3 Things You Shouldn't Say When Asking For An ID Consult

Roni K. Devlin, MD, MBS


June 22, 2022

We all know that certain words or phrases can trigger an intense emotion or initiate an action. After all, there are lists of trigger words used in marketing to prompt sales (such as amazing, new, and today) and by bloggers to encourage reader engagement (such as easy, delicious, and pure). There are endless articles suggesting how to arouse a lover with trigger words or phrases, while warnings about the negative effects of triggers are increasingly posted across media platforms.

The language of medicine is complicated, and interactions with both patients and providers are influenced by our choices of expression. Certain words can foster better understanding and improved rapport with patients, whereas some phrases can act as negative triggers for them.

Trigger words or phrases also affect communication between medical colleagues. I was once called by a very angry orthopedic surgeon after completing an infectious disease (ID) consult on a patient with diabetes, gangrene, and chronic osteomyelitis of a toe. Though he agreed with my assessment that the toe would "require an amputation for cure," he objected to my use of the word "require." When I asked him what word he would have preferred, he said "necessitate." To me, "require" and "necessitate" had essentially the same meaning (without a doubt, the surgery was needed for cure of the infection), but to the surgeon, "require" seemed to imply that I was forcing his hand in some way.

I've thought about this conversation often — it was a tense discussion given both his level of anger and my surprise as to its trigger, especially because we agreed on the patient's assessment and plan. After more than 15 years in practice, though, I've started to appreciate exactly how words can act as triggers for physicians. I think I am, for the most part, an easily approachable provider with a kind and steady demeanor. But, in truth, there are a few phrases often used during requests for ID consults that can immediately set me on edge.

'I've got a really interesting case for you.'

I would guess that at least two thirds of conversations about ID consults begin with this phrase. You'd think that it would prompt interest or curiosity, right? Unfortunately, it immediately turns me into a skeptic, which muddles the rest of the discussion. From an ID perspective, those words are frequently associated with cases that rely on intensive chart review for diagnostic clarification in complicated patients with lengthy hospitalizations. And those diagnoses often turn out to be noninfectious in nature. I'd much rather my colleagues admit that the consult will be difficult but that my experience and expertise would be appreciated.

'This consult is urgent.'

Frankly, there isn't much that an ID physician can do urgently for a patient. We're not frontline doctors for patients with bacterial meningitis or necrotizing fasciitis. For infections like these, ID input usually comes after the diagnosis has been made, surgical source control has been accomplished, and initial antibiotics have been ordered — as it should.

Waiting for an ID doc to confirm a diagnosis that necessitates immediate antibiotic administration or surgical source control would be a medical mistake. And if a timely consult is desired for nonmedical reasons (such as a patient's pending discharge or discovery of unexpected culture results), then I'm more likely to respond to a direct phone call and an honest conversation about its exigency.

'Reason for consult: pneumonia vs urinary tract infection.'

If anything is going to trigger a rant about the lack of critical thinking in medicine today, it is asking an ID doc to clarify the difference between two different infections in two unrelated systems. I'd argue that, given the distinct clinical presentations and diagnostic studies for lung vs bladder infections, most providers should be able to distinguish one diagnosis from the other. But for many of these requested consults, neither diagnosis is correct (for example, a one-view chest X-ray showing atelectatic infiltrates and a positive urine culture have no clinical significance in a patient being evaluated for an acute ankle fracture if they have no respiratory or urinary tract symptoms).

My consult-related trigger phrases might seem benign when taken out of context, and admittedly, they don't always hit their mark. But hearing or reading those words as I respond to yet another page during an already frustrating and demanding day is enough to shift my emotional balance in a negative, unhealthy direction. At those times, I worry that I become less approachable or less kind to my colleagues. Or, perhaps even more concerning, have those triggers ever limited my engagement with the patients that I've been asked to see?

For me, the reason those phrases are negative triggers is multifactorial, influenced by my own experiences, my ability to respond to stressors, and my collegial expectations. Recognizing my own responses has influenced how I connect with other providers. When asking for a consultation, I don't suggest that the case will be interesting; rather, I explain quickly and concisely why I think assistance is necessary. If I feel strongly that an opinion is needed sooner rather than later, I call the consultant directly with my concerns. I do an extensive chart review and formulate an assessment/plan before asking other consultants for help. These are all things I can easily do to help foster good consultative communication and courtesy. Hopefully, my colleagues are willing to do the same for me.

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About Dr Roni Devlin
Roni K. Devlin, MD, MBS, is an infectious diseases physician currently residing in the Midwest. She is the author of several scholarly papers and two books on influenza. With a longstanding interest in reading and writing beyond the world of medicine, she has also owned an independent bookstore, founded a literary nonprofit, and published articles and book reviews for various online and print publications. You can reach her via LinkedIn.


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