What is different and why might there be a problem?

• Can't see patient/they can't see you
• Few non verbal clues
• Increased difficulty of establishing rapport.
• May not be talking to patient directly (may be problems of confidentiality
• Can't eyeball the patient: difficult to assess severity of problem, have to rely on layman's observations
• Can't eyeball the patient: difficult to assess severity of problem, have to rely on layman's observations
• Can't examine patient
• May not know patient
• May be more time pressure

What skills are particularly needed?

• Need to be on higher state of alert.
• Need to develop ability to pick up patient's mood: anger, anxiety, etc
• Importance of attentive listening
• Be clear about what treatment the patient has already tried (avoids the "I have already tried that doctor")
• Greater use of focussed/closed questions - to be clear of exact nature of problems - exclude serious disease.
• Learn skills of the accepting response (without necessarily agreeing with the patient). E.g. "that is no problem - but before making a decision, can I have some more information? ....
• Importance of summarising "can I just check that I have got this right? ".
• Importance of signposting "I just want to ask a few more questions which will help me decide what is best"
• Clarify reason for call: "can I be clear about what you had hoped I could do for you?...."
  Check this out further: "my own view, from what you have told me, is that ......: what I can offer is ....."
• Importance of safety-netting. Be clear, precise, specific and repeat. "if he does x, y, z, please phone back, plus time-scales".
• Check understanding "are you clear about that?"
• Check patient agreed with course of management "are you happy with this plan of action?"
• Try and get and idea of patient's concerns, expectations "I wonder if you have had any thoughts on what is causing this".
• Clarify rapidity with which action needs to be taken: "I need to have more information in order to decide on how quickly to ....".
• Don't commit yourself too early to a course of action prior to getting all the information.
• By using skills appropriately, it is possible to "manipulate the outcome".

Teaching Telephone Consultations
Conclusions of Trainer Workshop held 28th May 2003

Potential uses of the telephone consultation:

• Out of hours care
• Request for home visiting in daytime
• Follow up
• Planned telephone consultations
• Future developments: the video phone

How to teach the telephone consultation

• Role play
• Observation of trainer and others (get GPR to analyse the skills)
• Use of the double socket
• Observation of GPRs: rehearse beforehand,then watch it, then discuss it
• Playback of recorded consultations
• Consider a specific tutorial: Look at:
  Phone manner
  Potential problems of telephone consultations
  Particular skills required for telephone consulting
  What telephone consulting can be used for
  What the research is
  What the GMC says