Intern Survival Guide Topic

Call a consult well.

The two minutes of prep that make the call short, the 5 Cs of Consultation, SBAR for the phone call, one specific question instead of "can you come see this?", curbside vs formal, and the pitfalls that earn a reputation.

Reviewed June 2026 · verify against current guidelines

Before You Dial

Do Not Call Cold

Earn the consultant's time

The fastest way to lose a consultant is to call before you know your own patient. Two minutes of prep makes the call short and makes you look ready.

Have these in front of you

Know the patient	One-liner, the active problem, the timeline. See and examine the patient first.
Pull the data	Latest vitals, pertinent labs, imaging, and the relevant meds, open on screen.
Write the question	One sentence. If you cannot finish it, you are not ready to call.
Check urgency	Decide if this is emergent, urgent, or routine. It sets your tone and theirs.

If you cannot say what you want from them in one sentence, do not pick up the phone yet.

Meds medications relevant to the consult question

The Framework

The 5 Cs of a Consult

A validated structure for handing off a question between physicians. Run them in order, every time.

Contact → Communicate → Core question → Collaborate → Close

Contact	Reach the right person. Give your name, role, team, callback number, and the patient up front.
Communicate	A focused story, not the whole chart. Lead with the one-liner and why you are calling.
Core question	State the single specific question. Make it impossible to miss.
Collaborate	Discuss together. Agree on the plan, timing, and who does what.
Close the loop	Read back the plan. Confirm urgency and how you will reach each other.

Most bad consults fail at Core question or Close the loop. Nail those two.

5 Cs Contact, Communicate, Core question, Collaborate, Close the loop

The Core Question

Ask One Real Question

Specific beats vague every time

“Can you see this patient?” wastes everyone's time. Tell them what you actually want.

Weak vs strong asks

Weak	“Renal, can you come see this AKI?”
Strong	“58F, day 2 of a cardiorenal AKI, creatinine up from 1.1 to 2.4 despite diuresis. Asking whether she needs renal replacement now or if we can keep diuresing.”

A strong ask names

Who the patient is, in one line.
The specific decision you are stuck on.
What you have already tried or considered.

A consultant answers a question. A good intern hands them a sharp one.

AKI acute kidney injury

On the Phone

Structure It With SBAR

Say it in this order

Situation	Who you are, who the patient is, and the one-line reason you are calling.
Background	The pertinent history, timeline, and relevant data. Brief.
Assessment	What you think is going on and how sick the patient is.
Recommendation	Your core question, or what you are asking them to do.

SBAR keeps you from rambling. The recommendation is where your question lives — do not bury it.

SBAR situation, background, assessment, recommendation

Which Kind

Curbside or Formal?

Pick the right channel

Curbside	A quick, general question with no chart review and no documented recommendation.
Formal consult	The consultant sees the patient, reviews the chart, and writes a note.

Go formal when

The answer will change management or needs to be in the chart.
It is patient-specific, not a textbook question.
There is real risk, complexity, or medicolegal weight.
You would be asking them to act on data they cannot see.

Curbside answers are general and uncharted. Do not act on one as if a specialist examined your patient.

Don't Get Burned

Etiquette and Pitfalls

What gets you a reputation

Calling before you have seen or examined the patient yourself.
No clear question — the “consult dump.”
Consulting for something you could look up in two minutes.
Paging then vanishing. Give a callback number and stay reachable.
Hiding the urgency, or crying emergent for a routine question.
Never closing the loop, then acting on a plan you half-heard.

Document the consult: who you spoke to, the question, and the plan. Then read it back before you hang up.

Sources

Verify against current guidelines and local protocol before acting.

Kessler CS et al. A prospective, randomized, controlled study demonstrating a novel, effective model of transfer of care between physicians: the 5Cs of consultation. Acad Emerg Med 2012;19(8):968.
Kessler C et al. The 5Cs of consultation: training medical students to communicate effectively in the emergency department. J Emerg Med 2015;49(5):713.
Goldman L, Lee T, Rudd P. Ten commandments for effective consultations. Arch Intern Med 1983;143(9):1753.
Salerno SM et al. Principles of effective consultation: an update for the 21st-century consultant. Arch Intern Med 2007;167(3):271.
Institute for Healthcare Improvement. SBAR Tool: Situation-Background-Assessment-Recommendation.
Conventions vary by program and service. Match your team and your consultants.

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