Rethinking the consultation process: Optimizing collaboration between primary care physicians and specialists

David W. Frost; Diana Toubassi; Allan S. Detsky

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Dr Ralph jones
Ralph William Miller Jones Jones

Published on: 16 August 2012

Published on: (16 August 2012)
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Dr Ralph jones
Ralph William Miller Jones Jones, physician
The 'Dom"
Dr Frost et al.'s thoughtful article got me reminiscing about consultant domiciliary visits in the UK,known to trainee GP's as "doms".
A "dom" occurred when you asked a consultant to visit a patient at home with you as the GP. Trainees such as myself often went. The "doms" were very well paid for the consultant and some arranged glide paths on the way home with the connivance of friendly GP's. Thes...
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The 'Dom"
Dr Frost et al.'s thoughtful article got me reminiscing about consultant domiciliary visits in the UK,known to trainee GP's as "doms".
A "dom" occurred when you asked a consultant to visit a patient at home with you as the GP. Trainees such as myself often went. The "doms" were very well paid for the consultant and some arranged glide paths on the way home with the connivance of friendly GP's. These visits were very beneficial for all concerned and are some of my favourite all time learning experiences even 34 years on.
One example should suffice. A "dom" with a psychiatrist to a meek, middle aged man whose wife was concerned with a change in behaviour. He had no family or previous psychiatric history. Now he was hypomanic, booking holidays and getting into trouble with sexual misadventures such as stealing "knickers " from washing lines.
The psychiatrist took a very detailed history and asked me what I noticed about his appearance. Not much was the answer. His heavily nicoline stained fingers were pointed out to me. The psychiatrist suspected a paraneoplstic psychiatric syndrome from cancer of the lung. Indeed that is what he had and what he died from. We do much less house calls here in Canada , but seeing a patient with a consultant in your office would have similar benefits
Conflict of Interest:
None declared
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Competing Interests: None declared.