“As you are aware,…” A consult note warning

“As you are aware, …”

IMG_0441: as you are awareCreative Commons License Ray Dehler via Compfight

How often do you read this in consult notes?


“As you are aware, the … gland increases in fibrosity, and …”


“As you are aware, the natural sequence of development includes…”


“As you are aware, the previous, inappropriate, reticence of physicians to prescribe…”


I’ve got a new New Year’s resolution. There’s lots of good ones. Exercise daily. Think before speaking, or typing. Eat less twinkies. But here’s a new one. One to consider for all of us GP’s. I’m going to look up these statements.


Have you ever done that? It might be an illuminating experience for you.


Perhaps unnerving. Because the term, “as you are aware…” is no guarantee that the statement or statements following is gospel. I used to assume it, and used consult letters as a learning source. I think we still can, with appropriate precautions.


It all started with a consult letter advising treatment completely at odds with what I thought I knew. Not just one item. A whole consult note full of theory that seemed extra-terrestrial, or if that’s too much hyperbole, at least completely outside the parameters of current medical practice.


It was from a consultant that my patient had asked to see. Perhaps that was the first warning sign. This consultant wasn’t even on my radar before. Usually, I ask patients if there is a consultant that they would prefer. I’ve found some great consultants that way. And this one.


I was so utterly gobsmacked, that I turned to my colleagues working 5 or 6 feet away, dredging through their own pile of consult notes. Some of them were younger, with their recent CCFP study notes. Eyebrows went up.


So, these statements, this first, illuminating occurrence, I didn’t look up. I wrote him a letter, professing my surprise and astonishment at the possibility of a new treatment avenue. What were his references? Please, could he respond, as I so enthusiastically waxed, so I could look all this up and shore up my shaky knowledge base.


I got a quick scrawled note back, as he was going off on vacation. The paper, his, “best one,” was from a journal I’d never heard of. My younger colleague, wrinkled her nose up at the journal, and, more internet savvy than I, immediately thought of Twitter. He had quite a following. And a big book signing at the mall.


“As you are aware,…” has taken on a whole new meaning for me. It’s tempting to just run your eyes over the sentence, perhaps even ignoring it. After all, you should be aware, right?


You owe this to your patients. If you don’t know the information following, “As you are aware…” look it up.


Then take action. I’ll leave that up to you.


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