Telephone Consultation

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Telephone Consultation
2
Growth Area

• There has been an explosive growth in the use of
  the phone in all areas of life, from telephone
  banking, insurance, shopping and not least
  medicine.
• GP co-operatives have accelerated the shift from
  home visits to telephone advice.
• NHS direct is another push in the direction of
  telephone health care provision.

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Out of Hours

• It is argued that a high proportion of out of
  hours calls can be dealt with over the phone.

4
Out of Hours

• There is little evidence that patients are
  satisfied with this.
• One study showed 33 who got telephone advice had
  originally wanted a home visit, of all the
  patients who got such advice, including the ones
  that were expecting it, 25 were unhappy with the
  telephone advice. And over all 49 of callers
  would have preferred a home visit.

5
Concerns

• Concerns have also been expressed with the
  performance of providers of telephone primary
  care.
• The main concerns have been the adequacy of data
  collected, premature conclusions drawn and
  communications unclear.

6
Anxieties

• GPs have also expressed anxiety about providing
  telephone consultations, particularly to patients
  they do not know.
• Telephone consultations require specific skills
  to compensate for the lack of visual clues and to
  manage patient expectations for a home visit.

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Anxieties

• GPs have also expressed anxiety about providing
  telephone consultations, particularly to patients
  they do not know.
• Telephone consultations require specific skills
  to compensate for the lack of visual clues and to
  manage patient expectations for a home visit.

8
Anxieties

• Undergraduate medical education and vocational
  training have tended to overlook these needs
• Undergraduate medical education and vocational
  training have tended to overlook these needs

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Anxieties

• Nothing has changed?So prove how up to date we!
• This wonderful letter to the lancet appears to
  be the first record in the medical literature of
  telephone consultations

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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
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Telephone Versus Face to Face Consultations

• Lack of non-verbal clues
• No direct observations
• No direct examination
• No diagnostic tests
• No smells
• Active listening
• Third party consultations

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Telephone Versus Face to Face Consultations

• Different anxieties of patient
• Different ways of expressing those anxieties
• Manifest versus underlying problem
• Secondary dialogue
• ExpectationsImpact of taping calls
• AccessTypes of problems - eg parasuicide, hoax,
  abusive etc
• Different endings

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Telephone Versus Face to Face Consultations

• Cultural and language obstacles aggravated
• Hearing difficulties
• Technical difficulties
• Accents
• Speed of access
• Access to advice for people with restricted
  mobility

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Telephone Versus Face to Face 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