Underlying meanings of the physician curbside consultation

Abstract

This study explored what goes on during the curbside consultation, a type of informal conversation between physicians for the purpose of managing a patient case. The study used a naturalistic inquiry perspective, qualitative research methods, and a case study approach. The investigator observed the work of 16 primary care physicians located in three geographical areas of one Midwestern state. Data was collected from field observations, 60 formal interviews, informal interviews, and conversations with peer review physicians. During data analysis, Giddens's framework for analysis of regularized social conduct and Goffman's ideas about the performative aspects of role served as entry points to identify elements of the practice that were less evident but nonetheless active. Study results indicated differences between what physicians say they want to accomplish in curbside consultations and what they report as a consequence of that activity. They also indicated the purposes for which physicians initiate curbside consultation, the tacit rules that govern those interactions, and the consequences when those rules are not followed. Finally, the results indicated that the curbside consultation constitutes a "presentation of self" during which physicians demonstrate their clinical reasoning abilities and their understanding of the values and norms that distinguish medicine from other professions. Based on these findings, the investigator concluded that the curbside consultation can be an effective means of information transfer among physicians but that professional conversations about what the curbside consultation "is" and how it is "used" in everyday clinical practice could increase its usefulness. Study findings also suggested that rethinking library and information services based on increased understandings of how physicians construct knowledge could lead to benefits for physicians as well as the patients whose needs they serve.