When I use a word: Consultation
Authors: Jeff Aronson
Journal: BMJ (2006)

In his account of the Persian wars, Herodotus tells how the Lydian king Croesus consulted the Delphic oracle, asking whether he should go to war with Persia. If Croesus attacks the Persians, said the oracle, he will destroy a mighty empire. Croesus confidently marched on Cappadocia, but it was his own mighty empire that he destroyed by doing so, not that of the enemy king, Cyrus. Other oracular pronouncements were equally ambiguous. According to Ennius, “Aio te Romanos vincere posse” (quoted by Shakespeare in Henry VI, Part 2) was the answer that Pyrrhus, king of Epirus, received when he asked about making war with Rome: “I assert that you can conquer the Romans/the Romans can conquer you.” The lesson is clear: listen carefully to those whom you consult—they may not be saying what you would like them to say. It is a lesson that seems to have been forgotten.

The word consult comes from the Latin verbs consulere (supine consultum) and consultare, both of which mean to apply to someone for advice or information. Consultare also means to consult an oracle. The Oxford English Dictionary gives several definitions for “consult,” including “to have especial respect or beneficial reference to (a person's good, interest, convenience, etc.) in forming plans;... To ask advice of, seek counsel from; to have recourse to for instruction, guidance, or professional advice... to seek permission or approval from (a person) for a proposed action.”

My concern that modern methods of consultation do not conform to this description received another dig in the ribs recently when an organisation enthusiastic to introduce author pays, “open access” publishing, and institutional repositories (with apparently little regard for the various deleterious effects that these policies may have (BMJ 2005;330: 759. [PubMed]) including damage to learned societies that publish their own journals) proclaimed that it would “discuss with the learned societies ways in which they can adapt to and exploit new models of publication.” To me this is rather like a doctor telling her patient that she will see him through his terminal illness, helping him to adapt to the inevitable. The patient may have consulted the doctor, but the doctor has not consulted the patient.

One way of getting the answer you want is to ask the right question. My local council (a word, incidentally, that comes from concilium; not to be confused with counsel), keen to introduce charges for allowing me to park outside my own house, recently sent me a consultation questionnaire. Did I agree that there should be a consistent policy about such charges throughout the city? My gut reaction was “yes,” because surely consistency is desirable. Well actually it isn't always. What is good and necessary in some parts of town may be harmful in others. So, should the same policy be applied throughout? I answered “no,” but it won't do any good—I suspect that they have already decided what they're going to do.

All too often today consultation seems to mean, as Paul Glasziou suggested to me when we discussed it, “This is what we intend to do; tell us how much you agree.” I therefore propose a novel Likert scale for responding to modern consultations: Agree/Agree strongly/Agree very strongly/Agree enthusiastically/Couldn't agree more.

I also note that another meaning of the Latin word consulere, listed in the Oxford Latin Dictionary, is “[with male, duriter, and similar] to plan harm (to), act mischievously, prejudicially, etc (towards)... [and with contra] to take steps against.”