Conciliating the Consultant

Interphysician conflict in emergency medicine is not just a culture problem; it degrades patient-care conversations and contributes to physician burnout. Admission calls between the ED and consulting services work better when disagreement is redirected toward shared bedside goals rather than personal affronts.

Consultant Conversations in the ED

• Burnout and patient care: Poor ED-consultant interactions are linked to physician burnout on both sides, and once the call turns adversarial the conversation becomes less useful for actual patient care.
• Admission friction points: A request for more testing or an alternate diagnosis is often heard in the ED as a delay tactic or critique of competence, even when the consultant is raising a legitimate concern.
• Conflict avoidance traps: Two common failure modes are doing the extra work without discussion or accepting the admission without speaking up; both shut down the clinical back-and-forth patients need.
• Resetting the tone: A deliberate pause after a heated comment can lower the temperature and reopen a productive exchange, then a calm return to the shared patient question becomes possible. We walk through the phrasing in the episode.
• Bring it back bedside: Asking the consultant to evaluate the patient in the ED reframes the disagreement around direct assessment and next steps instead of a stalled phone argument.
• Relationship before conflict: Knowing consultants by name, face, and perspective makes professionalism easier under stress, and humility about what happens after ED care often improves the consult itself.

References:

1. Amick AE, Schrepel C, Bann M, et al. From Battles to Burnout: Investigating the Role of Interphysician Conflict in Physician Burnout. Acad Med. 2023;98(9):1076-1082. PMID: 37043749