1. The Art Of Telephone Consultations
Dr. Ramesh Mehay

2. 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.

3. 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

4. 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?

5. 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?

6. 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

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

8. 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, Page 819

9. 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

10. 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

11. 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

12. 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