CURBSIDE CONSULTATION PRACTICES AND ATTITUDES AMONG PRIMARY-CARE PHYSICIANS AND MEDICAL SUBSPECIALISTS

Context.-Informal (curbside) consultations are an integral part of med ical culture and may be of great value to patients and primary care ph ysicians. However, little is known about physicians' behavior or attit udes toward curbside consultation. Objective.-To describe and compare curbside consultation practices and attitudes among primary care physi cians and medical subspecialists. Design.-Survey mailed in June 1997. Participants.-Of 286 primary care physicians and 252 subspecialists pr acticing in Rhode Island, 213 primary care physicians and 200 subspeci alists responded (response rate, 76.8%). Outcome Measures.-Self-report ed practices of, reasons for, and attitudes about curbside consultatio n. Results.-Of primary care physicians, 70.4% (150/213) and 87.5%(175/ 200) of subspecialists reported participating in at least I curbside c onsultation during the previous week. In the previous week, primary ca re physicians obtained 3.2 curbside consultations, whereas subspeciali sts received 3.6 requests for curbside consultations. Subspecialties m ost frequently involved in curbside consultations were cardiology, gas troenterology, and infectious diseases; subspecialties that were reque sted to provide curbside consultations more often than they were forma lly consulted were endocrinology, infectious diseases, and rheumatolog y. Curbside consultations were most often used to select appropriate d iagnostic tests and treatment plans and to determine the need for form al consultation. Subspecialists perceived more often than primary care physicians that information communicated in curbside consultations wa s insufficient (80.2% vs 49.8%; P < .001) and that important clinical detail was not described (77.6% vs 43.5%; P < .001). More subspecialis ts than primary care physicians felt that curbside consultations were essential for maintaining good relationships with other physicians (77 .2% vs 38.6%, P < .001). Conclusions.-Curbside consultation serves imp ortant functions in the practice of medici ne. Despite the widespread use of curbside consultation, disagreement exists between primary care physicians and subspecialists as to the role of curbside consultation and the quality of the information exchanged.