06 / Patient care · Consult

The ED is on the phone

A consult is the surgical skill nobody rehearses: choosing what to ask, what to examine and what to order, then committing to the question that makes it surgery, does this patient need an operation? Every choice you make is tagged honestly, and the consult is scored on what you walked past as much as what you found.

• Consult

  The ED calls: RLQ pain

  ED registrar, 21:40: 'Twenty-three-year-old with a day of abdominal pain, now right lower quadrant, looks uncomfortable. Bloods back. Can you come and see whether this is surgical?'

  Answer the phone

• Consult

  The ward calls: vomiting and distension

  Medical FY2, 14:15: 'Seventy-six-year-old admitted under us with vomiting, now distended and hasn't opened her bowels for three days. Abdominal X-ray looks dilated. Can surgery review, query obstruction?'

  Answer the phone

One of these patients needs theatre tonight. One needs a tube, a drip and patience. Knowing which is which is half the specialty.