Telephone Consultations Reducing the risk Why is this

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Telephone Consultations

• Reducing the risk

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Why is this important?

• Use of telephone consulting is increasing
• Co-operatives/out-of-hours centres
• Triage within practice
• Telemedicine
• Follow-up of patient management
• Patient demand access without attendance

3
What are the important issues?

• Patient satisfaction
• Doctors performance
• Anxiety/dealing with uncertainty
• Little formal training for doctors

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Patient satisfaction

• 25 patients unhappy with advice received
• More happy with appointment/visit
• More satisfied if
• Aged gt 60 yrs
• Less satisfied if
• Long wait for advice
• Originally requested a visit

5
Doctors Performance

• Do we
• collect adequate information?
• make assumptions?
• establish what the patient is expecting?
• communicate clearly?
• give the patient sufficient information?
• check agreement understanding?
• cope in crisis situations?
• empathise sufficiently?

6
What are the differences?

• Face to face vs. Telephone

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Why do patients call for help?

• Helmans model (1981)
• What is happening?
• Why has it happened?
• Why me?
• Why now?
• What will happen if I do nothing?
• What should I do?

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Cases for risk assessment

• What information is needed to make these
  assessments effectively?

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Top Ten Telephone Skills

• D Hobson/M Balme (KSS)

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Summary of skills required

• Safety skills
• Detect red flags quickly
• Patient-centred skills
• Empathy, listening, understanding
• Problem solving skills
• Logic, lateral thinking, framing
• Negotiating skills
• Persuading the caller of the best course of
  action
• Advice-giving skills
• selling your information with confidence
• More safety skills
• Creating a safety net to conclude

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Guidelines

• Obtain all available information about the caller
• Be aware of your state, voice put aside your own
  agenda
• Introductions try to talk to the patient
• Enquire about the reason for the call
• Listen actively, look for cues, ICE
• Elicit any other information. Exclude red flags
• Establish the clinical picture summarise
• Clarify mutual agreement, clear plan
  unambiguous advice
• Safety-net give permission to call back
• Record keeping
• Housekeeping/time management