Agreed on good consultation, with one qualification that I think matters. The reasoning holds for the case as described. Change the starting assumption and it does not, and the starting assumption is the part nobody states.
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Clinical · Prescriber conversations · continued
What a good consultation looks like from the other side posts 31–60
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
e.ferreira, post #11: Reading this good consultation thread as someone who came in with a fixed view: the third and seventh replies moved me and the confident ones did not. Go to post
Written summaries after an appointment are available in many systems and are worth asking for, because recollection of a consultation is unreliable.
The reasoning is more useful than the number, which is why I have shown it.
k.fonseca, post #1: What a good consultation looks like from the other side — that is the question, and I have not found it answered plainly anywhere I have looked. Something about good consultation does not reconcile and I would like a second pair of eyes before I decide which half is wrong. Two sources, both reputable, giving figures that cannot both be… Go to post
Marking my uncertainty on good consultation explicitly. I am confident about the direction, much less confident about the size, and not confident at all that it generalises past the case in the first post.
I read post #31 twice before replying, because I had assumed the opposite.
The reason good consultation keeps being re-asked is that the answer is conditional and people quote it without the condition. It is not that the answer is unknown.
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j.delacroix, post #9: Post #7 is the version of this I will quote in future. One addition. Having read the whole good consultation thread before replying: the question in the first post has not actually been answered yet, and three of us have answered a nearby one instead. Go to post
Good consultation is well covered in the tag pages, and the older discussions are better than the recent ones because they were argued out properly. Worth twenty minutes before adding to this one.
l.osei, post #33: Marking my uncertainty on good consultation explicitly. I am confident about the direction, much less confident about the size, and not confident at all that it generalises past the case in the first post. Go to post
That reframing is the whole thing. The facts I already had.
Post #35 describes the usual case. This is about the unusual one.
The failure mode on good consultation is boring rather than dramatic. It is almost always the step everyone assumes was done correctly because it is too simple to get wrong.
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Adding the measurement that post #39 says would settle it.
Prescription logistics: confirm whether it will be filled locally, requires mail order, or will be prescribed off-label and needs a compounding pharmacy. Different paths have different implications.
The conclusion is tentative; the arithmetic underneath it is not.
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t.ibarra, post #19: Post #18 put the caveat in the right place and I want to underline it. A question phrased as "what would you want to see before considering X" is answerable and is not a request for X. Small point, but it is the one that usually catches people. Go to post
Asking about the plan if the first approach does not work is a good use of an appointment and is rarely done.
r.scholten, post #28: Reframing good consultation slightly, because I think the disagreement is about the question rather than the answer. If the question is "does it happen", yes. If it is "how often", nobody here knows. Go to post
I would call the community position on good consultation likely rather than established, and I would be comfortable defending that hedge.
Collapsed as off-topic by two members at trust level 3 or above
Post #42 describes the usual case. This is about the unusual one.
Good consultation is a question about a distribution, not about a value, and treating it as a value is what produces the confident wrong answers.
Post #42 is the version of this I will quote in future. One addition.
Prescription logistics: confirm whether it will be filled locally, requires mail order, or will be prescribed off-label and needs a compounding pharmacy. Different paths have different implications.
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m.stephanopoulos, post #26: I had written a reply contradicting post #24 and deleted it. Here is what survived. Prescription logistics: confirm whether it will be filled locally, requires mail order, or will be prescribed off-label and needs a compounding pharmacy. Different paths have different implications. I have seen it go both ways, which is why I hedge. Go to post
Genuine question rather than a rhetorical one: has anyone here actually observed good consultation, as opposed to read about it? The thread is long and I cannot tell.
Answering the question post #46 raises rather than the one it answers.
Bringing a record of symptoms with dates and severities makes an assessment materially easier and is the single most useful preparation.
That is what the documentation says. What happens in practice is usually close.
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Post #46 put the caveat in the right place and I want to underline it.
A question phrased as "what would you want to see before considering X" is answerable and is not a request for X.
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Careful with the language on good consultation. "Not detected" and "not present" are different findings and the first is a statement about the method.
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Good consultation: I have looked for the primary source twice and failed twice. Either it does not exist or it is somewhere I do not know to look, and I would like to know which.
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Where I part company with post #49, and it is a narrow parting.
Discussing side effects: be specific. "Nausea" is less useful than "I have nausea worst 24 to 36 hours after injection, severity 2 to 3 out of 4, stable over weeks". That description helps determine whether to adjust dose or dose timing.
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c.dahlberg, post #17: Quietly grateful for the plain phrasing. Not every thread gets that. Go to post
Two questions I would want answered before drawing anything from the good consultation data above: how were the cases selected, and what happened to the ones that dropped out.
Collapsed as off-topic by two members at trust level 3 or above
I would keep good consultation and the decision it usually gets used for separate in this thread. They are related and they are not the same question, and merging them is why the last one went badly.
Bringing a record of symptoms with dates and severities makes an assessment materially easier and is the single most useful preparation.
One of those cases where knowing the mechanism does not help the decision.
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I had written a reply contradicting post #53 and deleted it. Here is what survived.
Small methodological point on good consultation: repeating a measurement is cheap and resolves most of what is being argued about here at no cost to anyone.
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KAndersson, post #12: The number people quote for good consultation is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly uninformative on its own. Go to post
I will take the caveat as seriously as the claim, which is the point of putting it there.
mi.amankwah, post #57: I had written a reply contradicting post #53 and deleted it. Here is what survived. Small methodological point on good consultation: repeating a measurement is cheap and resolves most of what is being argued about here at no cost to anyone. Go to post
Where I would push back on the good consultation consensus is the confidence, not the direction. The direction looks right. The confidence is borrowed.