"Curbside" consultations in gynecologic oncology: a closer look at a common practice

The aim of this article is to evaluate the nature and frequency of informal "curbside" consultations in a gynecologic oncology practice.

A log of all curbside consultations requested from a gynecologic oncologist in a tertiary multispecialty group practice was kept for 2 years (July 1996 to June 1998). New referrals or calls concerning mutual patients were excluded.

Three hundred thirty-three requests for advice were received from 87 different physicians. Most (81%) of the calls were from 51 obstetrician/gynecologists (Ob/Gyns); 13% of the calls were from family practitioners or general internists. The four most common topics discussed were lower genital tract dysplasia (18%), endometrial hyperplasia (17%), adnexal masses (11%), and endometrial cancer (10%). Overall, 29% of questions pertained to the management of an invasive gynecologic malignancy. Twenty-four percent of the questions were answered in less than 5 min, 43% in 5-10 min, 29% in 11-20 min, and 4% in over 20 min. The issues discussed were considered simple in 26%, of moderate complexity in 49%, very complex in 22%, and ultracomplex in 3%. One hundred nine questions (33%) were of sufficient complexity to warrant referral to a specialist, which occurred in 52 cases (48%); physicians employed by a staff-model health maintenance organization were less likely to request a formal consultation (14%, chi(2) = 0.001).

Curbside consultations are a frequent occurrence in the practice of a gynecologic oncologist, with most questions posed by general Ob/Gyns. Approximately one-third of the questions were of minimal complexity and involved topics covered in standard textbooks or residency training programs. In contrast, approximately one-third were of sufficient complexity that a casual discussion between colleagues may not yield optimal medical care.