Monday, February 21, 2005

The Life of a Consult

Having spent the last week as the official Renal consult I think that I’ve begun to understand what the life of a consult resembles. Ideally, you are called into a situation where others have little idea of what is really happening or if there is a specific question that needs answering. The answer, often, lies in the past. One critical event that sent the situation spiraling out of control. Is hindsight really 20/20? That is not always the case, I assure you.

On a typical day I receive anywhere from two to six consults. I thought it be entertaining if I describe a typical consult, as well as my thoughts while it occurs (In yellow).

Consulting Physician (CP): Hi, is this Renal? Listen, I got a guy who just walked in here and he’s got a history of Congestive Heat Failure, diabetes, and hypertension. Anyways, his primary physician sent him cause on the latest lab his creatinine went from one to four. (Creatinine is a sign of kidney function)

Me: Really. What do you think is happening? (Of course, as a physician, you are calling me to support your hypothesis. Obviously, you, a diagnostic machine, a shining knight among the commons, must have an id..)

CP: I have no idea.

Me: Aha!...Ok, so is he on any new medications recently? (Knowing full well, after your extensive training, that medications are likely to be the culprit you asked him a detailed history of recent medications as well as any others which may have caused his sudden decline in kidney function. Why, not since the kingdom of Solomon has such wisdom descended upon the face of the Earth. You are a beacon of light which..)

CP: Wait, I have to ask him that.

Me: Ohhhhh K….So what did the urine electrolytes show? (After four years in medical school and one year of internship I know that you must’ve sent the most important lab by now, knowing full well that the urine electrolytes may give us a lead on what is happening. A Hero of Rome, a Titan among men such as yourself would never call another physician without having done a thorough and extensive…)

CP: Haven’t sent it. You think I should?

Remember, I said “ideally” you are called into a situation where others don’t understand what is happening. More often, you are called into a situation where no one even tried to find out. Thus is the life of a consult.