This concern comes up a lot more from Family Physicians than it does from Specialists. In fact, depending on specialty, between 30-70% of all referrals sent for a traditional consult could be addressed by phone consults.

However, what we also know is that there are many situations where a patient may not have been referred for an in person consultation, but they could benefit from having a family doctor to specialist phone consultation. These types of situations may include:

• Uncertainty of which drug is the next best option;
• Uncertainty of the next best test to order;
• Uncertainty about whether a lab result is consequential or not.

In fact, consulting with a specialist earlier than one might for a usual in person consultation can improve the patient outcomes.

Sometimes, the outcome of a phone consultation may be a recommendation that a patient be referred for an in person visit. This happens, and in fact may end up enhancing the patient’s care because the specialist may provide some recommendations for the patient in the interim, while they wait for their in-person visit.

There are a few scenarios where an in-person (traditional) consultation is generally preferred:

• Emergency situations
• Clinical situations where a physical exam will be absolutely essential to diagnosis and treatment

Virtual Hallway is not an emergency service, so these situations are not well served through the platform as the specialist will not be able to respond quickly enough. Physical exams are sometimes needed for accurate diagnosis, so these situations may result in a recommendation for an in-person referral. However, there is a lot of grey area in these types of determinations.

Ultimately, appropriateness for a phone consult is a clinical judgment call. While the decision to send a consult request is the family physician’s, determining a patient’s disposition is ultimately a collaborative exercise between primary care and the specialist.