Dr. L. V. Kirchhoff and I have worked together as supervising faculty supervisors for more years than I care to admit on the Medical-Psychiatry Unit (MPU) at the University of Iowa Hospitals and Clinics. I consider him one of my wisest teachers. He’s an Infectious Disease specialist and provides vital expertise on the identification and management of patients who are suffering from a variety of both community-acquired and nosocomial infections. The other day, he had disparaging and enlightening comments about the so-called “curbside consultation” so common in many hospitals. Basically his “rant” as he typically calls his pearls is to curb the curbside. The curbside question is an informal telephone, stairwell, or elevator question posed by colleagues to specialists in order to avoid requesting a formal consultation. The motivation for getting a curbside can be simply a desire to get guidance on a purely technical issue, such as whether antibiotics share a similar mechanism of action or liability to allergic reactions.
However, curbsides commonly are complex questions about patient care that normally require the consultant to actually see the patient, conduct a thorough chart review and focused examination, and to then frame a carefully crafted patient-centered assessment with management recommendations the consultation requestor needs in order to provide the highest quality medical care.
The curbside in psychiatric consultation is particularly common and often are inappropriate. There are few questions for a psychiatric consultant that can be adequately addressed in a stairwell.
Dr. Kirchhoff decries the curbside and with good reason. There are usually no shortcuts in medicine. In order to provide safe and effective health care, physicians and other health professionals need to go the distance. We must keep the goal in mind, which is to provide the safest and most effective medical care possible both inside and outside of the hospital.