Divergent perceptions of the emergency consultation process between emergency physicians and consultants: a cross-sectional survey with latent class and dyadic risk analysis

OBJECTIVES: The emergency consultation process is a high-stakes interface between emergency and specialist physicians, yet systematic differences in how each party perceives this process remain poorly characterized. This study aimed to quantify the perception gap between emergency physicians (EPs) and consultants (CNs) across multiple consultation domains and to identify distinct perception profiles and dyadic conflict risk patterns. METHODS: A cross-sectional survey was administered to 186 physicians (81 EPs, 105 CNs) in Türkiye between January 2024 and January 2026, using parallel EP- and CN-specific questionnaires. Group comparisons were performed using the Mann-Whitney U test with rank-biserial effect sizes. Perception gap analysis, latent class analysis (LCA), and Monte Carlo dyadic conflict risk simulation (n = 10,000 dyads per combination) were conducted. RESULTS: Statistically significant between-group differences were identified in six of eight domains. The largest perception gaps were observed for frequency of unnecessary consultation requests (r = 0.723), clarity of expectations stated in requests (r = 0.658), and timeliness of responses (r = 0.624). LCA identified two latent classes: "Dissatisfied Requesters" (88.1% EPs) and "Overwhelmed Responders" (94.0% CNs; χ² = 110.49, p < 0.001). Dyadic simulation revealed the highest conflict risk in conflictual × conflictual pairings (mean risk score 3.46; 24.8% high-risk dyads), with no asymmetry between mixed-profile combinations (Δ = 0.02). CONCLUSIONS: Emergency physicians and consultants exhibit systematically divergent perceptions of the consultation process, converging only in their shared perception of workflow burden. The absence of asymmetric conflict risk in mixed profiles in this exploratory simulation may be consistent with interprofessional conflict being a bidirectional phenomenon, suggesting that system-level rather than individual-level approaches may warrant consideration. Structured consultation training and shared expectation frameworks are proposed as directions for future investigation. CLINICAL TRIAL NUMBER: Not applicable.