Friend’s Curbside Consult
A “curbside” consult is when you want to ask another doctor’s opinion about a patient, and it’s either a really quick question, or (you expect) a really quick answer. Otherwise it’s an “official consult,” which means the other doctor has to do the full exam on the patient, write a note, all that jazz.
So I just got a call today from an old friend from Chicago whose father is scheduled to undergo a CABG (heart surgery) next week, and he wanted to know which option was better–regular CABG or OP-CABG (off-pump). As I am definitely not a heart surgeon, or even a cardiologist, I have no freaking clue.
(This is where med school comes in handy.)
An attending once told our class that medical training allows you to quickly learn new things and quickly recall old things you’ve forgotten, and I’ve run across so many circumstances that prove his point. The background courses–anatomy, physiology, etc–provide a physician with a framework to use to understand the body. So even if a patient comes to you with 20 articles on some new therapy for some disease, you can skim the articles and become almost as proficient with the gist of the therapy as the patient is.
So I quickly login to UpToDate–essentially the new textbook for my generation of physicians–punch in a few keywords, and voila, I’ve got a summary of the latest research and data on the two procedures, written by someone who knows the field well. No, I’m still not a heart surgeon or cardiologist, but in 10 minutes, I’ve already leap-frogged over my friend’s knowledge (which he’s been reading all week), and can talk to him about the risks of each procedure, the outcomes, all of that–and give him some better details than he can get at easily.
I’m glad to be able to help and interpret medicalese back into English–I just suspect these curbsides from my friends and family will become even more common as:
- I get older (and their parents get older)
- Treatment options get even more advanced
- More and more people end up with chronic diseases, as we all will eventually.
Hell, my own family already comes to me for medical advice and discuss their issues with me (sorry Dad, but I’m sure they’ll still go to you for mental health!)–I try to explain things simply, and generally defer to the physician still, always with a “well, your doctor probably has more experience than me, and knows all your medications and other medical problems better than I do, so that can always affect what he/she chooses to do.” We were warned numerous times during med school orientation that this would happen, but it’s definitely seemed to pick up now that I have a year of clinics under my belt and manage patients.
(I also won major points with my mom when I knew what “Saturday Night Palsy” was when she mentioned it.)
I hope you continue your enthusiasm. I once shared yours, but now I limit my research to finding the best guy in the field through personal contacts and giving him/her the name.
There are many opinions for treatments and I don’t value mine very much if its not in my specialty. Now if it pertains to urologic problems, especially cancer, I have no problem giving advice.
One thing you should realize, which I didn’t at one time, that you could be help liable by giving advice.
Yeah–I definitely try to never give advice, just information.
The answer to your friend’s question, according to my husband’s cardiothoracic surgeon (yes, I asked him pre-op) is “We’ll decide when we get in there”
The answer to my husband’s question (How many vessels will you have to bypass?”) was “As many as it takes.”
In his case, the answer to question #1 turned out to be “some of each” and the answer to #2 was 5
7 years later, he’s doing quite well.
Ah! Love it! Did something similar just today. Anyone other than family I usually say talk to your doc, they know you better; but my family hates doctors, so they settle for me. :)
Be very careful on this.
#1 You don’t want Uncle Bob to be telling you about all his health problems at the next family reunion because you’ve set a bad precedent.
#2 Like Domenico said, you can be held liable. CMPA (the body that defends Canadian doctors if we get sued) told us about a nurse who asked a random doctor on the ward about her husband’s chest discomfort. He said “Oh, sounds like it’s probably reflux.” It turned out to be an MI, and the doc was successfully sued.
#3 Curbside consults are not wise. You should be formally documenting everything, or else you won’t have a leg to stand on. Again, there was a case of an orthopedic surgeon who got curbside consulted by an emerg doc who had looked at an X-ray of a fracture and decided it was closed and wanted to know if the surgeon would treat with antibiotics. He didn’t look at the film, it turned out to be open, patient got osteomyelitis, sued and won. Even though the surgeon didn’t even see the patient or the films and wasn’t really even aware that he was being “consulted”.