Telephone consulting

Issues during telephone consultations

• Non-verbal cues
• Unable to see physical signs
• ?Different questioning style
• Less control over environment
• Different agenda
• May be talking to friend/relative
• Difficult to resolve dysfunctional consultation
• ?Safe
• Less control over termination of consultation
• Confidentiality
• Informing people of results
• Unreasonable expectations
• Prescribing based on phone assessment
• Manipulation
• ?Confrontational

Comparative issues during face to face consultations

• Better rapport
• Recognition
• Explanation is easier
• Recording consultations is easier

Telephone communication: framework

• Introduction
• Agenda setting – keeping it open
• Summarising
• Gathering information
• Assessing priority
• Clarification questions
• Triage
• Ideas concerns and expectations
• Negotiation
• Clarifying plan
• Checking understanding
• Safety netting
• Ending

Telephone communication: skills

• Maintaining/developing an adult-adult interaction
• Listening
• Signposting
• Assertive rather than aggressive – keeping cool
• Thinking quickly, or making space to think
• Negotiation

Telephone triage

Improving triage techniques

Using telephones in primary care Peter D Toon BMJ 2002;324 1230-1231

Negotiation

• Listening
• Understanding
• Agenda-setting
• Equality
• Problem-solving
• Depersonalising
• Both sides owning
• Compromising
• Clarity
• Honesty
• Following through with plan

Negotiating skills

Takeaway

It’s the same approach as a face-to-face consultation, without the non verbal communication and the examination – this means that features like signposting are even more important.

Calgary Cambridge