For a general medicine consultation service to be effective, compliance with recommendations is essential, as is an understanding of the factors that improve compliance. Residents in a general medicine consultation service attempted prospectively to improve their skills as consultants and to enhance compliance by implementing the following steps, reported to influence compliance: (1) identify critical recommendations; (2) make early, direct oral contact with the referring surgeon; (3) limit the number of recommendations; and (4) render definite recommendations. At the end of the study period, recommendations were tabulated and categorized as to whether each was diagnostic or therapeutic and critical or noncritical, and the time of contact with the referring surgeons was noted when applicable. Multivariate analysis of the factors, in relation to the type of recommendation, demonstrated that compliance can be improved, especially if a consultant clearly identifies the critical recommendations and makes contact with the referring physician within 24 hours.
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