Other Considerations

Knowing the patient

One thing that distinguishes GP phone consultations from the service provided by NHS Direct is the medical professional’s familiarity with patients and access to their records. This reduces uncertainties in communication and diagnosis. When the doctor doesn’t know the patient, for example, if a locum makes the call, it is less likely to be successful.

Structure and teamwork

So that patients are given consistent advice and treatment when they call, policies and boundaries need to be established within the primary care team. Practices should decide what proportion of clinical time should be set aside for telephone consultations, what conditions will be managed this way and what advice will be given for each condition.

Risks and warnings

A lack of training and confidence can limit the effectiveness of telephone consultations.Doctors tend to feel more confident when conducting telephone consultations with familiar patients during practice hours, than when making calls out of hours. According to 38 doctors interviewed for a study in Cambridge in 1997, the factors most frequently associated with difficult calls are:

• a difference of opinion on the need for a visit;
• parental anxiety about children;
• chronic conditions; and
• mental health problems.

Telephone consultations are prone to errors in:

• information gathering, from inadequate knowledge of drug usage and allergy history;
• relationship building, usually through anger on one or other side;
• decision-making, for example premature decisions; and
• explanation and planning, due to poor communication.

The relative anonymity patients have when talking on the phone promotes clear communication, but it’s just as likely to inhibit it. Doctors should keep this uncertainty in mind when conducting telephone consultations. Be prepared for any eventuality.

Credit and references

Some of the information here is adapted from Telephone Consultations in Primary Care by Tony Males (Royal College of General Practitioners, London, 2007, available to purchase from the RCGP bookshop.)