Posted by: Gillham8 December 2014
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.