So how long do you think a consult should take?

I look at consults the way a freudian would analyze a dream: there's the latent consult and the manifest consult.

no one ever consults psychiatry for delirium recs, or to diagnose a patient with mental disorder, or to look for other causes of their psychiatric distress. And this is where understanding what the latent content of the consult is comes in as the real reason for the consult

Examples

Manifest consult: "We think this patient has schizophrenia and appreciate your recs"
Latent consult: "We want to turf this patient to your service because we're not doing anything for him and he's being a nuisance"
Phatansy/defense: disavowal
What actually happens: patient has delirium. make recs for behavioral management and prn haldol with advice look for underlying medical cause. ortho discharges patient anyway

Manifest consult: "This patient has borderline personality disorder, we'd appreciate your recs for management of her non-compliance with insulin"
Latent consult: "We're pissed off because she won't do what she's told. Please make her do what she's told!"
Phantasy/defense: wishful thinking, magical thinking
What actually happens: patient feels helpless in hospital, regresses, non-compliance only way of asserting control. but you can't make her do what they want because they won't listen to her. Consulting service angry at you for not being magically able to make her comply

Manifest consult: "This patient said she was suicidal, please come and do a safety assessment"
Latent consult: "please come and take this patient off our service"
Phantasy/defense: passive aggression, disavowal
What actually happens: patient has hypoactive delirium, doesn't know what she's doing. recommend look for underlying cause and behavioral mx.

Manifest consult: "Please come and assess capacity to refuse placement"
Latent consult: Please help us force this patient into placement
Phantasy/defense: disavowal, wishful thinking, intellectualization
What actually happens: patient has capacity to refuse placement. even if she didn't you couldn't force them into a SNF. consulting service displaces hostility onto psychiatric consultant

Manifest consult: "Please come and assess capacity to refuse surgery"
Latent consult: "please consent thing patient for surgery and explain procedure to them because I wasn't able to explain this to them effectively"
Phantasy/defense: intellectualization
What actually happens: they need to actually explain procedure to patient. you can help assess capacity if relevant while consenting patient.

Manifest consult: "patient is violent, please come and assess"
Latent consult: "I'm having murderous thoughts about this patient, and they are becoming increasingly agitated, please admit to your service"
Phantasy/defense: projective identification
What actually happens: patient is frustrated about how they are treated in the hospital and feel better when has chance to vent about it but ultimately leaves AMA

I enjoy seeing consults but let's face it, most of it is pretty basic stuff. I don't think it would make a difference in the majority of cases if you spent 2-3 hours vs. 45 mins if the consult is BS in the first place. At any rate, even if you had wonderful recs they probably wouldn't listen to them anyway because that wasn't what they wanted. I think about 50% consults I could make recs without even seeing the patient and most of the time you can figure it out in 20 mins of so. 10-20% of the time there is something a bit more challenging to tease apart.

I wouldn't write more than a paragraph for the simple ones. no one wants to read more than that and it's not necessary for billing as should be on time and >50% counseling and coordination of care.

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So how long do you think a consult should take?