Dealing with Difficult Healthcare Consultants: Strategies for Navigating Tough Conversations

Every hospital has one. Maybe it’s the cardiologist who's never “impressed” by the EKG. The urologist who insists  that every stone should go home with a follow-up. Or that one hospitalist who never quite  understands why social admissions exist. 

Even if you are new to emergency medicine, chances are you’ve already encountered a difficult healthcare consultant—the one whose name draws a collective groan from everyone in the dictation room. The one who pushes back, no matter how clear the admission seems. They may pick apart your case, question your workup, or challenge your exam. They might try to offload the patient onto another service or demand unnecessary tests and reassessments.

Sound familiar? You’re not alone.

A Widespread Challenge in Healthcare

As EM clinicians, we’re at the crossroads of decision-making, constantly assessing whether patients are safe to go home or require admission. When we’ve done our job well, it can be frustrating—demoralizing, even—to have our judgment scrutinized or dismissed.

And yet, we often accept this dynamic as “just part of the job.” We tolerate the dismissiveness. We plead our case. We move on. Over time, this behavior becomes ingrained in the culture of medicine, a learned expectation rather than an exception.

But should it be?

Incivility and Burnout: A Modifiable Risk Factor 

We already navigate an exhausting landscape—overflowing inboxes, understaffed shifts, administrative demands, and experience abuse at the hands of the very patients and families we are trying to serve. So why do we convince ourselves that it’s acceptable to endure toxic behavior from those who are supposed to be our peers?

If you’ve ever dreaded a phone call to a particular consultant, know that you’re not alone. And more importantly—there are strategies to handle these situations effectively. In ERcast’s March 2025 episode, "Navigating the Difficult Consultant Without Becoming a Drama Llama," physician coach and wellness expert Dr. Rob Orman sits down with Dr. Kim Bambach to talk about how to navigate a difficult healthcare consultant, how to set yourself up for success, and why incivility should never be tolerated. 

How to Handle a Difficult Healthcare Consultant: 3 Strategies That Work

1. Lead with the need

Before making the call, be clear on why this patient needs a consult. Emphasize the specific interventions or resources that necessitate in-patient care. Instead of a long, winding presentation that leaves room for debate, state your case concisely and confidently.

If you anticipate pushback, identify potential weak points ahead of time so you’re not scrambling for justification mid-conversation. And whatever you do—don’t apologize for calling. This creates a subordinate power dynamic and implies that their input is optional.

2. Don’t dance—detach

When a healthcare consultant starts pushing back, take a breath. Do not match their energy. Stay calm, professional and objective. Instead of engaging in a back-and-forth, redirect the conversation to solutions.

Try this:

“What needs to happen for you to come see this patient?” 

“What is getting in the way of the patient being admitted?” 

This forces the consultant to define their objection instead of defaulting to resistance. Paraphrase their response back to them to ensure alignment and move toward resolution.

3. First, do no harm. Second, call HR

If a healthcare consultant’s refusal could lead to patient harm or rapid clinical decompensation, escalate immediately.

1. 1. 1. 1. Ask to call them back on a recorded line. This gives both parties time to reflect and ensures accountability.
      2. Reassess their concerns. Are they valid? Could you be missing something?

• If they remain unreasonable, escalate. Call the medical director or administrator on duty. If necessary, document the encounter and report it to HR using your facility’s reporting method, including any witnesses who were involved in the case.

Demand Meaningful Change

Difficult healthcare consultant dynamics shouldn’t be just another “frustrating part” of the job. In a system that already challenges clinician wellness, toxic behaviors don’t belong.

Speaking up is hard. It requires vulnerability. But that doesn’t mean it isn’t necessary.

At the end of the day, you deserve respect. You deserve support. And you should expect both. 

 “Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.” - Atul Gawande