1.  You contact me, preferably by email, briefly explaining why you would like a consult.  Include in your contact the question you would like addressed, your current primary care provider, and what has been done so far to address the issue.  Understand that I do not participate with health insurance.

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2.  I will contact you back, usually by email, to clarify the reason for your consult, and if your reason is appropriate for my services, will then suggest an appointment time, either meeting in-person (in most cases) or via Zoom, FaceTime, or phone call.  If I think I need your medical records to review for our consultation, I will ask for your permission and date of birth to do so.  I will want to know where your records are located.  I will probably ask you to fill out some preliminary paperwork regarding your health history to email back to me before or to bring with you to our consultation meeting.  And I may ask you to write up a brief narrative of what you have been experiencing and how you have sought help along the way.

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3.  We will have our consultation meeting.  I will set aside enough time, usually at least an hour, depending on your issue.  I will gather as much information at that time, both by careful active listening and physical examining.  At the end of the visit, I will work with you to further clarify your initial question, and decide what further information is needed in order to address it appropriately.  I will usually not render any final conclusion at this time, but will share my preliminary thoughts.

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4.  After our meeting, my work continues.  I will consider and re-consider your case.  I will take your concerns and the more specific clinical questions we have come up with and review the relevant research on the question.   I will look at specific articles and studies in the medical literature that address your question.  I will use well-recognized sources including UpToDate and PubMed.  (I may even use developing resources like BARD, and Google's AI resource.)  I will "work" your question until I feel I have some clear, evidence-based answer.  This may take a few days.

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5. I will then get back in touch with you with a my formal consultation recommendations.  This will be usually through email, in order for me to put in understandable writing my thoughts, to be as clear as possible.  Sometimes I will call you, as well, if needed. I will be happy to share my findings with your other providers and will ask you if that is something you would like me to do for you.

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6.  I will then send you my bill for the time I have spent on your case.