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Phone triage? It is a pain in the neck

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It may have its advocates, but telephone triage doesn’t come without its problems.

We launched a ‘subtotal triage’ system last July, in response to calls for better patient access and more efficient use of precious little time. In our surgery, we’re certainly going home more punctually, but here’s just a few issues to consider before you make the leap.

1 Risk of venous thromboembolism. Telephone triage is a staggeringly immobile pursuit. A GP can spend three hours dangerously stagnant, with little or no lower limb movement. Some colleagues develop paraesthesia. If you’re a smoking GP, taking the Pill or suffering with migraine, I suggest investing in a calf massage, or taking regular jaunts around the surgery building.

2 Neck spasm. Over the last few months, I have squeezed my way through several tubes of Voltarol gel (other brands are available) and taken a few weak opioids. The pains that shoot down my left trapezius can be crippling. The subtle head movements from left to right, betwixt phone and monitor, must be responsible. I’m loathe to admit it, but perhaps we need “workstation assessments” – are they part of CQC?

3 Blurring of vision. The first on-call GP is triaging most of the day. That’s often eight hours, in a halogen-lit room, staring at a pixilated screen. When the GP does emerge from his luminescent cave – either to replenish caffeine supplies or drain their consequence – it can take minutes for his or her eyes to re-adjust. Otherwise-well individuals have been seen wandering ataxically down the corridor, eyes bleary and blurry from an assault of fine lens adjustments.

4 Spelling mistakes. Our admin team are asked to put a brief description of the patient’s problem, some context to the call. Some misspellings catch us off guard, cause amusement and threaten a triaging GP’s intensity and focus. Examples recently include an elderly man in pain after “Chester Drawers” fell on him. Today, a young man had a “pilonidal abyss”. Luckily, the lady who had “divers titilitis” settled without antibiotics.

Telephone triage is a time-efficient tool in managing on-the-day demand, though it’s certainly not universally popular. Personally, I’m a big fan, but it has cost me a fortune over the counter.

Dr Tom Gillham is a GP in Hertfordshire and specialty doctor in A&E. You can follow him @tjgillham.

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Readers' comments (22)

  • 9 years in training to do telesales work????

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  • Solutions:
    1. Invest in a hands free phone kit
    2. Share out the triage between all GPs so everyone's day is a mixture of triage and face to face consulting. The great side effect is enhanced continuity of care
    3. Have a mandatory coffee break for 20 mins

    All of the above have hugely changed my life for the better and I am a massive fan of triage as it allows patient education and ensures patient responsibility.

    As for the above comment, I'd rather be viewed as telesales than an overqualified social worker/dentist/counsellor/health visitor etc.

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  • We have been doing this for the last 2 years.
    Unfortunately sub-total does not work - all GPs triaging their own appointments is required.

    The plus: same day access, meeeting patient demand, no DNAs and on call days no longer exist as work load is shared evenly

    The minus: You need the right number of GPs in on any given day to make it work, a lot more sitting (I Agree), and some days the calls seem never-ending

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  • Yes, you'll need to do a VDU assessment as part of your responsibilities to any employees - as a partner you are technically exempt, but it would be good practice.

    http://www.hse.gov.uk/pubns/indg36.pdf

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  • Peter Swinyard

    Lightweight bluetooth wireless headset of good quality is essential - also personal lists make telephone triage easier, safer and more professionally rewarding.
    My call-in rate about 35% but these patients have already had history taken so can move straight on to the examination/special investigations.
    Hard to do language line or sign language by phone but doubtless a way will be found. And no, I am not going to do Skype. One look at my grumpy face on a Monday morning for a patient would be quite pathogenic.
    Final advantage - it's hard for the most ardent snot-donor to give you their cold down the phone....

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  • Also makes it really easy for governments to sell off phone contacts in a few years as the primary care contact of choice, with all the medico legal risk on the GP.

    It'll take several years to find out how this affects medico legal costs, we're in a honeymoon period wrt phone triage currently.

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  • Total triage for 5 years is what finally pushed me over the edge into an austere early retirement ( best thing I ever did). After an initial honeymoon period of feeling as if the control has been regained the demand slowly and inexorably rises . Why bother with Google when a real life doctor will phone you back. I dealt with 120 calls a day plus home visits etc. There is no finite end to demand. It used to anger me that some practices near walk in centres just fill their appointment slots and then their receptionists re-direct any extras to these centres. That's the extent of their triage. In truth though if we had all demanded this rather than participating in this weird combination of macho-masochism that we doctors do so well maybe we wouldn't be in the mess were in.

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  • After the trauma of telephone triage, we found it much easier to ask people if they needed a telephone or surgery appointment . Its much more empowering for patients who love telephone appointments -- but hated triage because they felt it set them against us.

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  • How often do you ring someone who's asked for a call only to find they don't answer, so you leave a message and then they call back later at some random time when you are in the middle of checking blood results or doing a referal, and they expect to be able to talk to you immediately

    How often do you find yourself making an treatment decision which in hind sight carried a risk but you did it anyway because you didn't have any physical appointments available in which to see them? Hopefully not often but it does happen.

    Medical training is based upon history and examination ...you can not examine a patient over the telephone.

    Some issues can be delt with on the phone but in my opinion this is a slippery slope driven by the desire to cut costs and involves a significant increase in risk of the Dr missing something. Ultimately it is the Drs who carry this risk and will pay for it through missed diagnosis and increasing medical indemnity costs.

    Throughout my career I have continually come across situations in which I have been asked to do things that aren't really safe, by people 'in charge', due to inadequate funding, inadequate staffing or when I've been asked to work too long without a break. Almost always it is the clinician who carries the can when things go wrong - not the people who commission and fund the service. Telephone triage is a good example of this and not a positive development. It lays us open to increasingly being asked to provide care which isn't safe...basically to reduce costs.

    As always there will be people who say 'yes I can do this' but I think this is more a result of a general tendency to machismo in medicine than genuine balanced regard for safe and good practice.

    I'm not a fan of telephone 'triage'.

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  • Oh you poor GPs, ha ha! I worked as a triage nurse adviser for NHS Direct for 12 years. I was "tied" to my desk by my headset cord and in the last few years by the phone system, I even had to put a code into the phone when I went to the toilet! No one, HR or Occupational Health, worried about the DVT risk even though some nurses worked 12 hour shifts!
    My advice is,
    1 stand and move around every hour
    2 get a headset
    3 perform eye exercises every hour.
    4 work station assessments which include VDU assessments should be carried out
    5 if you don't like telephone triage then employ one of the many highly trained Nurse Advisers made redundant when the government decided to use computers and call takers instead (NHS111)
    The spelling mistakes lighten the day, I wish I had documented them.

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