Difference between revisions of "Consultation"

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<noinclude>{{Top
 
|author1=[[User:Mikael Häggström|Mikael Häggström]]
 
|author1=[[User:Mikael Häggström|Mikael Häggström]]
 
|author2=
 
|author2=
 
}}
 
}}
Save phone numbers to pertinent seniors so that you can contact them in urgent situations.
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<noinclude/>Save '''phone numbers''' to pertinent seniors so that you can contact them in urgent situations.
 
{{Comprehensiveness}}
 
{{Comprehensiveness}}
 
==When to ask==
 
==When to ask==
For grossing, general factors for asking for assistance include:
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For '''[[grossing]]''', general factors for asking for assistance include:
 
*'''Unfamiliarity''' with the specimen type at hand.
 
*'''Unfamiliarity''' with the specimen type at hand.
 
*'''Malignancy''' risk of the case.
 
*'''Malignancy''' risk of the case.
 
*'''Inability to retake''' sections in case the first ones are insufficient:
 
*'''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.
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:*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 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>
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*'''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>
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 +
For microscopic '''[[evaluation]]''', as a pathology trainee, preferably 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. After becoming a pathologist, the following are general factors for consulting others:
 +
*'''Unfamiliarity''' with the specimen type at hand.
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*'''Borderline''' findings whenever there may be a significant difference in treatment, prognosis or other management.
 +
*'''Discordant''' findings that do not sufficiently fit your diagnosis.
 +
 
 
==What do ask for==
 
==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. 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.  
 
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.  
  
What you generally want to know are:
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If taking a slide '''tray''' with you:
*If taking a slide tray with you, don't forget the slide on your microscope.
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*Don't forget any slide still '''on your microscope'''.
*{{Comprehensive-begin}}Note if the office '''door open''', and how much, and generally leave it the same way on the way out.{{Comprehensive-end}}
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*Keep the slides in '''order''' (including recuts and stains).
*The pathology '''issues''' at hand.
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*If you are given information for writing a pathology report, what will you do '''after''' writing it in the system? Save, sign or notify them otherwise?
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{{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==
 
==Getting in touch with clinicians==
Ask the referring doctor for clarification whenever needed for your diagnosis. In more emergent situations:
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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.
 
#Look at the '''referral''' for any number to call.
 
#If intraoperative, call the '''operating room number'''.
 
#If intraoperative, call the '''operating room number'''.
 
#Call the '''hospital switch''' to connect you with the referring doctor.
 
#Call the '''hospital switch''' to connect you with the referring doctor.
 
In less emergent situations, you may also try the following:
 
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 if not using an appropriately encrypted connection).
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*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, even if with a '''nurse or other caregiver''', and ask that person for the phone number to the referring doctor, or other person in charge of the patient.
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*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.
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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>
 
<noinclude>
 
{{General notes}}
 
{{General notes}}
 
{{Bottom}}
 
{{Bottom}}
 
</noinclude>
 
</noinclude>

Revision as of 09:21, 22 December 2022

Author: Mikael Häggström [note 1]
Save phone numbers to pertinent seniors so that you can contact them in urgent situations.

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

When to ask

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. Further information: 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.[note 2]

For microscopic evaluation, as a pathology trainee, preferably 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. After becoming a pathologist, the following are general factors for consulting others:

  • Unfamiliarity with the specimen type at hand.
  • Borderline findings whenever there may be a significant difference in treatment, prognosis or other management.
  • Discordant findings that do not sufficiently fit your diagnosis.

What do ask for

When consulting a senior, generally read up on the medical history and(/or) 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 taking a slide tray with you:

  • Don't forget any slide still on your microscope.
  • Keep the slides in order (including recuts and stains).

((Remember if the office door is open, and how much, and generally leave it the same way on the way out.))

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:

  1. Look at the referral for any number to call.
  2. If intraoperative, call the operating room number.
  3. 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).

General notes edit

Further reading:

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. 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).

Main page

References


Image sources