intern Med. 2014;174(9):1477-1478. doi:10.1001/jamainternmed.2014.1499

Dr William Mason1 described the limitations of individual physician practice to provide the best care in the era of complex diagnostic and treatment algorithms in 1929. He explained medical consultation as a medium by which to secure ideas and the opinion of physicians with diverse medical expertise for patients segregated by specialized service units. An open and effective communication is necessary between surgeons and medical specialists for proper management of the patient with a complex medical history. Fast forward to 1983. Goldman and colleagues2 provide explicit instructions for effective consultation, labeled as “Ten Commandments for Effective Consultations.” These include the following: determine the question asked; establish the urgency of the consultation; gather primary data; communicate as briefly as appropriate; make specific recommendations; provide contingency plans; understand one’s role in the process; offer educational information; communicate recommendations directly to the requesting physician; and provide appropriate follow-up. This listing describes the traditional role of a consulting physician. However, significant specialty-specific differences exist for the involvement of a consultant.3 Hence, it is important that the medical consultant clarify the level of involvement with the requesting physician to avoid “turf battles.”

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