A quick guide to phone consultations
Telephone consultations can be a highly efficient method of giving medical advice, says Sally-Anne Pygall, as long as they are conducted correctly
What is the GP's role in a telephone consultation?
A telephone consultation can be an incredibly useful service for both patients and the practice.
To gain the patient's trust and facilitate clear communication it is vital that you adopt a manner that reflects your competence and specialist skills. At the end of a consultation the patient should be satisfied that all their concerns were addressed and nothing was overlooked. The best telephone consultations consist of open ended questions matched with an unbiased attitude that provides the patient with plenty of opportunity to express any concerns.
As a qualified clinician, your interpersonal skills are already finely tuned; however it is always worth ensuring that you are able to adopt the mindset of a patient when conducting a telephone consultation. It is important that you can relate to their emotions and are able to take control.
What constitutes ‘good interaction' in a telephone consultation?
Standards should be delivered on par with surgery appointments and patients should never feel as though they have experienced a second rate approach. A great deal depends upon the communication style adopted by the person triaging. Although it seems an obvious statement, a patient is much more likely to respond positively to a friendly, caring intonation.
The triager should never sound distracted, preoccupied or stressed and the patient should never feel as though they are wasting time. Always make sure that they understand and are happy with the advice given.
The lack of cues of facial expression, context and evident symptoms, requires the additional use of specialist techniques. Knowing which questions to ask and how to ask them, while also taking into account the patient's environment on the other side of the telephone and relating to their frustrations or fears, are elements that all need to be factored into a telephone consultation.
How do telephone consultations benefit the patient?
A telephone consultation service can be hugely beneficial for patients as it provides quick and convenient access to medical advice when it is difficult to fit face to face appointments around busy schedules. When advice is all that is required to manage minor ailments or a request for a sick note renewal or prescription is asked for, a telephone consultation is perfect.
Patients can also benefit from reduced costs that come from saved travel, child care expenses or time off work. A telephone call can result in a quicker referral or management rate in an emergency situation and can even saves lives by saving time. It also provides a readily accessible supply of advice for patients with long term conditions such as diabetes, asthma or coronary heart disease. It's always reassuring to know that there is a health professional available on the end of the line to answer any questions.
What are the risks posed by telephone consultations?
As with most medical formats, telephone consultations present potential risks. As you can't see the patient, it can be difficult to diagnose and understand what the problem is if the patient is unable to describe the symptoms accurately or is distressed and confused. Another major risk is when the person contacting the surgery is not actually the patient. This is not uncommon when the patient is the child, but many patients have their partner or another member of the family ring on their behalf. This means the person ‘triaging' loses considerable information in the translation, especially when the patient is not even with the caller.
However, with appropriate training and good communication skills you can conduct a telephone triage with a great degree of accuracy, although much will come down to the caller's cooperation. If the comprehension level of the caller is in doubt or they are in a hurry and therefore prefer not to spend time answering questions, the triager may rush the interaction which can then lead to an inappropriate or even dangerous outcome.
What do patients usually expect from telephone consultations?
Many patients approach a telephone interaction with a set agenda; typically they feel they need to be seen. If both parties are able to approach the interaction with an open mind, the exchange of information will result in a smoother, more effective use of time. You need to be prepared for a patient who thinks they need to be seen even if you know that they don't. Persuading them of this and advising them on the best action to take needs to be handled with diplomacy; explaining their situation in a calm, controlled manner will help to ease any concerns. Ultimately they should leave the conversation happy with the advice and confident that they know how to manage things. If this doesn't happen then the telephone consultation has been a failure.
Callers or patients should beprepared to spend time answering questions and should be mindful not to answer the phone in an area where they cannot talk freely. GP receptionists can facilitate this by warning the caller that a telephone consultation requires time and privacy; are they in a position to offer both? If that isn't the case, perhaps a face to face appointment may be best?
Sally-Anne Pygall is the managing director of Telephone Consultation Services