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

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

4. What’s different? Need to identify who you’re 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. What’s 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

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 patient’s 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