Doctor and patient on the telephone
Should doctors and patients
talk to one another about medical matters over the phone? Is the telephone
perhaps only a substitute of surgery time used to save time and to avoid
direct contact? The answer is as follows: telephone conversations with
patients can certainly be a useful form of medical discussion when they
are employed to supplement, round off or to maintain necessary contact,
and are limited in content.
The advantages of
telephone discussion are obvious. It can save an enormous amount of time
for both the doctor and the patient. There is no reason why an old handicapped
person should have to travel on public transport and spend 2 hours coming
to the practice to be informed of results of investigations which could
have been given to him over the phone in 3 minutes. Patients can also be
informed as soon as the results are available. This is particularly true
where favorable results from investigations (such as histological findings)
can remove much anxiety from the patient. The telephone allows the otherwise
very trying waiting period to be reduced considerably.
Even informing the patient
of the result of an investigation which is interesting for the patient
but not of tremendous significance, can be used to consolidate the relationship
between the doctor and the patient. A doctor who tells a patient that he
will be informed of the results as soon as they come back, clearly demonstrates
a personal interest in the patient and takes away the feeling that he is
one of many in the waiting room. One gynecologist made it his habit to
phone the results of histological and cytological findings immediately
to his patients, and the majority of women considered this very positively.
A patient who knows that
he can reach his doctor by phone at almost any time in order to discuss
certain side effects of therapy or particular symptoms, feels that he is
better cared for and more secure. In as much as a telephone conversation
about questions of therapy can lead to an improvement in compliance,
it can also reduce the need for check-ups of therapy and progress.
Finally patients who require long-term care because of chronic disease,
and who do not comply optimally, can be led on a "long lead" by the use
of occasional phone calls.
However communication with
the patient by phone also has definite disadvantages. As only verbal
contact is possible, the complete range of non-verbal forms of communication
are missing (gesticulation, facial expression, body language). The "clinical
glance" (which has not lost its importance even in high-tech medicine)
is not possible. Telephoning tends to lead to a more succinct and compressed
form of passing on information. Therefore a higher degree of summarizing
is required, and the more redundant parts of conversation are reduced.
This can quickly lead to misunderstandings. This abbreviated form of conversation
can leave the character of telephone discussions seeming dry and impersonal.
A most crucial disadvantage
of telephone discussion is the difficulty of not being able to assess
the patient's reaction. Most people are more emotionally guarded on
the phone, and additional information from non-verbal signals is not available.
One finds again and again that patients or relatives who appeared to completely
accept difficult findings over the phone, later describe how they were
actually deeply affected.
There are a series of typical
mistakes and short-comings made while telephoning, which certainly
does not exclude discussions between doctors and patients. G.F.
Gross describes the most important points in his review of mistakes
during telephone conversations:
caller is not prepared.
||The caller reaches
for the phone before considering why he is calling.
||Pen and papers
are got together after dialing.
misleading introduction or time-wasting preamble.
complicated explanation, unnecessary repetition.
unimportant matters interweave too much.
||The caller submerges
the person he is calling with a flood of words, and takes a long time to
say the little that he wanted to.
The following important points
apply to professional telephone conversations between doctor and patient:
find out when the person with whom one wants to telephone fairly
frequently is most likely to be available.
out if this time is also suitable for a conversation with a medical
content. For example it may be easy to reach a patient at his work-place
but, as he is likely to be disturbed, he cannot discuss symptoms or findings.
secrecy have to be taken seriously into account when telephoning. Is
the person answering really the patient with whom one wishes to speak?
If there is the slightest doubt, one should not continue.Is it possible
that someone else is listening, but the patient cannot let you know? Problems
also arise when relatives rather than the patient himself answer
the phone if one does not know how far they can be informed, or how much
information the patient would like them to have. Even relatives may only
be given information over the phone where there is no doubt that this is
in the interests of the patient.
||In cases where
the patient has been promised that he will be informed of an important
result, the call back should be undertaken promptly. If one is prevented
from calling, or the results are not yet available, the patient should
be informed of this at the time he is expecting the call. It is sensible
to inform the patient when the doctor can best be reached. Some
general practitioners have a "telephone surgery", at a particular time
of day (i.e. noon - 12.30 pm).
||Rather than making
at various times, it is more economical to make them together in one
or two blocks.
||It is wise to
consider not only what has to be said during the discussion, but also the
answer to some likely questions.
record must be made of everything that has been said over the phone.
||If the patient
is expecting an important finding, there should be no long preamble
which keeps him hanging on. If the result is favorable, this can be said
at first and details can be left until later: "I am ringing to let you
know the good news that the results of your blood tests have been found
to be completely normal."
||The patient must
be given time to react to the news, and the doctor must make some
effort, in spite of the limitations to assess the patient's reaction. Likewise,
the patient must have enough time to ask questions which are a result of
the information which has been given.
||If the result
of the test which the patient is expecting by phone is of serious import,
this should not be given over the phone but in direct discussion
(i.e. histological evidence of malignancy, positive HIV test). As the patient
is expecting the call, it must still be made. One method is to phone the
patient and tell him that the result is available but it would be better
if he came to the surgery so that it could be explained to him (the appointment
must be as soon as possible!)
it is not possible to resolve or mitigate anxiety, misunderstandings and
problems over the phone, these should be sorted out as soon as possible
by a discussion during surgery hours.
If used correctly, telephone
conversations can help to save time, improve compliance and make the relationship
between the doctor and the patient more personal.
Geisler: Doctor and patient - a partnership through dialogue
Pharma Verlag Frankfurt/Germany, 1991
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