Cohen M C
Department of Medicine, Maine Medical Center, Portland, USA.
Prog Cardiovasc Dis. 1998 Mar-Apr;40(5):419-40. doi: 10.1016/s0033-0620(98)80015-7.
Consultation represents the act of providing advice regarding diagnosis and/or management and may comprise a major component of a cardiologist's practice. A frequent cause for cardiac consultation is preoperative risk assessment. With steadily decreasing morbidity and mortality related to noncardiac surgery, cardiovascular management strategies that are known to improve long-term outcomes should guide decision making in the perioperative setting. The preoperative cardiac consultation may represent an opportunity to initiate or modify cardiac care including primary and secondary preventive measures. A stepwise approach to perioperative cardiac risk assessment, as set forth by joint American College of Cardiology and American Heart Association guidelines, should be employed. The hallmark of successful preoperative cardiology consultation is effective communication with referring physicians. A consultant's good clinical judgement will only impact a patient's care if recommendations are communicated effectively. There is no substitution for direct, verbal contact. Recommendations should be kept to less than five when possible, be brief and specific. The consultant should provide contingency plans and follow-up. Good consultative technique increases compliance with recommendations and facilitates efficient patient care.
会诊是指就诊断和/或治疗提供建议的行为，可能是心脏病专家临床工作的一个主要组成部分。心脏会诊的一个常见原因是术前风险评估。随着与非心脏手术相关的发病率和死亡率稳步下降，已知能改善长期预后的心血管管理策略应指导围手术期的决策制定。术前心脏会诊可能是启动或调整心脏护理（包括一级和二级预防措施）的一个契机。应采用美国心脏病学会和美国心脏协会联合指南提出的围手术期心脏风险评估的逐步方法。术前心脏病会诊成功的标志是与转诊医生进行有效的沟通。只有当建议得到有效传达时，顾问医生良好的临床判断才会对患者的治疗产生影响。直接的口头接触无可替代。建议应尽可能少于五条，要简洁明了且具体。顾问医生应提供应急计划和随访安排。良好的会诊技巧可提高对建议的依从性，并促进高效的患者护理。
