Background: Consultative medicine has been identified as a core part of internal medicine (IM) resident education by providing the opportunity for residents to care for the non-medical patient. In the early 1980s, two separate academic institutions detailed the initiation of their General Medicine Consultation service. They described who consulted them and the reason for consultation. However, over the last three decades, much has changed. There appears to be an increase in the role of IM in the care of non-medical patients. We sought to evaluate current practices in medicine consultation.
Methods: We report a multi-institutional observational study, developed through collaboration with a regionally diverse sample of U.S. academic institutions, the Medicine Consult/Co-management Consortium (MC3). We obtained baseline demographic data: hospital affiliations, IM residency program associations, and characteristics of the medicine consultation service. Each institution reported consultation data for a continuous two-week time frame every three months using an online form. Data were collected from July 2014 to July 2015, and included service requesting the consult, reason for the consult, additional issues addressed by the consultant, and whether the patient was transferred to the inpatient medicine service.
Results: Our group recorded 1,261 initial consult requests. Surgery services accounted for most of consults (79.1%), with orthopedics (46.1%) and neurosurgery (11.2%) comprising more than half; general surgery accounted for 6.7%, while surgical services accounting for less included urology, otolaryngology, trauma, vascular, plastics, cardiothoracic, oral-maxillofacial, and ophthalmology. Additional consult requests came from psychiatry (9.6%), neurology (5.5%), obstetrics/gynecology (3.3%), and rehabilitation medicine (2.3%). The most frequent reasons were medical management/co-management (12.7%) and preoperative evaluation (10.4%). Other common reasons were glycemic control (6.6%) and blood pressure management (6.1%). Consult requests accounting for less than 5% each included pulmonary problems, infectious disease, arrhythmias, gastrointestinal problems, renal failure, hematologic abnormalities, transfer to medicine, electrolyte abnormalities, anticoagulation management, chest pain, altered mentation, fever, and venous thromboembolic disease.
Conclusions: To our knowledge, our study is the first multi-institutional assessment of nature of consultation requests. Compared to previous studies, some characteristics of those requesting consults have changed. Most consultations still originate from surgical colleagues, with orthopedics most frequently seeking consultation; consultations from neurosurgery have increased. Management of multiple medical problems/chronic illness and the preoperative evaluation remain the highest requested reason for consultation. These data can provide guidance to programs seeking to optimize the consultative training of their residents.