Context.— Informal (curbside) consultations are an integral part of medical culture
and may be of great value to patients and primary care physicians. However,
little is known about physicians' behavior or attitudes toward curbside consultation.
Objective.— To describe and compare curbside consultation practices and attitudes
among primary care physicians and medical subspecialists.
Design.— Survey mailed in June 1997.
Participants.— Of 286 primary care physicians and 252 subspecialists practicing in
Rhode Island, 213 primary care physicians and 200 subspecialists responded
(response rate, 76.8%).
Main Outcome Measures.— Self-reported practices of, reasons for, and attitudes about curbside
Results.— Of primary care physicians, 70.4% (150/213) and 87.5% (175/200) of subspecialists
reported participating in at least 1 curbside consultation during the previous
week. In the previous week, primary care physicians obtained 3.2 curbside
consultations, whereas subspecialists received 3.6 requests for curbside consultations.
Subspecialties most frequently involved in curbside consultations were cardiology,
gastroenterology, and infectious diseases; subspecialties that were requested
to provide curbside consultations more often than they were formally consulted
were endocrinology, infectious diseases, and rheumatology. Curbside consultations
were most often used to select appropriate diagnostic tests and treatment
plans and to determine the need for formal consultation. Subspecialists perceived
more often than primary care physicians that information communicated in curbside
consultations was insufficient (80.2% vs 49.8%; P<.001)
and that important clinical detail was not described (77.6% vs 43.5%; P <.001). More subspecialists 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 important functions in the practice of
medicine. 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.