Objective: Consultation is a common and important aspect of emergency department (ED) care. We prospectively examined the consultation rates, the admission rates of consulted patients, the emergency physician (EP) disposition prediction of consulted patients and the difficult consultations rates in 2 tertiary care hospitals. Methods: Attending EPs recorded consultations during 5 randomly selected shifts over an 8-week period using standardized forms. Subsequent computer outcome data were extracted for each patient encounter, as well as demographic data from the ED during days in which there was a study shift. Results: During 105 clinical shifts, 1930 patients were managed by 21 EPs (median 17 patients per shift; interquartile range 14-23). Overall, at least 1 consultation was requested in 38% of patients. More than one-half of the patients (54.3%) who received a consultation were admitted to the hospital. Consultation proportions were similar between males and females (51% v. 49%, p = 0.03). Consultations occurred more frequently for patients who were older, had higher acuity presentations, arrived during daytime hours or arrived by ambulance. The proportion of agreement between the EP's and consultant's opinion on the need for admission was 89% (κ = 0.77, 95% confidence interval 0.72-0.83). Overall, 92% of patents received 1 consultation. Six percent of the consultations were perceived as "difficult" by the EPs (defined as the EP's subjective impression of difficulties with consultation times, accessibility and availability of consultants, and the interaction with consultants or disposition issues). Conclusion: Consultation is a common process in the ED. It often results in admission and is predictable based on simple patient factors. Because of perceived difficulty with consultations, strategies to improve the EP consultation process in the ED seem warranted. RÉSUMÉObjectif : La consultation est un aspect courant et important des soins prodigués à l'urgence. Nous avons étudié prospectivement, dans deux centres de soins tertiaires, les taux de consultation, les taux d'admission des patients vus en consultation, les prédictions du médecin d'urgence quant à l'issue des patients vus en consultation ainsi que les taux de difficulté des consultations. Méthodes : Les médecins d'urgence traitants ont consigné, sur des formulaires normalisés, les consultations réalisées pendant cinq quarts de travail choisis au hasard sur une période de huit semaines. Subséquemment, des données informatiques des résultats ont été extraites pour chaque ORIGINAL RESEARCH • RECHERCHE ORIGINALE EM ADVANCES

The expectations which both consumers and service providers bring to health care relationships are based on ethnicity and culture, as well as on individual and family characteristics, education and social circumstances. This article looks at the relationship between ethnicity and prevalence of illness; the interplay between ethnicity and social disadvantage; some cultural meanings attributed to illness; and how meanings may affect treatment. Four accounts are given of how two chronic illnesses - asthma and diabetes - may be viewed within the Timorese, Chinese, Turkish and Vietnamese communities.