Our first consultation to another specialty for a baby today. The history and culture of consultation in medicine is interesting. In ancient civilizations, physicians served as generalists. We do know from ancient Egyptian papyri, however, that specialty physicians existed even in ancient times (particularly for royalty or academic centers).

As hospitals expanded in the 18th and 19th centuries, the role of consulting physicians began to formalize in urban areas. These were relatively elite academic physicians whose role was non-interventional and advisory only.

In the 20th century specialization became the norm. Advances in medical science (pathology, radiology, microbiology, etc.) and technologies demanded more focused care. In this vein, consultants became more procedural and domain-specific. In the U.S., the development of board certification and academic department cemented specialization as formal and necessary. Today, consulting services are integral to daily hospital care and cultural paradigm shifts have moved towards approachability, clear communication, and co-management of shared patients. In EM they would call this “loading the boat”.

“A problem shared is a problem halved.”

Dorothy Sayers in Five Red Herrings