Requesting Consultations using Kessler’s 5-Cs



This is the first in a series of talks that I attended at a local faculty development day. The speakers agreed to have me share their wisdom with you – enjoy! The following is an exerpt from my brilliant colleague Dr. Rob Woods’ talk on using the 5 C’s of consultation.

Bad consults are bad for patients.

Consulting colleagues is a critical skill in Emergency Medicine. The success of a good consultation is more than simply getting the consultant to come see the patient. Rather – it’s getting the best out of your consultant so that ultimately the patient benefits. Poor consultations not only make you look like a dork. They will have downstream effects on how  well your consultations are received for the rest of that day and in the future.  Additionally they WILL impact how you and your colleagues are perceived by others [see my blog on Branding Yourself]. Worse – they CAN lead to bad patient care as you may not be taken very seriously.

Things that set you up for a bad consult

  1. You’re not ready to deliver your question – You are trying to get the consultant to see things the way you see them. You need all the details at hand. Anticipate questions/be your own devil’s advocate.
  2. You do not have a clear question. Getting the best out of people means letting them know what you want.
  3. No previous contact with the consultant [either you or consultant may be new]. It’s important to introduce yourself. It’s also important to seek opportunities to network with the colleagues you consult most.
  4. The system is overloaded. The reality today is all other services are also overwhelmed. No-one wants to hear from the ER – even more reason to do things right.
  5. Known-to-be difficult consultant. Nothing you can do about this except owning how you interact with this person.
  6. Lack of skills – Let’s face it. We don’t get a lot of instruction on the so-called  “soft skills” in medicine.

Chad Kessler’s 5-C Model

Dr Kessler has studied and published his model for communicating with consultants [Pubmed Link].

Kesslers 5Cs

Here’s the Coles Notes:


This is the first part where the consulting and consultant physicians are introduced. The goal is to build a relationship. The way to do this is:

  • State your  name
  • State your rank and service
  • Identify your supervising attending
  • Get the name of consultant physician [crucial for relationship AND ALSO for documentation]

Core Question

  • You MUST have a specific question or request of the consultant. State this clearly and early on [especially at night] as it gives the consultant an idea why you’re calling and he can get his thoughts in order [or refer you to the appropriate service without listening to the entire story]
  • Decide on reasonable time frame for consultation.


In this phase, provide  a concise story and ask focused questions.

  • Speak clearly and methodically [slow down at night – remember you just woke the guy up]
  • Give an accurate account of the details


Be open to – and even solicit alterations in management from the consultant.

  • Remember – you aren’t always right some back and forth is normal and appropriate.

Closing the  Loop

Ensure that both parties are on the same page regarding the plan and maintain proper communication about any changes in the patient’s status.

  • Repeat this plan back to the consultant
  • Write it down

Further Reading

A fellow blogger also blogged about this – please take time to round out your learning by reading her post [click here]. You probably should also follow her on Twitter @LWestafer

Here’s @stemlyns Take on Making a Referal [click here]

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