1. Telephone consultations

2. Why discuss them? Major increase in use of telephone in primary care (like banking, insurance etc) No undergraduate training in telephone work Some evidence that doctors lack confidence in telephone consulting Different contexts Similarities and differences with face to face consultations Major increase in use of telephone in primary care (like banking, insurance etc) No undergraduate training in telephone work Some evidence that doctors lack confidence in telephone consulting Different contexts Similarities and differences with face to face consultations

3. Contexts Out of hours Triage of visit requests Patient queries and requests (medication, sick notes, advice) Medication reviews Other practice-initiated reviews (e g for QOF targets) Routine follow up (e g for depression) Communicating test results to patients Out of hours Triage of visit requests Patient queries and requests (medication, sick notes, advice) Medication reviews Other practice-initiated reviews (e g for QOF targets) Routine follow up (e g for depression) Communicating test results to patients

4. Whats different? Need to identify who youre talking to Frequently 3rd party Patient expectations may be less clear Language, communication and cultural problems aggravated Lack of most non verbal clues Fewer direct observations No examination Confidentiality issues Possibility of hoax or abusive calls Need to identify who youre talking to Frequently 3rd party Patient expectations may be less clear Language, communication and cultural problems aggravated Lack of most non verbal clues Fewer direct observations No examination Confidentiality issues Possibility of hoax or abusive calls

5. Whats similar? Need for accurate record keeping Length of time - often no shorter than face to face Basic consultation model, but all stages need extra care on the telephone Need for accurate record keeping Length of time - often no shorter than face to face Basic consultation model, but all stages need extra care on the telephone

6. Stages of telephone consultation Preparation - gather available information Initiate consultation - identify yourself and caller, build rapport Gather information re patient expectations and re problem - clarify, reflect, summarise, check you understand patients position Make a plan including a safety net Explain plan to patient - check they understand and agree End the consultation when caller feels heard, respected and understood Afterwards - record consultation and take any planned action Preparation - gather available information Initiate consultation - identify yourself and caller, build rapport Gather information re patient expectations and re problem - clarify, reflect, summarise, check you understand patients position Make a plan including a safety net Explain plan to patient - check they understand and agree End the consultation when caller feels heard, respected and understood Afterwards - record consultation and take any planned action