Telephone consultationsTelephone consultations

Why discuss them?Why discuss them?

Major increase in use of telephone in primary care (like banking, insurance etc)

No undergraduate training in telephone work Some evidence that doctors lack confidence

in telephone consulting Different contexts Similarities and differences with face to face

consultations

Major increase in use of telephone in primary care (like banking, insurance etc)

No undergraduate training in telephone work Some evidence that doctors lack confidence

in telephone consulting Different contexts Similarities and differences with face to face

consultations

ContextsContexts

Out of hours Triage of visit requests Patient queries and requests (medication,

sick notes, advice) Medication reviews Other practice-initiated reviews (e g for QOF

targets) Routine follow up (e g for depression) Communicating test results to patients

Out of hours Triage of visit requests Patient queries and requests (medication,

sick notes, advice) Medication reviews Other practice-initiated reviews (e g for QOF

targets) Routine follow up (e g for depression) Communicating test results to patients

What’s different?What’s different?

Need to identify who you’re talking to Frequently 3rd party Patient expectations may be less clear Language, communication and cultural problems

aggravated Lack of most non verbal clues Fewer direct observations No examination Confidentiality issues Possibility of hoax or abusive calls

Need to identify who you’re talking to Frequently 3rd party Patient expectations may be less clear Language, communication and cultural problems

aggravated Lack of most non verbal clues Fewer direct observations No examination Confidentiality issues Possibility of hoax or abusive calls

What’s similar?What’s similar?

Need for accurate record keeping Length of time - often no shorter than

face to face Basic consultation model, but all stages

need extra care on the telephone

Need for accurate record keeping Length of time - often no shorter than

face to face Basic consultation model, but all stages

need extra care on the telephone

Stages of telephone consultationStages of telephone consultation

Preparation - gather available information Initiate consultation - identify yourself and caller, build rapport Gather information re patient expectations and re problem -

clarify, reflect, summarise, check you understand patient’s position

Make a plan including a safety net Explain plan to patient - check they understand and agree End the consultation when caller feels heard, respected and

understood Afterwards - record consultation and take any planned action

Preparation - gather available information Initiate consultation - identify yourself and caller, build rapport Gather information re patient expectations and re problem -

clarify, reflect, summarise, check you understand patient’s position

Make a plan including a safety net Explain plan to patient - check they understand and agree End the consultation when caller feels heard, respected and

understood Afterwards - record consultation and take any planned action