Curbside Consult: To ask another physician a question about the management of one of your patients when they are not actively seeing that patient.
In residency I was taught to never curbside another physician.
Mainly it was presented as a liability and courtesy issue. You don’t ask another physician to take legal responsibility for giving advice on a patient they have not examined and are not receiving payment for… payment that is going to help cover their malpractice insurance in case it is needed, God forbid. In residency I even had physicians refuse to discuss cases that I was referring to them until I had done the referral and they had actually seen that patient in their clinic and if I did ask a question, I had to be very careful how I asked it. They were downright ugly about it at times. I expect it is exceedingly frustrating for them to get asked the same dang questions each year by each new set of residents.
The bottom line when you are in residency for primary care is that specialists just don’t want to see your patients. They are often disagreeable patients and have been fired from other practices (they take their toll emotionally on you and your staff) or they are indigent or on Medicaid or Medicare (unless you are paying residents a tiny pittance as indentured servants you cannot take more than a certain percentage of these patients and still remain a viable business). Often the waiting time to get patients in is months long so you learn to treat a lot of stuff yourself. You eventually get to the point where referring a patient feels like a sign of weakness and you try to avoid it all costs.
Then, you graduate and start practicing in the real world and discover that no matter how good you are at treating something, patients would generally rather see a specialist. As primary care, it is thought by many that you know next to nothing.
The flip of this is that all of a sudden you find that specialists actually want to see your patients. They are nice to you. They say nice things about you to your patients. They may even curbside you for something not in their scope of practice as if you are the expert. Now I have the cell phone numbers of tons of specialists handwritten written on their business cards stashed in my desk. They hand them to me and say, “Call or text anytime!” I still have a hard time believing it and cannot bring myself to ever do it.
For some, networking like this comes easy. They are very good at it. They build vast collections of people they can consult at any moment and asking for help doesn’t bother them. Not for me, though. This is one of my weaknesses, one of the drawbacks of being a physician who is a closet introvert. Asking for help is painfully difficult. So is ordering pizza by phone.
Until this week.
I had something that I really needed help with, something I had never seen before and could not find the answer to myself. Ultimately doing the right thing by patients has to take precedence over my discomfort. So I phoned a friend, so to speak. I don’t intend to make it a habit, but it was super nice to be able to get good advice quickly without feeling stupid about it.
So thank you.