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Career coach - telephone consultations

Dr Pam Brown gives advice on telephone triage and consultations

Dr Pam Brown gives advice on telephone triage and consultations

Telephone triage and telephone consultations offer both doctor and patient a great many benefits. These include cost-effective allocation of resources, control of workload, appropriate allocation of consultations and visits, the ability to provide patients with access to appropriate healthcare professionals – and saving of valuable time. So it is worth getting them right. Here are some points to bear in mind.

• Some patients and doctors are resistant to telephone triage/consultations – highlighting the benefits may help.

• There is an overlap between telephone triage and telephone consultations, since telephone consultation is one possible outcome of triage.

• Telephone triage can be used for assessing:

– all patients requesting appointments

– all patients requesting visits

– urgency of visits

– patients who request appointments when none are available.

• In addition, practices may offer telephone consultations on request.

• It is important to ensure that patients understand the system. Effective systems include:

– time slots for incoming patient calls

– time slots for doctors to ring patients back

– ringing patients back opportunistically when time is available.

• Ringing patients back increases control, but also increases costs and is not as convenient for the patient.

• Telephone consultations follow the same models as surgery consultations but lack of visual feedback makes building a rapport with the patient more challenging.

• Before making each call:

– review past medical history, recent consultations and medication

– review the reason for the call and prepare for it

– consider using written checklists to facilitate information gathering and delivery.

• Facilitate communication and protect yourself by:

– speaking directly to the patient

– recording all calls

– using a hands-free phone if one is available

– listening actively and paraphrasing what you heard

– allowing the patient to ask questions

– making contemporaneous notes

– completing actions from one call before tackling the next

• With patients requiring face-to-face consultation, telephone triage can be brief.

• Patients receiving telephone consultations only need guidance on:

– self-treatment

– expected course of the illness

– how to recognise any deterioration

– how to get further advice and treatment.

• Hone your technique from listening to taped triage and telephone consultations. When you listen to yours, notice the speed, tone and timbre of your voice, not just the words you use. What did you do well? What could you have done better? Did you achieve all parts of your consultation model?

• Online appointment booking means patients bypass triage; strategies are needed for frequent attenders.

Dr Pam Brown is a GP in Swansea

Telephone consultations

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