Requesting Consultations using Kessler’s 5-Cs

In Medical Concepts, Tiny Tips by Nadim Lalani1 Comment



Bad consults are bad for patients.

Consulting colleagues is a critical skill in Emergency Medicine. The success of a good consultation is more than simply getting the consultant to come see the patient. Rather, it’s about getting the best out of your consultant so that ultimately the patient benefits. Poor consultations not only make you look like a dork, they will also have downstream effects on how well your consultations are received for the rest of that day and in the future.  Additionally, they WILL impact how you and your colleagues are perceived by others [see my blog on Branding Yourself]. Even worse, they CAN lead to bad patient care as you may not be taken very seriously.

Things that set you up for a bad consult

  1. You’re not ready to deliver your question. – You are trying to get the consultant to see things the way you see them. You need all the details at hand. Anticipate questions/be your own devil’s advocate.
  2. You do not have a clear question. Getting the best out of people means letting them know what you want.
  3. You’ve never contacted the consultant before.  Maybe you or the consultant are new, or maybe you just haven’t crossed paths yet. Either way, it’s important to introduce yourself. It’s also important to seek opportunities to network with the colleagues you consult most.
  4. The system is overloaded. The reality today is that all hospital services are also overwhelmed. No one wants to hear from the ER – even more reason to do things right.
  5. The consultant is known-to-be difficult. There’s nothing you can do about this except owning how you interact with this person.
  6. Lack of skills – Let’s face it. We don’t get a lot of instruction on the so-called  “soft skills” in medicine.

Chad Kessler’s 5-C Model

Dr Kessler has studied and published his model for communicating with consultants.

Kesslers 5Cs




This is the first part where the consulting and consultant physicians are introduced. The goal is to build a relationship. The way to do this is:

  • State your  name
  • State your rank and service
  • Identify your supervising attending
  • Get the name of consultant physician  – crucial for building a relationship AND ALSO for documentation



In this phase, provide a concise story and ask focused questions.

  • Speak clearly and methodically
    • Slow down at night! – remember you just woke the guy up
  • Give an accurate account of the details

Core Question

  • You MUST have a specific question or request of the consultant. State this clearly and early on – especially at night- as it gives the consultant an idea why you’re calling and he or she can get his/her thoughts in order, or refer you to the appropriate service without listening to the entire story.
  • Decide on a reasonable time frame for consultation.  If you have a differing concepts of the urgency of the consultation, its best to get an idea in advance, of when they will show up.


Be open to – and even solicit – alterations in management from the consultant.

  • Remember – you are calling them not just to see the patient, but also for their specialist opinion. It is normal and appropriate to have a back and forth discussion about your management plan.

Closing the  Loop

Ensure that both parties are on the same page regarding the plan and maintain proper communication about any changes in the patient’s status.

  • Repeat this plan back to the consultant
  • Write it down

This is the first in a series of talks that I attended at a local faculty development day. The speakers agreed to have me share their wisdom with you – enjoy! The following is an exerpt from my brilliant colleague Dr. Rob Woods’ talk on using the 5 C’s of consultation.



Further Reading

A fellow blogger also blogged about this – please take time to round out your learning by reading her post [click here]. You probably should also follow her on Twitter @LWestafer

Here’s @stemlyns Take on Making a Referal [click here]

Nadim is an emergency physician at the South Health Campus in Calgary, Alberta. He is passionate about online learning and recently made a transition into human performance coaching. He is currently working on introducing the coaching model into medical education.