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

• Consult

  The ED calls: right upper quadrant pain and fever

  ED consultant, 03:10: 'Fifty-four-year-old woman, two days of right upper quadrant pain, now febrile with a white count of 16. Ultrasound in the morning. Are you happy for us to admit her under you?'

  Answer the phone

• Consult

  The ED calls: a groin lump that will not go back

  ED registrar, 19:50: 'Sixty-eight-year-old man, known inguinal hernia for years, came in because it will not reduce since this morning and he has started vomiting. Tender lump. Can you see him now?'

  Answer the phone

• Consult

  Paediatric ED calls: acute scrotal pain

  Paediatric ED registrar, 05:40: 'Fifteen-year-old boy, woke an hour ago with sudden severe left testicular pain and vomited. The testis looks high and he will not let me touch it. I have asked for an ultrasound; can you see him?'

  Answer the phone

• Consult

  The ED calls: left-sided pain and a CT report

  ED consultant, 16:20: 'Fifty-eight-year-old woman, three days of left lower quadrant pain, febrile at 38.1, CT shows sigmoid diverticulitis with a small pericolic phlegmon, no free air. Radiology wrote query abscess. Can surgery take her, and does she need an operation?'

  Answer the phone

Some of these patients need theatre within the hour, some tonight, some on this admission, and some need a tube, a drip and patience. Knowing which is which is half the specialty.