The Art Of Telephone Consultations

Dr. Ramesh Mehay

Why are telephones so important?

The Telephone Explosion Era GP Co-ops are using it more As is NHS Direct

Is It a Good Tool? It is argued that a high proportion of

out of hours calls can be dealt with over the phone.

Will patients Be Happy? Studies show : 30% who got telephone advice had

originally wanted a home visit Only 25% were unhappy with the

telephone advice. BUT over all 49% of callers would

have preferred a home visit.

Concerns & AnxietiesConcerns Is the Data gathered adequate? Are we prone to Premature Conclusions? Is the Communications Clear? Telephone consultation technique

Anxieties Providing telephone consultations, particularly to

patients we do not know. How good are our telephone skills How do you manage patient expectations for a

home visit?

The Root of the Problem

Telephone consultation skills training is often overlooked in

Undergraduate Schools Vocational Training Schemes Post-VTS training PGEA

The First Telephone Consultation

This wonderful letter to the lancet appears to be the first record in the medical literature of telephone consultations

PRACTICE BY TELEPHONE

The Yankees are rapidly finding out the benefits of the telephone. A newly made grandmamma, we are told, was recently awakened by the bell at midnight, and told by her inexperienced daughter, "Baby has the croup. What shall I do with it?" Grandmamma replied she would call the family doctor, and would be there in a minute. Grandmamma woke the doctor, and told him the terrible news. He in turn asked to be put in telephonic communication with the anxious mamma. "Lift the child to the telephone, and let me hear it cough," he commands. The child is lifted, and it coughs. "That's not the croup," he declares, and declines to leave his house on such small matters. He advises grandmamma also to stay in bed: and, all anxiety quieted, the trio settle down happy for the night.

The Lancet Nov. 29, 1879. Page 819

Telephone vs Face-Face Consultations Lack of non-verbal clues

No direct observations

No direct examination

No diagnostic tests

No smells

Active listening

Third party consultations

Telephone vs Face-Face Consultations Different anxieties of patient

Different ways of expressing those anxieties

Manifest versus underlying problem

Secondary dialogue

ExpectationsImpact of taping calls

Access

Types of problems - eg parasuicide, hoax, abusive etc

Different endings

Telephone vs Face-Face Consultations

Cultural and language obstacles aggravated

Hearing difficulties

Technical difficulties

Accents

Speed of access

Access to advice for people with restricted mobility

Advantages of Telephone Consultations

Easy access to advice as circumstances change

Time efficient for all parties

Patients may feel less guilty/defensive at taking up doctor's time