The medical consultation is not a straightforward procedure, and the effectiveness
of such consultations is not easily studied in a randomized controlled trial.
Proving and improving the value of consultations.
It is, however, a common intervention in patient care, and nearly all medical professionals
request or provide consultative services as part of their clinical work. As with many
other competencies and subcompetencies, there is significant overlap in the skill
sets that are required. For consultation skills in particular, specific expertise
is required in the domains of medical knowledge and patient care. Certain specific
aspects of professionalism are also critical and have been the subject of much ethical
and medicolegal debate as they relate to consultation.
The role of the medical consultant.
The American Medical Association
- Opinions and reports of the Judicial Council
noted 9 ethical principles directly pertaining to physician consultation, 3 of which
apply to the referring physician; the remaining 6 focus on the consultant. These serve
to clarify the responsibilities and role of the consultant and are summarized briefly
as follows: 1) one physician should direct the patient's care and treatment, and the
consultant should not take on primary management without the consent of that primary
provider; 2) the consultation should be done in a timely manner, the results should
be communicated directly to the referring provider, and the results should be shared
with the patient only by prior consent of that provider; and 3) differences of opinion
need to be resolved with a second consultation or withdrawal of the consultation,
although the consultant has the right to discuss her opinion with the patient in the
presence of the referring physician.