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Common Q's: Internal Medicine Consults

Practitioners on Virtual Hallway spend a lot of time thinking how best to help their patients. We often get queries about what types of problems make a good consult request. Having effective consult requests can streamline the entire consultation process, allowing more quality time spent problem solving through the patient’s problem. 

So what are some examples of effective consult requests? We’ve gathered a few tips examples and tips from Virtual Hallway General Internists:

Abnormal lab values

Often labs come back abnormal, but the direction to go next is unclear. This is a common and effective use of phone consultation. Consulting on this can lead to a faster diagnosis, avoid unnecessary tests and in some cases, reassure patients.

Congestive heart failure

CHF is a complex problem, and made even more complex as individuals with CHF typically have multiple other medical problems that might be exacerbated by some medications. This type of problem is a excellent example of where consultation can help optimize a patients treatment. 

Blood Thinners

Whether it be for atrial fibrillation or venous thromboembolism, stopping, starting and titrating anticoagulants can be tricky. This is where talking through matters with an Internist can help make this process as efficient as possible. 

Making a Diagnosis

Patient’s symptoms don’t always lead to an obvious diagnosis. Often, it takes a lot of history taking, physical exam and investigation to figure out what might be going on. Consulting with a General Internist during this process can help narrow the diagnostic possibilities down, and also help in selecting the investigations with the highest yield for a patient’s presenting problems. 

Treatment planning

Making a diagnosis is part one. Choosing the best treatment is step two. Working through the treatment options for a patient’s diagnosis is an excellent exercise to do with a General Internist. 

While these are some examples of situations where consultation is appropriate, there are no hard and fast rules about consulting. A consult should be an option whenever there is uncertainty about a patient’s condition. Two heads are better than one.

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