Core Competencies

3.12 Medical Consultation and Comanagement

© 2017 Society of Hospital Medicine

As consultants, hospitalists provide expert medical opinion regarding the care of patients scheduled for surgery or who may be admitted to other medical and surgical services. Additionally, hospitalists may also be asked to participate in active comanagement of such patients, especially those with multiple or serious medical comorbidities. Comanagement of surgical patients between surgeons and hospitalists reduces hospital costs and improves healthcare professionals’ perceptions of care quality.1 Effective and frequent communication between the hospitalist and the requesting clinical service ensures safe and quality care.

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Hospitalists should be able to:

  • Define the role of a consultant.

  • Describe the principles of effective consultation.

  • Describe factors influencing compliance with consultant recommendations.

  • Recognize the importance of arranging appropriate follow-up.


Hospitalists should be able to:

  • Determine their scope as a consultant or a partner participating in comanagement.

  • Assess the urgency of the consultation and the nature of the question posed by the requesting physician.

  • Obtain an independent relevant history, perform a physical examination, and review the medical record to inform clinical impression.

  • Provide concise and specific evidence-based recommendations for risk assessment and management.

  • Use a patient-centered approach when making recommendations.

  • Communicate recommendations in an expedient and efficient manner.

  • Transmit written communication legibly and include contact information.

  • Communicate effectively with patients and families to convey recommendations and treatment plans.

  • Provide timely and appropriate follow-up, including review of pertinent findings and laboratory data, and ensure that critical recommendations have been followed.

  • Anticipate potential complications and provide recommendations to prevent complications.

  • Lead, coordinate, and/or participate in multidisciplinary initiatives to promote patient safety, improve care quality, and optimize resource use for all medical and surgical patients.


Hospitalists should be able to:

  • Respond promptly to the requesting physician’s need for consultation.

  • Lead by example by performing consultations in a collegial, professional, and nonconfrontational manner.

  • Acknowledge when the role as a consultant in the patient’s care is complete, document final recommendations, and maintain availability.


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