Perioperative diabetic consultation: a plead for improved training

To determine the clinical and educational impact of an academic general internal medicine consultation service, the investigators selected as a model the perioperative management of diabetes mellitus. They analyzed 17 consultative episodes over two years by retrospective medical record review to identify patterns and shortcomings. Most patients were elderly black females with maturity-onset diabetes mellitus exhibiting numerous past diabetic complications and other active general medical problems. Major findings included common failure to define the consultation purpose or document adequately follow-up visits, incomplete professional adherence to published guidelines for perioperative diabetic management, and correlation between failure to document the consultant's own physical examination and failure to reach new conclusions. Median cost for consultant-recommended tests was $179 (range $82 to $552) without clear linkage between medical care process and outcome. Consultative skills must be taught more effectively if medical consultations are to have maximal impact.