Consultation: Difference between revisions

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~~{{General notes}}~~

<noinclude>{{Top

{{Top

|author1=[[User:Mikael Häggström|Mikael Häggström]]

|author2=

}}

<noinclude/>Save '''phone numbers''' to pertinent seniors so that you can contact them in urgent situations.

==When to ask==

For grossing, general factors for asking for assistance include:

For '''[[grossing]]''', general factors for asking for assistance include:

*'''Unfamiliarity''' with the specimen type at hand.

*'''Malignancy''' risk of the case.

*'''Inability to retake''' sections in case the first ones are insufficient:

:*A risk of '''irreversibility''' of any processing, such as inability to perform special tests by putting it in formalin.

:*A risk of '''irreversibility''' of any processing, such as inability to perform special tests by putting it in formalin. {{further|Fixation}}

:*'''Low redundancy''' of tissue at hand, such as very small pieces of relevant tissue.

*'''Low accessibility''' in obtaining the specimen at hand, such as through deep surgery or imaging-based biopsy.<ref group=~~notes~~>Low '''accessibility''' is associated with both a higher risk of '''malignancy''' (enough to motivate extensive methods for obtaining the specimen) and '''irreversibility''' (as it would be difficult to retake a specimen in case the first one does not result in an adequate diagnosis).</ref>

*'''Low accessibility''' in obtaining the specimen at hand, such as through deep surgery or imaging-based biopsy.<ref group=note>Low '''accessibility''' is associated with both a higher risk of '''malignancy''' (enough to motivate extensive methods for obtaining the specimen) and '''irreversibility''' (as it would be difficult to retake a specimen in case the first one does not result in an adequate diagnosis).</ref>

For microscopic '''[[evaluation]]''', as a pathology trainee that always has somebody else signing out your cases, preferably still write reports for cases you are involved in as if you were to sign it out, and follow up on how it was actually signed out, and note any differences. After becoming a pathologist, the following are general factors for consulting others:

*'''Unfamiliarity''' with the specimen type at hand.

*'''Discordant''' findings that do not sufficiently fit your diagnosis.

*'''Borderline''' findings whenever there may be a significant difference in treatment, prognosis or other management. Conversely, when you are uncertain whether you need to consult someone else, look up the clinical consequences for the patient for your main differentials. Substantial differences in the consequences increases the indication for consulting others.

==What do ask for==

When consulting a senior, generally read up on the medical history and{{Moderate-begin}}/or{{Moderate-end}} operative report of the patient. ~~What~~ you ~~generally want to know are:~~

When consulting a senior, generally read up on the medical '''history''' and{{Moderate-begin}}/or{{Moderate-end}} operative report of the patient. Also, try to '''diagnose''' each case as much as possible before asking, so that you will practice your skills and further improve them based on how they differ from what a senior would do.

*If ~~bringing~~ a slide tray~~, don~~'t forget ~~the~~ slide on your microscope.

*{{Comprehensive-begin}}Is the office '''door ~~open~~''', and ~~if so,~~ how much~~? Generally~~ leave it the same way on the way out.{{Comprehensive-end}}

If taking a slide '''tray''' with you:

*~~The pathology~~ '''~~issues~~''' ~~at hand~~.

*Don't forget any slide still '''on your microscope'''.

*~~If information~~ is ~~given for writing a pathology report~~, ~~what will~~ you do '''~~after~~''' ~~writing them? Save~~, ~~sign~~ or ~~notify them otherwise?~~

*Keep the slides in '''order''' (including recuts and stains).

{{Comprehensive-begin}}Remember if the office '''door''' is open, and how much, and generally leave it the same way on the way out.{{Comprehensive-end}}

==Getting in touch with clinicians==

Ask the referring doctor for clarification or more information whenever needed for your diagnosis, or for delivery of diagnoses that likely require quick management. In more emergent situations:

#Look at the '''referral''' for any number to call.

#If intraoperative, call the '''operating room number'''.

#Call the '''hospital switch''' to connect you with the referring doctor.

In less emergent situations, you may also try the following:

*Consider '''texting''' the person rather than call (and use case/patient number rather than identifiable information, unless you are using an appropriately encrypted system).

*For inpatients, find out from for example medical records where the patient is located, call the hospital switch to connect you with that location, also including any '''nurse or other caregiver'''. They may be able to answer any questions. Otherwise, ask that person for the phone number to the referring doctor, or other person in charge of the patient. Ask to repeat their names when needed, and ask if you can get direct phone numbers of any potentially useful people that you encounter in the process.

The optimal time to get in touch with hospitalists is generally around '''2pm to 3pm''' (when they are usually done with the more emergent tasks of the day but haven't yet left the hospital).

