As the clinician in charge of a client/patient, we sometimes have to involve other specialists or their opinion in the care. Colleagues please appreciate a fundamental value, that while we delegate work (such as an assessment), we cannot delegate responsibility unless it is explicitly communicated and accepted with both the client and a receiving colleague.

One important resource to consider is time. It takes time to complete assessment, sometimes to manage and stabilize conditions, and other times to observe effect of intervention about optimization. It is good risk management to give ample time to assessments by another colleague, and to allow adequate time to observe effects, including the what-if’s when our definitive treatment needs deferral.

Another important aspect is professional communication. It is easy to write down ‘consult medical’. It is important that we understand the treatment prescribed, and we agree with the management. A consulted colleague is officially a guest doctor the clinician-in-charge invites, and has not taken over unless it is otherwise agreed. Whether to carry out the suggestions, and observation of effect, is still primary duty of the original doctor.  It is safe practice to communicate verbally on top to written notes. Experienced doctors all talk to each other.

One example is preoperative assessment by anaesthetist. When a patient is medically fit (technically ASA 1), the assessment may be brief. Other times, admission well before intervention to allow thorough assessment is appropriate, and the time span might be considered in days instead of hours. Anaesthetists as well as internal medicine physicians may be consulted in clinic before operation for complicated problems, and further optimization may sometimes be necessary. The same principles apply to solo or team anaesthetists.  With the former, the anaesthetist is individually approached, but anaesthetic team leaders are contact points with the latter. Answers may be complicated, and sometimes straightforward answer fit or not fit for operation does not apply.