Infectious Diseases Consultative Recommendations: If Heard, They Can Be Listened To

When the members of the Clinical Affairs Committee (CAC) of the Infectious Diseases Society of America (IDSA) first met to discuss writing an article about the value of an infectious diseases (ID) specialist [1], even with the disparate types of practices represented and their diverse geographic distribution, we brought nearly identical reports about how our referring physicians truly valued our services. Their statements ranged from how ID specialists were the best clinicians, to how they were the most skilled diagnosticians, to how they were the best qualified to analyze and clarify the most complicated clinical cases, and to how they were then able to organize these data into a cogent, logical consultation note with directed and thorough recommendations. However, we rapidly recognized that there was a paucity of published studies to substantiate these claims and even found literature questioning the cost effectiveness of subspecialty care [2, 3]. We did find studies that supported the favorable impact of ID consultative care for patients with Staphylococcus aureus bacteremia [4], patients with HIV infection [5], bone salvage in patients with osteomyelitis at a public hospital [6], and appropriate management of antimicrobial therapy in bacteremic patients [7–9]. The caveat in many of these studies was that the benefit of ID consultations was only realized if the recommendations were followed. For example, in the study by Fowler et al. [4], only 46% of the pieces of “management advice” were followed—even when there was discussion of the recommendations with the treating physician—for patients with S. aureus bacteremia. None of the studies carefully assessed what factors favored adherence to the recommendations.