Older physicians often bemoan what’s perceived as a decline in professionalism during residency training. Caps on the number of inpatients assigned to an intern or resident. Duty hour limits. Wellness retreats. While these may be imperfect, they’re at least aligned with or heading in the direction of what is the right way to balance the rigors of a lifetime of training in and practicing medicine with the safety, quality, and staffing needs of individual patients and the health system as a whole.

But one trend is definitely a step back. The decline in verbal (face-to-face or telephone) communication between consultants and those requesting consultation (e.g., inpatient or ED teams).

As a tertiary care hospital emergency physician, I often wish to speak with consultants to inform them of a case with which I’d appreciate their assistance.

However, each department in my health care corporation has a different means by which they want their residents and fellows to be contacted. Some through a narrative text pager. Some through a numeric text pager. Some through secure messaging systems such as Microsoft Teams. And some through email. Imagine that: an email to consult a patient in the ED; that is truly an assumption by a specialty department that ED patients are not terribly sick.

The consultants often don’t close the loop with us in the ED. Instead, they leave notes without telling us they’ve seen the patient. This is detrimental in three respects compared with the “old way” of consultants discussing cases with us face-to-face (or, at least, by phone):

We fail to learn from consultants’ recommendations and thought processes.

We fail to intervene or disposition the patient more quickly.

We fail to get to know consultants and create trust and camaraderie.

What should be done:

This is a system-level problem, not an individual department-level problem.

Each department should have the same process for contacting consults. We in the ED should not need to guess or memorize how each department wants to be contacted. Such variation is inconsistent with the concept of a system (as in “health system”), as it is literally not systematic but random. This process should not involve email. The ED is not an office. We in the ED don’t have time to write or read emails. We have no way of easily being notified that an email has been read by a consultant (i.e., that the consultant has been successfully contacted).

Consultants should close the loop with the person who has consulted them. They should talk to us in person before leaving the ED. Or, at least call us.

So:

Dear consultants,

Working closely with and learning from you was a very important part of my training. By speaking with you, patients got better, faster care. I made many friends outside my department. I enjoyed learning, and had less need to call you for future cases because of what I’d learned.

Any time I’ve called you, please pick up the phone (you probably have one or two in your pocket right now) and, as Debbie Harry and her band Blondie sang in their 1980 song “Call Me”: “Call me, on the line; call me, call me any, any time.”

The author is an anonymous physician.