The Art Of Telephone Consultations

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The Art Of Telephone Consultations
Dr. Ramesh Mehay
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Why are telephones so important?

• The Telephone Explosion Era
• GP Co-ops are using it more
• As is NHS Direct

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Is It a Good Tool?

• It is argued that a high proportion of out of
  hours calls can be dealt with over the phone.

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Will patients Be Happy?

• Studies show
• 30 who got telephone advice had originally
  wanted a home visit
• Only 25 were unhappy with the telephone advice.
• BUT over all 49 of callers would have preferred
  a home visit.

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Concerns Anxieties

• Concerns
• Is the Data gathered adequate?
• Are we prone to Premature Conclusions?
• Is the Communications Clear?
• Telephone consultation technique
• Anxieties
• Providing telephone consultations, particularly
  to patients we do not know.
• How good are our telephone skills
• How do you manage patient expectations for a home
  visit?

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The Root of the Problem

• Telephone consultation skills training is often
  overlooked in
• Undergraduate Schools
• Vocational Training Schemes
• Post-VTS training
• PGEA

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The First Telephone Consultation

• This wonderful letter to the lancet appears to
  be the first record in the medical literature of
  telephone consultations

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PRACTICE BY TELEPHONE The Yankees are rapidly
finding out the benefits of the telephone. A
newly made grandmamma, we are told, was recently
awakened by the bell at midnight, and told by her
inexperienced daughter, "Baby has the croup. What
shall I do with it?" Grandmamma replied she would
call the family doctor, and would be there in a
minute. Grandmamma woke the doctor, and told him
the terrible news. He in turn asked to be put in
telephonic communication with the anxious mamma.
"Lift the child to the telephone, and let me hear
it cough," he commands. The child is lifted, and
it coughs. "That's not the croup," he declares,
and declines to leave his house on such small
matters. He advises grandmamma also to stay in
bed and, all anxiety quieted, the trio settle
down happy for the night. The Lancet Nov. 29,
1879. Page 819
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Telephone vs Face-Face Consultations

• Lack of non-verbal clues
• No direct observations
• No direct examination
• No diagnostic tests
• No smells
• Active listening
• Third party consultations

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Telephone vs Face-Face Consultations

• Different anxieties of patient
• Different ways of expressing those anxieties
• Manifest versus underlying problem
• Secondary dialogue
• ExpectationsImpact of taping calls
• Access
• Types of problems - eg parasuicide, hoax, abusive
  etc
• Different endings

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Telephone vs Face-Face Consultations

• Cultural and language obstacles aggravated
• Hearing difficulties
• Technical difficulties
• Accents
• Speed of access
• Access to advice for people with restricted
  mobility

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Advantages of Telephone Consultations

• Easy access to advice as circumstances change
• Time efficient for all parties
• Patients may feel less guilty/defensive at taking
  up doctor's time