Ideal world. Functioning health system and doctors...
Consult orders will come in as consult, consult + management, Management
A patient is a ward. A classic term, meaning they are under the care and 'owned' by one physician. That physician is the captain of the ship and at times may hand off to another. Such as nocturnist service for IM or whatever ICU they might be on, next doc on shift assume their care as the attending of record.
The attending of record, when consulting with other specialists has the option to accept or reject their recommendations. They are responsible to implement their orders. A grey zone exists, where Consult + Management happens, and orders may be entered in (and welcomed) by the attending of record.
Pure consultative service, IMO, has potential to be the best. The Attending of record knows exactly what is going on with their ward, and guides everything. BUT as we've seen some primary services... don't read the notes or implement or pay attention to things... and one of my reasons why I too loathe C/L is they are requested but nothing more than a chart ornament, a sticker to pretty up the chart - but most often ignored. As the consultant this is the better/easier way, because you don't have to put orders, you don't have to risk the liability of following up on those results - or the consequences - of those meds/labs/imaging etc. You simply guide, and walk away, or continue to guide. But if ignored, lower investment, not as concerning - not your patient, not your ward. You also can see more patients, which means you as a resource can stretch further.
Some hospitals, and perhaps the real world, Hospitalist or whatever primary service ... is ... [adjectives here] and the consultants fall into this grey zone trap of placing orders and some how patients find their way eventually being discharged... Best soup to eat from when you are a lawyer.
I once worked an inpatient psych unit where this was in full force... IM during the night would field the psych admissions from ED and admit to psych. They were the attending of record. They were placing orders and responsible for the patient. But they would place an order for Management by psych, and once we rolled in the morning, did consult, we would formally flip over the patient to being psych managed. Great for not having burdensome call at night - because IM hospitalists did the basic work in wee hours. They would some times even keep/manage basic detox patients on the psych unit too, and we would follow as consultants. Psych manages detox the best, but it wasn't an issue big enough to fight about. But the point is, units can have different Attendings - based upon hospital privileges. At times the IM hospitalist service for some patients on IM general floor, would transfer care to psych, sign off, and now psych had a patient simmer on a different unit that we were attending of record for.