Making the Most out of the Diabetes ConsultationPosted December 17, 2013 by Jay Shubrook, DO, FACOFP, FAAFP
Having served both as a primary care physician and as a specialist, I have intimate knowledge of both roles. I have the greatest respect for primary care physicians who have to handle the entire spectrum of humanity and who must not only balance many medical problems at one time but often balance them in the context of family, community, and culture. I also have learned that the subspecialist has knowledge and experience of rarer forms of diabetes and complications that most primary care physicians only read about. Both knowledge and experience sets are needed for the team approach often required in a condition as multifaceted as diabetes.
What Specialists Want Primary Care Providers to Know
Primary care educational organizations strive to teach primary care physicians to manage the majority of the people (and conditions) that come through the door each day. However, knowing which patients need specialty help is also a very important skill to have, as is knowing how to approach the consultant effectively.
The following are suggestions to help primary care physicians get what they need from specialists when they request a diabetes consultation for a patient:
- Be specific. What do you want the consultant to do? Do you want recommendations regarding treatment, do you need help with evaluating what type of diabetes the patient has, do you want the consultant to start insulin, or do you want the consultant to co-manage the patient?
- Send all relevant notes and testing. This prevents the consultant from needing to repeat testing and further clarifies your thought process and intent.
- Inform the patient that you are referring them and why. This allows the patient to be an assistant in the process. Often the patient’s first knowledge of having diabetes is when the specialty office calls for an appointment.
- Send a letter to the consultant communicating the above issues. This allows the consultant to know why you are referring the patient and gives relevant background information, including what testing has been completed and what diabetes treatment you have tried. Make sure the letter arrives before the patient’s appointment. I will often even include the date of the appointment in my letter when this information is available.
- Expect to have a letter come back with the consultation and recommendations. Again, the more specific you were initially, the better the response can be. Not all consultants communicate equally well, so you will need to find out what specialists in your area are best to work with. This return letter will likely include when the consultant expects to see the patient again.
- Do not be afraid to be surprised. One of the most important parts of a consultation is that a new set of eyes is looking at your patient. Sometimes taking a fresh look at a patient and having the luxury of a good previous medical record can yield a new previously undiagnosed problem or new treatment option. New diagnoses may expand the treatment options. and there are many new diabetes treatments that the specialist may recommend or initiate.
- Plan to see the patient after the consultation. It is important to ask the patient to hear from they learned from the consultation and that this matches the note from the consultant. Often medical consultations are intimidating to the patient. and they may miss critical pieces of information.
What Primary Care Providers Want Specialists to Know
The following suggestions—and insights—may also help specialists work most effectively with primary care providers who request a consultation for patients with diabetes:
- Remember that we primary care providers are inviting you to be part of our healthcare team for this patient. We want to work collaboratively with you.
- Please send us your report in a timely manner so we know what happened and what we should do next. Often when physicians share in the care of the patient the lines get blurred on who is responsible for each aspect of care.
- If you find something serious or urgent, please call us so we are prepared to answer the family’s questions, which surely will be coming within the next 24 hours.
- Please let us know what diabetes treatments or diagnostic tests you are going to order and follow through with, and which ones you want us to take responsibility for.
- If we are sending you consultations that are inappropriate or information that is not helpful, let me know.