If you want a useful consult, explicitly state why you want the consult.

In the first place, you’ll make your consultant happy for two reasons.  One, a reason for consult is required by insurance companies for billing a consult.  Two, it makes figuring out what role you want me to play easier and the visit better.

The second reason is you’ll make yourself happier.  There are many reasons to request a consult.  If I know you, your skill set, your work ethic etc. then I may be able to figure out what you want with relative ease.  Trouble arises when I have no idea who the person making the consult is.  My default setting for all consults is to first diagnose.  If the diagnosis is something that I manage or treat then I will continue to do so and if not refer them back for management and treatment with some suggestions for doing so. 

The trouble arises when I get a consult for something that I consider obvious as to the diagnosis and treatment, so I am stuck trying to figure out why the person is sitting in front of me. 

Are they a hypochondriac or paranoid and demanded a “specialist” for their osteoarthritis?  Tell me that so I don’t insult you by explaining the use of ibuprofen to you and can tell the patient how smart you are and how much I respect your clinical judgement.  Are you pretty sure of the diagnosis but there is just one caveat (morning stiffness for 2 hours) or other differential (secondary causes) you would like me to explain or exclude for you?  Tell me, so I don’t just send a patient back to you with no new information that you didn’t already know.  Are you a total dumb-fuck?  Tell me so I can write out detailed instructions so that you can provide your patient adequate care while you go back to medical school.  Are you too lazy to work the patient up?  Tell me so I can do a complete work up and bill like a lawyer for it.

I will always do the best I can to provide excellent medical care but consults are often about something more and the better I know what you want, the better quality “something more” I can give you.