Top 5 tips for becoming an effective gastroenterology consultant

Below are five essential tips to guide your development as a high-impact GI consultant with a reputation for excellence. 

1. Be kind

Survey studies of medical/surgical residents and attending hospitalists have demonstrated that willingness to accept consultation requests was the single factor consistently rated as most important in determining the quality of the consultation interaction.^3,4 Unfortunately, nearly 65% of respondents reported encountering pushback when requesting subspecialty consultation. It is critical to recognize that when you receive a GI consult request, the requester has already decided that it is needed. Whether that request comports with our individual notion of “necessary” or “important,” this is a colleague’s request for help. There are myriad reasons why a request may be made, but they are unified in this principle.

Effective teamwork in healthcare settings enhances clinical performance and patient safety. Positive relationships with colleagues and healthcare team members also mitigate the emotional basis for physician burnout.⁵ Be kind and courteous to those who seek your assistance. Move beyond the notion of the “bad” or “soft” consult and seek instead to understand how you can help.

A requesting physician may phrase the consult question vaguely or may know that the patient is having a GI-related issue, but simply lack the specific knowledge to know what is needed. In these instances, it is our role to listen and help guide them to the correct thought process to ensure the best care of the patient. These important interactions establish our reputation, create our referral bases, and directly affect our sense of personal satisfaction.

2. Be timely

GI presents an appealing breadth of pathology, but this also corresponds to a wide variety of indications for consultation and, therefore, urgency of need. In a busy clinical practice, not all requests can be urgently prioritized. However, it is the consultant’s responsibility to identify patients that require urgent evaluation and intervention to avert a potential adverse outcome.

We are well-trained in the medical triage of consultations. There are explicit guidelines for assessing urgency for GI bleeding, foreign body ingestion, choledocholithiasis, and many other indications. However, there are often special contextual circumstances that will elevate the urgency of a seemingly non-urgent consult request. Does the patient have an upcoming surgery or treatment that will depend on your input? Are they facing an imminent loss of insurance coverage? Is their non-severe GI disease leading to more severe impact on non-GI organ systems? The referring provider knows the patient better than you – seek to understand the context of the consult request.

 

 

Timeliness also applies to our communication. Communicate recommendations directly to the consulting service as soon as the patient is seen. When a colleague reaches out with a concern about a patient, make sure to take that request seriously. If you are unable to address the concern immediately, at least provide acknowledgment and an estimated timeline for response. As the maxim states, the effectiveness of a consultant is just as dependent on availability as it is on ability.

3. Be specific

The same survey studies indicate that the second most critical aspect of successful subspecialty consultation is delivering clear recommendations. Accordingly, I always urge my trainees to challenge me when we leave a consult interaction if they feel that our plan is vague or imprecise.

Specificity in consult recommendations is an essential way to demonstrate your expertise and provide value. Clear and definitive recommendations enhance others’ perception of your skill, reduce the need for additional clarifying communication, and lead to more efficient, higher quality care. Avoid vague language, such as asking the requester to “consider” a test or intervention. When recommending medication, specify the dose, frequency, duration, and expected timeline of effect. Rather than recommending “cross-sectional imaging,” specify what modality and protocol. Instead of recommending “adequate resuscitation,” specify your target endpoints. If you engage in multidisciplinary discussion, ensure you strive for a specific group consensus plan and communicate this to all members of the team.

Specificity also applies to the quality of your documentation. Ensure that your clinical notes outline your rationale for your recommended plan, specific contingencies based on results of recommended testing, and a plan for follow-up care. When referring for open-access endoscopy, specifically outline what to look for and which specimens or endoscopic interventions are needed. Be precise in your procedure documentation – avoid vague terms such as small/medium/large and instead quantify in terms of millimeter/centimeter measurement. If you do not adopt specific classification schemes (e.g. Prague classification, Paris classification, Eosinophilic Esophagitis Endoscopic Reference Score, etc.), ensure you provide enough descriptive language to convey an adequate understanding of the findings.

4. Be helpful

A consultant’s primary directive is to be of service to the consulting provider and the patient. As an educational leader, I am often asked what attributes separate a high-performing trainee from an average one. My feeling is that the most critical attribute is a sense of ownership over patient care.

As a consultant, when others feel we are exhibiting engagement and ownership in a patient’s care, they perceive that we are working together as an effective healthcare team. Interestingly, survey studies of inpatient care show that primary services do not necessarily value assistance with orders or care coordination – they consider these as core aspects of their daily work. What they did value was ongoing daily progress notes/communication, regardless of patient acuity or consulting specialty. This is a potent signal that our continued engagement (both inpatient and outpatient) is perceived as helpful.

