Curbside Consults by Subscription

When I started out, most specialists were in private practice, as were most primary care doctors. Fresh out of my residency, the specialist consultants I referred to were obviously a little older than I. They were well established, made good money and were their own bosses. The grace in their lives was obvious to me.

Their consultation reports were typed on delicious, thick, often colored, stationery and signed with flair, often with a fountain pen. If I called them for what we call “curbside” advice, they were gracious and never seemed rushed. They took pleasure in sharing their knowledge with younger colleagues like me. I’m sure they also expected our referrals over time to be better and more appropriate.

Times have changed. Most of the specialty practices were bought up by the hospitals and specialist doctors became employees with a little less control over how their day went. I could tell when I called for advice that they had tighter schedules than they used to. Many of them also had less help in the office than they were used to having.

The other thing that happened over time was that, since they were all older than I was when I began practicing, one by one, most of them have now retired. The new generation of specialist isn’t as easfor me to call for curbside consultations because we don’t have as much history with each other.

My new practice has a subscription to a nationwide service that I was late in starting to utilize, but now I am hooked. I go to the service’s website, type my question and the clinical background, import labs or imaging reports and, typically in half an hour or less, get a helpful reply from a specialist with at least comparable credentials to what I was used to years ago, and often from somebody with an academic background.

I have received no-nonsense, real-world guidance with a urine culture growing enterococcus faecalis, with a case of Todd paralysis and once got ammunition in the case of an elderly cholecystitis patient with a cholecystotomy tube my local surgeons didn’t want to deal with.

I am now telling my patients here in this physician shortage area that I have almost instant access to specialists and subspecialists my patients would have to wait many months and travel hundreds of miles to see. This sometimes lets me handle more things myself and at the very least it helps ensure that my patients will get the right treatment while they wait for their “local” consultation here in Maine.

My practice actively encourages its doctors and nurse practitioners to use this service. This is such a time saver and worry reducer for both us frontline clinicians and for our patients.