10 Consult Commandments for Surgeons to Dominate the Day

The Art of the Surgical Consult

• 🎯 Mastering the surgical consult is a crucial milestone for young surgeons, transitioning from data gathering to data synthesis.
• ✨ The ability to break down complex patient presentations into an immaculate assessment and plan is described as an art form.

The 10 Consult Commandments

• 📜 The "10 Consult Commandments" are guiding principles developed from personal mistakes and observed patterns to help trainees navigate consults.
• 💡 The commandments aim to improve patient care by ensuring thoroughness, clear communication, and accurate documentation.

Commandment Breakdown

• 🛠️ Have a System: Establish a routine for reviewing patient acuity, vitals, labs, imaging, comorbidities, and prior history before engaging with the patient or ED note.
• 🛡️ Trust No One, Expect Sabotage: Verify all information and perform your own assessments, as other specialties may not have the same focus on surgical details.
• ❓ Always Ask at Least One Why: Dig deeper than the surface-level information to fully characterize the patient's condition and history, but avoid getting lost in excessive detail.
• 👁️ Always Look at the Imaging Yourself: Develop proficiency in interpreting imaging, but also collaborate with radiologists, discussing discrepancies to leverage their expertise and your clinical context.
• 🆘 Don't Worry Alone: If you feel out of your depth, immediately involve senior residents, fellows, or attendings to ensure timely and appropriate patient management.
• 📢 Don't Bury the Lead: Clearly state the urgency, operative status, and the specific consult question upfront to frame the conversation effectively.
• 🚫 Never Lie: Maintain credibility by admitting when you don't know something rather than fabricating information, as honesty is crucial for patient care and professional integrity.
• 📝 Include a Real Assessment and Plan: Document a thorough assessment and plan to demonstrate your thought process, build trust with other teams, and ensure continuity of care.
• ❤️ Goals of Care are Important and Individual: Understand the patient's wishes, code status, and what constitutes an acceptable quality of life, especially for high-acuity situations, to guide treatment decisions.
• 💬 Overcommunicate: Ensure all relevant parties (primary team, senior, attending, patient, consulting service) are informed and aligned on the plan to streamline care and prevent conflicting narratives.