At many teaching hospitals, the task of providing consultations on nonmedical patients has been assumed by academic divisions of general or primary care medicine. Incorporated as a faculty-attended rotation for medical residents, the consultation service seeks to prepare house officers to perform what is—for many practicing internists—a key professional role.
While much of the literature on medical consultation has addressed what might be called the "logistics" of the process—how to organize a consultant's note, what kind of advice tends to be followed by the requesting service and what ignored, how to communicate with the physicians who have asked for your aid, etc—physicians have paid inadequate attention, in my opinion, to the political and professional uncertainties of the role of generalist-as-consultant. For example, in the historical gap between the demise of the academic generalist as "senior diagnostician" and the rise of modern divisions of primary care/ general medicine, many surgeons, gynecologists,