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Curbside Consultation Practices and Attitudes Among Primary Care Physicians and Medical Subspecialists
David Kuo, MD;
David R. Gifford, MD, MPH;
Michael D. Stein, MD
JAMA. 1998;280:905-909.
Context.— Informal (curbside) consultations are an integral part of medical culture and may be of great value to patients and primary care physicians. However, little is known about physicians' behavior or attitudes toward curbside consultation.
Objective.— To describe and compare curbside consultation practices and attitudes among primary care physicians and medical subspecialists.
Design.— Survey mailed in June 1997.
Participants.— Of 286 primary care physicians and 252 subspecialists practicing in Rhode Island, 213 primary care physicians and 200 subspecialists responded (response rate, 76.8%).
Main Outcome Measures.— Self-reported practices of, reasons for, and attitudes about curbside consultation.
Results.— Of primary care physicians, 70.4% (150/213) and 87.5% (175/200) of subspecialists reported participating in at least 1 curbside consultation during the previous week. In the previous week, primary care physicians obtained 3.2 curbside consultations, whereas subspecialists received 3.6 requests for curbside consultations. Subspecialties most frequently involved in curbside consultations were cardiology, gastroenterology, and infectious diseases; subspecialties that were requested to provide curbside consultations more often than they were formally consulted were endocrinology, infectious diseases, and rheumatology. Curbside consultations were most often used to select appropriate diagnostic tests and treatment plans and to determine the need for formal consultation. Subspecialists perceived more often than primary care physicians that information communicated in curbside consultations was insufficient (80.2% vs 49.8%; P<.001) and that important clinical detail was not described (77.6% vs 43.5%; P <.001). More subspecialists than primary care physicians felt that curbside consultations were essential for maintaining good relationships with other physicians (77.2% vs 38.6%; P <.001).
Conclusions.— Curbside consultation serves important functions in the practice of medicine. Despite the widespread use of curbside consultation, disagreement exists between primary care physicians and subspecialists as to the role of curbside consultation and the quality of the information exchanged.
From the Department of Medicine (Drs Kuo, Gifford, and Stein) and the Department of Community Health (Dr Gifford), Brown University, Providence, RI.
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