As a hospitalist, I am frequently the admit doc for most patients with multiple medical conditions. While a get asked to consult on patients who have been admitted by another service, often times I am the one asking for the consultation from another specialist. So when a doctor tells me "Thanks for the shitty consult", one is forced into thinking mode to try and define shitty.
What determines whether a consult is shitty or not?
- Time. We all know that time is money. Insurance companies do not pay based on time. Any consult that swings the pendulum from quick and easy to long and hard is a shitty consult. The four box theory of life arranges consults into four possible scenarios. Quick and easy. Quick and Hard. Long and Easy. Long and Hard. The best consult is the quick and easy. The shitty consult is the long and hard. Sorry, I didn't make them sick.
- Money. If the patient does not have insurance, the consult automatically becomes a shitty consult by default. It does not matter if they are the nicest people in the world. It is a shitty consult. As one doctor told me once: "I am not a not for profit entity." Sorry. I didn't make them unemployed.
- Patients who are awake and with it move you toward the long arm of the four box theory. Patients sedated on a ventilator move you toward the quick arm of the four box theory. The more awake the patient, the shittier the consult. Docs, you know it's true, however crass that statement is. Sorry, I didn't make them awake.
- Urgency. Getting called away from insurance paying out patient consults to rush to the hospital for a life threatening condition is a shitty consult. It ruins the day. It costs money. It increases liability. It increases the hard factor and time factor. The more urgent the consult, the shittier it is. Sorry. I didn't make the patient sick.
- Time Of Day. The later in the day the consult, the shittier it is. Middle of the night, say 2ish am? That's a really shitty consult. 5 pm on a Friday afternoon when you are getting ready to go to your daughters dance recital? Shitty. This ties into urgency. If it can wait till morning, it will. Otherwise enjoy the shitty consult. Sorry I didn't make the patient sick.
- In-patient consults. As a rule, inpatient consults are shitty, when compared to outpatient consults. It's true, most specialists would much rather consult on stable outpatients than sick, time consuming inpatients. Sorry, I'm a hospitalist. My consults only come from hospitalized patients. Enjoy the shitty consult.
- Lots of medical problems. The sicker the patient, the shittier the consult. Of course, that may only apply for hospitalists. The consults I receive on patients with 20 medical problems are much harder than the patients I get consulted on with one or two medical problems.
- Non English speaking are shitty consults, mostly because where I live, most doctors only speak English and it's really hard to do a consult by talking really loud and really slow.
- Too many family members in the room? Shitty again. Call me when all the family goes to lunch.
- Hard of hearing and demanding to use a dry erase board to communicate. Oh, the pain.