🤔 What to do when someone asks you for a curbside consult? 😪

As doctors we often get cornered by people we know, in various social settings, asking for our “quick advice” on this rash, or that pain, or in recent times, the abnormal lab report that has been bothering them. 🥴

Without digging deeper, it’s not possible to determine whether they have already discussed this issue with another doctor (and only seeking a “harmless” quick second opinion from someone they trust). Or this is the first time they’ve ever disclosed this to any doctor! 👩🏻‍⚕️

We don’t want to answer these queries with limited information, as that would be a big disservice to the patient. Most conditions need a painstaking gathering of history, a scrupulous examination, and often some quick referencing of guidelines or other resources. Quick answers are usually wrong in medicine! 🙊

What about doing a full consultation? A family gathering or a footpath may not be the right place to ask many questions that are pertinent to ask in most patients, for example, menstrual history in women or urine problems in elderly. Examination is almost impossible. 🚽

But then the patient may not understand that a good diagnosis (which is what they expect from us as their trusted doctor) needs this whole process. And they might feel that we’re behaving rudely or selfishly, if we ask them to come to the clinic whenever they ask us for advice. 🏥

The strategy that works for me is triage: quickly figure out in a few questions whether the query can be answered there and then, or whether the patient needs a full consultation. 🔀

If I decide to dispense a quick solution, which is relatively uncommon, I often like to add a “safety-netting” statement: “If this doesn’t help, please call me or come see me in the clinic.” 🥅

Most patients need to be referred to the clinic for a detailed assessment, and therefore, need tactful handling. It helps to put the blame on the disease, and to offer a home remedy to tide over the period till they reach the clinic. Many of my curbside consults end with something like: “Back pain can have a lot of different causes. It would be better to discuss in detail in the clinic. In the meantime, please try hot fomentation with a hot water bag.” 🗣️

Such “free” advice, plus the few questions asked during the triage would hopefully show the patient that we care for their health and wellbeing! 🤗

What is your favourite strategy to deal with curbside consults? What quick questions help you triage the situation better? 💁🏽‍♂️

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