When consultants write orders: physicians' attitudes, beliefs, and practices

The process by which a consultation is performed may significantly impact the extent to which the content of the consultation contributes positively to patient care. The practice of consultants writing orders independent of the explicit permission of the consultation requester is a common event. A survey of 211 multispecialty physicians on the medical staff of a large, urban, Northeastern, teaching hospital about their attitudes, beliefs, and practices regarding consultation on the inpatient service reveal that the majority of respondents in all specialties were unaware of departmental or hospital policy regarding the practice of consultant order writing. Significant differences between specialties existed in the perception of the impact of consultant order writing on patient outcomes, in the practice of discussion with the primary attending prior to order writing, and in the documentation practices. The authors discuss such results and their policy implications in light of important medico-legal and ethical principles, and best practice standards.