The Art Of Telephone Consultations Dr. Ramesh Mehay www.bradfordvts.co.uk

Why are telephones so important? The Telephone Explosion Era GP Co-ops are using it more As is NHS Direct The Telephone Explosion Era -There has been an explosive growth in the use of the phone in all areas of life, from telephone banking, insurance, shopping and not least medicine. GP co-operatives have accelerated the shift from home visits to telephone advice. NHS direct is another push in the direction of telephone health care provision.

Is It a Good Tool? It is argued that a high proportion of out of hours calls can be dealt with over the phone. Hence savings in terms of Doctor – time & travel Patients – time & travel

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. 49% of callers would have preferred a home visit. Not necesarilly because they needed one but perhaps because as doctors, we have no training in telephone consultations. May be we come across as too aggressive or grumpy?

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? Is the data we gather adequate enough? Do we tend to make premature conclusions? Is the Communication clear enough using this method? Are our telephone consultations up to scratch?

The Root of the Problem Telephone consultation skills training is often overlooked in Undergraduate Schools Vocational Training Schemes Post-VTS training PGEA Undergraduate medical education and vocational training have tended to overlook these needs

The First Telephone Consultation This wonderful letter to the lancet appears to be the first record in the medical literature of telephone consultations

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

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

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

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

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