Kandel Leonid, Barzilay Yair, Friedman Adi, Ilsar Idan, Safran Ori, Mattan Yoav
Department of Orthopaedic Surgery, Hadassah-Hebrew University Medical Center, POB 23816, 91237, Jerusalem, Israel.
Department of Orthopaedic Surgery, Shaarei Zedek Medical Center, Jerusalem, Israel.
Arch Orthop Trauma Surg. 2017 May;137(5):607-610. doi: 10.1007/s00402-017-2667-1. Epub 2017 Mar 12.
Informal (hallway) medical consultation is an integral part of the physician's work. As musculoskeletal complaints are very common, orthopedic surgeons stand in the frontline of this practice. Many of these consultations are poorly, if at all, documented, thus imposing a potential medical danger to the patient and a medicolegal danger to the surgeon. We conducted this first study to examine whether this practice is common among the orthopedic surgeons in university hospital.
In this prospective study, a 2-month record of informal consultations was kept. Six orthopedic surgeons-two joint reconstruction surgeons, one spine surgeon, two arthroscopy and sports medicine surgeons, and a shoulder surgeon participated. They recorded the details of the consulter, whether the consultation was for himself or somebody else, the major complaint, and whether it was a second opinion. All patients were advised to go to the formal orthopedic consultation and no advice or treatment was given. At the end of 2 months, each surgeon was asked to evaluate the percentage of cases he had failed to report.
During the 2-month period, 158 people asked for informal (hallway) consultations. 11 of them (7%) were physicians, 114 (72%) were other hospital personnel, 26 (17%) were unrelated to hospital, and 6 (4%) were treated patients' relatives. 93 (59%) of consultations were about the consulter himself and the rest were about a relative or a friend. 41 (26%) were requests for a second opinion. The estimated percentage of not reported cases was 10-40%; when the number of consultations was corrected for these figures, it reached 208 consultations in 2 months.
In this prospective study, six participating surgeons recorded 158 informal consultation requests in 2 months. If a correction is performed, it averages 0.6 consultations a day for a surgeon (or, if only workdays are counted-0.8 consultations a day). Orthopedic surgeons should be aware of this frequent habit and send these patients to a formal consultation.
非正式（走廊）医疗会诊是医生工作中不可或缺的一部分。由于肌肉骨骼方面的主诉非常常见，骨科医生处于这种会诊的前沿。这些会诊中许多记录很差，甚至根本没有记录，从而给患者带来潜在的医疗风险，给外科医生带来法医学风险。我们开展了这项首次研究，以调查这种做法在大学医院的骨科医生中是否常见。
在这项前瞻性研究中，对为期2个月的非正式会诊进行了记录。六位骨科医生参与其中，两位关节重建外科医生、一位脊柱外科医生、两位关节镜与运动医学外科医生以及一位肩部外科医生。他们记录了会诊者的详细信息、会诊是针对本人还是他人、主要主诉以及是否是寻求第二种意见。所有患者都被建议去进行正式的骨科会诊，未提供任何建议或治疗。在2个月结束时，要求每位外科医生评估他未报告病例的百分比。
在2个月期间，有158人请求进行非正式（走廊）会诊。其中11人（7%）是医生，114人（72%）是其他医院工作人员，26人（17%）与医院无关，6人（4%）是接受治疗患者的亲属。93次（59%）会诊是关于会诊者本人，其余是关于亲属或朋友。41次（26%）是寻求第二种意见的请求。未报告病例的估计百分比为10% - 40%；根据这些数字对会诊次数进行校正后，2个月内达到208次会诊。
在这项前瞻性研究中，六位参与的外科医生在2个月内记录了158次非正式会诊请求。如果进行校正，每位外科医生平均每天有0.6次会诊（或者，如果仅计算工作日，则每天0.8次会诊）。骨科医生应该意识到这种常见的习惯，并将这些患者送去进行正式会诊。
