To the Editor.
—As a consultation psychiatrist in a health maintenance organization, I was pleased to see "Ten Commandments for Effective Consultations,"1 which was published in the September 1983 Archives. As with the original commandments or the Bill of Rights, one cannot help wishing to elaborate or expand the list further.Most research into consultation practice occurs in university centers where transient house staff have the primary responsibility for patient care, somewhat different from sites where physicians tend to stay and develop personal and professional rapport of longer standing. Goldman et al1 stated that face-to-face contact is particularly valuable when recommendations are crucial or controversial, but I would suggest that such an approach is vital whenever physicians are attempting to establish an ongoing alliance. When the consultee and. consultant are known to each other, telephone contact can suffice and perhaps save time.Consultants in general need reminding, I think,