Helpfulness is further aided by ensuring mutual understanding. While survey data indicate that sharing specific literature citations may not always be perceived positively, explaining the consultant’s rationale for their recommendations is highly valued. Take the time to tactfully explain your assessment of the patient and why you arrived at your specific recommendations. If your recommendations differ from what the requester expected (e.g. a procedure was expected but is not offered), ensure you explain why and answer questions they may have. This fosters mutual respect and proactively averts conflict or discontent from misunderstanding.

Multidisciplinary collaboration is another important avenue for aiding our patients and colleagues. Studies across a wide range of disease processes (including GI bleeding, IBD, etc.) and medical settings have demonstrated that multidisciplinary collaboration unequivocally improves patient outcomes.⁶ The success of these collaborations relies on our willingness to fully engage in these conversations, despite the fact that they may often be logistically challenging. 

We all know how difficult it can be to locate and organize multiple medical specialists with complex varying clinical schedules and busy personal lives. Choosing to do so demonstrates a dedication to providing the highest level of care and elevates both patient and physician satisfaction. Having chosen to cultivate several ongoing multidisciplinary conferences/collaborations, I can attest to the notion that the outcome is well worth the effort.

5. Be honest

While we always strive to provide the answers for our patients and colleagues, we must also acknowledge our limitations. Be honest with yourself when you encounter a scenario that pushes beyond the boundaries of your knowledge and comfort. Be willing to admit when you yourself need to consult others or seek an outside referral to provide the care a patient needs. Aspiring physicians often espouse that a devotion to lifelong learning is a key driver of their desire to pursue a career in medicine. These scenarios provide a key opportunity to expand our knowledge while doing what is right for our patients.

Be equally honest about your comfort with “curbside” consultations. Studies show that subspecialists receive on average of 3-4 such requests per week.⁷ The perception of these interactions is starkly discrepant between the requester and recipient. While over 80% of surveyed primary nonsurgical services felt that curbside consultations were helpful in patient care, a similar proportion of subspecialists expressed concern that insufficient clinical information was provided, even leading to a fear of litigation. While straightforward, informal conversations on narrow, well-defined questions can be helpful and efficient, the consultant should always feel comfortable seeking an opportunity for formal consultation when the details are unclear or the case/question is complex.

Closing thoughts

Being an effective GI consultant isn’t just about what you know—it’s about how you apply it, how you communicate it, and how you make others feel in the process.

The attributes outlined above are not ancillary traits—they are essential components of high-quality consultation. When consistently applied, they enhance collaboration, improve patient outcomes, and reinforce trust within the healthcare system. By committing to them, you establish your reputation of excellence and play a role in elevating the field of gastroenterology more broadly.

Dr. Kahn is based in the Division of Gastroenterology and Hepatology at Mayo Clinic, Scottsdale, Arizona. He reports no conflicts of interest in regard to this article.

References

1. Goldman L, et al. Ten commandments for effective consultations. Arch Intern Med. 1983 Sep.

2. Salerno SM, et al. Principles of effective consultation: an update for the 21st-century consultant. Arch Intern Med. 2007 Feb. doi: 10.1001/archinte.167.3.271.

3. Adams TN, et al. Hospitalist Perspective of Interactions with Medicine Subspecialty Consult Services. J Hosp Med. 2018 May. doi: 10.12788/jhm.2882.

4. Matsuo T, et al. Essential consultants’ skills and attitudes (Willing CONSULT): a cross-sectional survey. BMC Med Educ. 2021 Jul. doi: 10.1186/s12909-021-02810-9.

5. Welp A, Manser T. Integrating teamwork, clinician occupational well-being and patient safety - development of a conceptual framework based on a systematic review. BMC Health Serv Res. 2016 Jul. doi: 10.1186/s12913-016-1535-y.

6. Webster CS, et al. Interprofessional Learning in Multidisciplinary Healthcare Teams Is Associated With Reduced Patient Mortality: A Quantitative Systematic Review and Meta-analysis. J Patient Saf. 2024 Jan. doi: 10.1097/PTS.0000000000001170.

7. Lin M, et al. Curbside Consultations: The Good, the Bad, and the Ugly. Clin Gastroenterol Hepatol. 2016 Jan. doi: 10.1016/j.cgh.2015.09.026.