</noinclude>

@@ Line 1: / Line 1: @@
-{{General notes}}
+<noinclude>{{Top
-{{Top
 |author1=[[User:Mikael Häggström|Mikael Häggström]]
 |author2=
 }}
+<noinclude/>Save '''phone numbers''' to pertinent seniors so that you can contact them in urgent situations.
 {{Comprehensiveness}}
 ==When to ask==
-For grossing, general factors for asking for assistance include:
+For '''[[grossing]]''', general factors for asking for assistance include:
 *'''Unfamiliarity''' with the specimen type at hand.
 *'''Malignancy''' risk of the case.
 *'''Inability to retake''' sections in case the first ones are insufficient:
-:*A risk of '''irreversibility''' of any processing, such as inability to perform special tests by putting it in formalin.
+:*A risk of '''irreversibility''' of any processing, such as inability to perform special tests by putting it in formalin. {{further|Fixation}}
 :*'''Low redundancy''' of tissue at hand, such as very small pieces of relevant tissue.
-*'''Low accessibility''' in obtaining the specimen at hand, such as through deep surgery or imaging-based biopsy.<ref group=notes>Low '''accessibility''' is associated with both a higher risk of '''malignancy''' (enough to motivate extensive methods for obtaining the specimen) and '''irreversibility''' (as it would be difficult to retake a specimen in case the first one does not result in an adequate diagnosis).</ref>
+*'''Low accessibility''' in obtaining the specimen at hand, such as through deep surgery or imaging-based biopsy.<ref group=note>Low '''accessibility''' is associated with both a higher risk of '''malignancy''' (enough to motivate extensive methods for obtaining the specimen) and '''irreversibility''' (as it would be difficult to retake a specimen in case the first one does not result in an adequate diagnosis).</ref>
+For microscopic '''[[evaluation]]''', as a pathology trainee that always has somebody else signing out your cases, preferably still write reports for cases you are involved in as if you were to sign it out, and follow up on how it was actually signed out, and note any differences. After becoming a pathologist, the following are general factors for consulting others:
+*'''Unfamiliarity''' with the specimen type at hand.
+*'''Discordant''' findings that do not sufficiently fit your diagnosis.
+*'''Borderline''' findings whenever there may be a significant difference in treatment, prognosis or other management. Conversely, when you are uncertain whether you need to consult someone else, look up the clinical consequences for the patient for your main differentials. Substantial differences in the consequences increases the indication for consulting others.
 ==What do ask for==
-When consulting a senior, generally read up on the medical history and{{Moderate-begin}}/or{{Moderate-end}} operative report of the patient. What you generally want to know are:
+When consulting a senior, generally read up on the medical '''history''' and{{Moderate-begin}}/or{{Moderate-end}} operative report of the patient. Also, try to '''diagnose''' each case as much as possible before asking, so that you will practice your skills and further improve them based on how they differ from what a senior would do.
-*If bringing a slide tray, don't forget the slide on your microscope.
-*{{Comprehensive-begin}}Is the office '''door open''', and if so, how much? Generally leave it the same way on the way out.{{Comprehensive-end}}
+If taking a slide '''tray''' with you:
-*The pathology '''issues''' at hand.
+*Don't forget any slide still '''on your microscope'''.
-*If information is given for writing a pathology report, what will you do '''after''' writing them? Save, sign or notify them otherwise?
+*Keep the slides in '''order''' (including recuts and stains).
+{{Comprehensive-begin}}Remember if the office '''door''' is open, and how much, and generally leave it the same way on the way out.{{Comprehensive-end}}
+==Getting in touch with clinicians==
+Ask the referring doctor for clarification or more information whenever needed for your diagnosis, or for delivery of diagnoses that likely require quick management. In more emergent situations:
+#Look at the '''referral''' for any number to call.
+#If intraoperative, call the '''operating room number'''.
+#Call the '''hospital switch''' to connect you with the referring doctor.
+In less emergent situations, you may also try the following:
+*Consider '''texting''' the person rather than call (and use case/patient number rather than identifiable information, unless you are using an appropriately encrypted system).
+*For inpatients, find out from for example medical records where the patient is located, call the hospital switch to connect you with that location, also including any '''nurse or other caregiver'''. They may be able to answer any questions. Otherwise, ask that person for the phone number to the referring doctor, or other person in charge of the patient. Ask to repeat their names when needed, and ask if you can get direct phone numbers of any potentially useful people that you encounter in the process.
+The optimal time to get in touch with hospitalists is generally around '''2pm to 3pm''' (when they are usually done with the more emergent tasks of the day but haven't yet left the hospital).
+<noinclude>
+{{General notes}}
 {{Bottom}}
+</noinclude>

Consultation: Difference between revisions

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