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Haslam's view: Telephone consultation leaves me lost for words

Why are some GPs so very nervous of the telephone? it's not as if it is even a vaguely recent invention, but it has taken some GPs rather a long time to have accepted that it can have real benefits. Only last week I was talking to a senior government health policy adviser, who told me that his own GP's practice would not accept phone calls from patients and insisted on face-to-face contact every time. He couldn't understand it and, to be honest, neither can I.

That doesn't mean that everything about the telephone is wonderful. Few things drive me to greater levels of irritation than the thoughtless use of mobile phones in public.

But telephone consultations do have a very clear value. I'm not talking about the use of the phone in emergencies, or even out of hours, but the routine, time-saving phone call that can replace the need for appointments, the time spent travelling to the surgery and all the paraphernalia of the traditional way of doing medical business.

Provided adequate safeguards are built in, complete records are made and both parties are entirely happy with the situation, then the phone consultation seems of huge benefit to everyone concerned.

But that doesn't mean that telephone consultations are necessarily any easier. A patient phoned me last week with yet another "first time in my career that's happened" type of question.

She has been my patient now for more than 25 years and has always struck me as eminently sensible.

‘David,' she said, ‘I need your advice. We had a girls' night out last night and, just for a laugh, we all consulted a reflexologist. I hadn't come across reflexology parties before, but it seemed harmless enough. She looked at my feet and did something with my toes, and then announced that she was worried that I had a problem with my colon and should come and see my doctor right away. She thinks I need a scan. What do you think?'

Well, doctor, what do you think? Sometimes I think I am being pursued by investigative journalists, who consult me with all manner of ridiculous requests and questions either to test me out or to write an article demonstrating how prejudiced Britain's GPs are. I may just be paranoid, but requests like this come from so far out of left field as to be almost impossible to prepare for.

So what would you do in this situation? There seem to be all manner of options. You could choke, laugh, tell her not to be so ridiculous, put the phone down and get on with some real work. Or you could explore her ideas, concerns and expectations, and recognise the criticism you will inevitably face if you don't investigate her and at any time in the next decade she develops bowel symptoms.

You could take a detailed history of bowel symptoms. You could simply arrange a scan. Or you could offer an appointment to discuss it all in more detail, with an offer to investigate if it felt appropriate and an intention not to investigate unless it really seemed essential.

I bet our colleagues in other medical specialties don't have to face these dilemmas day in and day out. And I would bet even more that the reflexologist didn't lose a moment's sleep about the hornet's nest she had disturbed.

Funny old world, isn't it?


Professor David Haslam CBE
GP, Ramsey, Cambridgeshire; President, Royal College of General Practitioners; national clinical adviser to the Healthcare Commission; and visiting professor at de Montfort University, Leicester

Telephone consultation leaves me lost for words

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