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Nila S. Radhakrishnan, MD
Assistant Professor, Medical Director, Consult/Co-Management Service
Division of Hospital Medicine
PO Box 100238
Gainesville, FL 32610
Office: (352) 594-3589
Fax: (352) 265-0379
Welcome to the Medicine consult service. On this service, you will work with a senior resident and, at times, a medical student to provide inpatient consultation and comanagement to services other than internal medicine. As part of this service, you also will head the procedure team.
1) Consults vs Co-management- we have specific co-management agreements with Orthopedics and Urology (see Memorandum of Understanding). For co-management, you do write orders, etc with the exceptions highlighted in the documents. Essentially, you are primary for the medical aspects of the patients.
2) Consults- for other services, you place a consult and then page the service with recs. You can ask them if they want you to write the orders. For any consult or comanagement, we represent the entire Department of Medicine. Our motto is always “How can we help?” and we strive to maintain the utmost collegiality and professionalism.
3) Transfers to medicine: If there are active medical issues or surgical issues are over, we will transfer the patients to MHS. The process is to let the team know that the patient has been accepted for transfer the NEXT morning at 7am. Please make sure to indicate in your note that MHS will only assume responsibility at 7am. IF you think the patient needs to come to medicine right away, you can transfer patient to the MHS attending on consults immediately. All transfers to MHS are subject to total MHS census and at discretion of the consult attending.
4) Procedure Service: We perform the following procedures for MHS and the General Medicine teaching services: 1) Paracentesis 2) Central Line 3) Lumbar Puncture. Kits are found on 74 or 75 (ask the charge nurse). We do not place vas caths. All thoracenteses are to have a pulmonary consult who will either do the procedure or refer the team to IR.
5) Residents: Residents get one day off in 7 days (typically a weekend day). They sign out at 5pm on weekdays and if it is slow, we let them signout at 2 or 3 pm on weekends. They can see 5 (Five) NEW patients a day (consults or comanagement) and write a maximum of 12 notes a day (includes new pts and follow ups). Please give them the interesting cases to follow and divide up the work as much as possible.
6) Resources: https://www.shmlearningportal.org/Education.aspx
In general, seeing more than five new patients in a day (consult or co-management) is uncommon. Second, the maximum number of notes you should writing in one day is 12 (includes news and follow ups). The hospitalists on 74/75 and general medicine (non sub-specialty) teams may call the consult service for a para, central line or LP. The attendings on service are all recently re-certified for all of these procedures so should be able to fully assist if you are not certified. If your consult team is receiving a heavy consult load it is completely reasonable to pass on a procedure. The consult resident typically signs out around 5 pm on weekdays and 2-3 pm on weekends (you are expected to see consults/procedures until 5 and may have to return from clinic to do so). Emergent consults needing to be seen after you sign out should be seen by the bridge (north tower) or AOD resident (south tower).
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