AHA/ACC Joint Guidelines

UW Medicine

UWMC Anticoagulation Clinic

Harborview Medicine Consult Service


The Medicine Consult Handbook

Medicine Consultation remains an evolving field.  At UWMC, we care for patients of varying degrees of medical complexity and therefore different levels of risk.  We believe that teamwork between internists, surgeons, anesthesiologists, and nursing staff improves patient care.  This handbook was created to provide useful information, advice, and guidelines, based on a combination of clinical experience and evidence-based medicine.  It is designed with a medical resident in mind, but others may also find it useful.  We welcome your comments.

As with any handbook, this is simply a guide, and is no substitute for clinical judgment of the individual patient.



Reilly DF, McNeely MJ, Doerner D, Greenberg DL, Staiger TO, Geist MJ, Vedovatti PA, Coffey JE, Mora MW, Johnson TR, Guray ED, Van Norman GA, Fihn SD.  Self-Reported Exercise Tolerance and the Risk of Serious Perioperative Complications.  Archives of Internal Medicine 159:2185-2192, 1999.

Legner VJ, Doerner D, McCormick WC, Reilly DR.  Clinician Agreement With Perioperative Cardiovascular Evaluation Guidelines and Clinical Outcomes.  American Journal of Cardiology 2006; 97:118-122.

Farwell DG, Reilly DF, Weymuller EA, Greenberg DL, Staiger TO, Futran NA. Predictors Of Perioperative Complications In Head And Neck Patients.  Archives of Otolaryngology- Head and Neck Surgery. 2002; 128:505-511.

Legner VJ, Doerner D, Reilly DF, McCormick WCL:  Risk Factors for Nursing Home Placement Following Major Non-Emergent Surgery.  American Journal of Medicine 2004; 117(2):82-6.



Medicine consultation at the University of Washington began in the General Medicine Clinic in the late 1980s.  At that time, general medicine attendings took turns taking call for medicine consultation, in addition to their primary care practices.

In 1991 Ray Ramasack, MD began seeing consult patients as part of a half-time Medicine Consult service, seeing inpatients as well as evaluating surgical patients in the surgical clinics.

Dominic Reilly, MD took over managing the Medicine Consult Service in 1992, and was able to provide full time care of Medicine Consult patients beginning in 1993.  Attendings and R4s filled out the service. 

In 1995 the Medicine Consult Service began its own clinic with one exam room shared with Dermatology.  Over the next years the service has expanded in number of staff, patients seen, and clinic size.  Diane Doerner assumed leadership of the service from 1997 until 2005.

In November of 2003 the Medicine Consult Clinic moved into the Surgical Pavilion.  Nason Hamlin has been director of the service since 2005.

Other "alums" of the Medicine Consult Service include Kristie Blade (now a primary care physician at Virginia Mason), Gail Welch (now at the Mayo Clinic), Mark Mora, Tim Johnson, Michael Geist, Katherine Kovacs, Oliver Tai, James Colquhoun, David Kauff, Sue Kelkar, Christopher Wong, Margaret Yu (now a nephrology fellow), Diane Levitan, Phil Vedovatti, and many others.