Learning objectives

The stages of the telephone consultation

Stage 0 PREPARATION
  • any available information about the caller
  • anticipate time delay
  • note taking
Stage 1 TRUST
  • identify yourself
  • tone of voice
  • acknowledging caller's emotions
  • acknowledging caller's previous experience of health services
  • letting the caller know that they are being heard * empathy
Stage 2 EXPLORATION
  • questioning choosing open or closed forms
  • probing through reflection
Stage 3 CLARIFICATION
  • caller's agenda
  • caller's understanding
  • reflecting
  • summarising and paraphrasing
  • allow time for the caller to talk including silences
Stage 4 ACTION
  • empower the caller to take action where possible
  • clarify what action you will take on their behalf
  • check that agreed plan is understood
Stage 5 END
  • when the caller feels heard, respected and understood
  • end the call for the caller not for yourself
Stage 6 AFTER THE CALL
  • time to reflect
  • note taking
  • other action

Improving The Telephone Consultation

Some Simple Guidelines

Communication Style

An individual's personal style of communication can be considered as their preferred way or ways of interacting. Each of us will have a different range or repertoire of skills which we are inclined to draw upon in combination during any interpersonal interaction.

In relation to patient consultations and telephone consultations in particular this can be thought of in a number of ways. For example, Heron's framework of types of interaction can be used to analyse the range of different types of interaction employed during a consultation and to review alternative ways of handling specific types of calls.

Furthermore, our inclination to initiate certain types of interaction during a consultation may be influenced by the communication techniques we are skilled in using.

Heron's six category intervention analysis (adapted)

AUTHORITATIVE
  • Simple Informational
    • seeks to impart or gather straightforward knowledge and information
  • Prescriptive or advisory
    • seeks to direct the behaviour of the client
  • Confronting
    • seeks to raise the consciousness of the client about some limiting attitude or behaviour of which he is relatively unaware
FACILITATIVE
  • Cathartic
    • seeks to enable the client to discharge, to abreact painful emotion, primarily grief, fear and anger
  • Catalytic
    • seeks to elicit self-discovery, selfdirected learning, living and problem-solving in the client
  • Supportive
    • seeks to affirm the worth and value of the client's person, qualities, attitudes or actions
SPECIFIC TECHNIQUES
  • Summarising
    • to reassure the caller that you are listening
    • to clarify what you have heard
    • to signal moving on to another phase of the call
  • Reflecting the caller's own words
    • as a verbal nod
    • to probe gently
    • to offer a challenge
  • Questioning
    • choosing open constructions to allow a wide exploration of the caller's concern
    • or closed questions to narrow the focus by ruling in or out specific options