Early Career Professionals Corner: To Consult or not to Consult?

Monika Parikh, PhD
Monika Parikh, PhD

Monika Parikh, PhD
Geisinger Health System

A common experience of any newly licensed Early Career Professional (ECP) is a desire to demonstrate one’s potential and to be perceived as a competent and confident provider. I think one of the biggest mistakes we can make in our career is to forget the value of consultation with more seasoned clinicians. As an ECP, one of the greatest challenges I faced was whether to consult with my colleagues about patient concerns, decision-making, and clinic procedures. In particular, when I first started practicing independently, I wanted my colleagues to believe that they made the right choice in hiring me. I also did not want to burden them with my continued questions. Given the nature of our practice, behavioral health providers are central in supporting the emotional wellbeing of patients. Without consultation, especially in complex patient presentations, it is possible that a provider could miss important contributing factors in the clinical presentation. Furthermore, consultation offers a forum in which to process difficult patient experiences via a different perspective. Overall, consultation likely serves as a protective factor for clinicians (i.e., self-care), and assists with ensuring that the highest quality of care is being provided to patients.

Developing a personal and professional model of consultation is integral to one’s professional identity. Through my experiences, I have learned that it is important to work with supervisors to be better prepared for effectively consulting with others. To me, consultation involves discussing key clinical issues, asking for help, and receiving and applying feedback delivered by a colleague. As an ECP who supervises trainees at different developmental stages (externs, pre-doctoral interns, and post-doctoral fellows), I consistently stress the importance of frequent consultation with colleagues to ensure optimal patient care. Fears of being perceived as weak or incompetent often prevent trainees from seeking support. Ironically, active and assertive requests for feedback actually demonstrate increased self-awareness regarding limitations in clinical skill and areas for growth. Asking questions communicates that a clinician recognizes what they do not know.

How does one consult with others? Consultation is an interactive process in which two or more clinicians deliberately discuss a clinical case to provide education or enhance patient care. It may also involve shared decision-making and problem-solving issues related to service delivery. Core elements of effective consultation involve:

  1. Determining the primary concern or question of interest,
  2. Providing a concise overview,
  3. Clearly communicating how the other person can be helpful,
  4. Actively listening to each other,
  5. Sharing each others’ perspectives and contributions to the decision making process,
  6. Following up with involved parties.

Even when consulting with others, we can make some missteps. Common pitfalls or errors made by ECPs when consulting include failure to actively listen to others, behaving as if “they know it all,” providing a limited context to the problem, and difficulty clearly communicating how others can help resolve the issue. Before I consult with anyone, I start by asking myself, “What is the problem that I need assistance with and what do I need in order to resolve the issue?” Overall, when consulting with others, it is helpful to clearly outline how the other person can help, state efforts that have been implemented to rectify or address the situation, and remain open and willing to receive feedback.

Looking back to the start of my journey as an ECP, one area that I wished I was better prepared for was how to request support from others. When transitioning to a lead role within any health system, I would recommend that you speak with your administration and supervisors about receiving targeted training and support to ensure you are successful in your position. As an ECP who serves as a lead clinician in an integrated primary care setting, I feel honored to consult with my colleagues and believe that it highlights our shared goal to best serve our patient population. The most valuable lesson I have learned is that consulting with others and asking for help is a sign of professional strength rather than weakness. I am thankful for this lesson and I would urge other ECPs in any setting to consider developing their own style of consultation as a part of their clinical and professional practice.