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If specialists can't manage patients over the phone, should a GP be doing it?

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I recently attended a Paediatrics course. As is traditional, one of the lectures was absolutely terrifying – a series of case studies in which every headache was meningitis, and every cough was TB or a bizarre and rapidly fatal malignancy. It’s easy to get paranoid listening to this catalogue of tragedy. The kid you’d seen the day before and sent home with mild bronchiolitis had without doubt died overnight, and when you got back to your surgery it would be packed to the rafters with bereaved parents.

This isn’t the first time a consultant’s talk has seemed designed to give GPs the heebie-jeebies. A dermatology conference that I once attended seemed entirely geared to creating uncertainty and increasing referrals. It consisted of endless slides of what looked like melanoma but wasn’t, interspersed with completely harmless-looking freckles that had proven swiftly lethal. Every leg ulcer hid a squamous cancer, every scar was a morphoeic BCC, and the lawyers definitely had your number.

But back in the Paeds talk, as 300 GPs fretted in the darkness, there was an interesting throwaway comment. The consultant mentioned that, following a case of meningitis, his hospital had taken the decision to completely do away with telephone triage. No advice at all without seeing the patient. This had been prompted by a case review of a fatality, when the key point in the history had been that the child’s vomiting had got worse when she was moved. Not gastroenteritis, but cerebral irritation, and by the time anyone twigged, she was dead.

My next day on-call was, as usual, fairly full of mums who weren’t sure how anxious to be, and were just looking for a bit of reassurance. They were mostly asking for phone calls – with other kids needing to get to school, and jobs to go to, they didn’t want to come down to the surgery unnecessarily. It simply isn’t possible to see them all.

But if the specialists don’t feel they can safely manage children on the phone, should a generalist be doing it? Is our level of workload and risk sustainable?

Dr Nick Ramscar is a GP in Bracknell, Berkshire

Readers' comments (3)

  • Fantatsic point- I am a locum and work in some practices who are reliant on telephone triage and some that wouldnt entertain it.
    To say I hate telephone triage is an understatement- I feel it leads to poor medicine .
    It is fraught with potential danger.
    It seems to go against the first thing we were taught at medical school always view the patient and examine !

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  • There are various cases in MPS type magazines that point to a failure to examine the patient as a failure in duty of care - it usually is qualified with the implication of 'even if you have to visit them'. However, the practicalities of this are difficult to juggle on a busy day.

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  • And for 111 it's not even generalists who are triaging and giving advice over the phone ...

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