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Linus Geisler: Doctor and patient - a partnership through dialogue   © Pharma Verlag Frankfurt
Doctor and patient on the telephone
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:
The caller is not prepared.
The caller reaches for the phone before considering why he is calling.
Pen and papers are got together after dialing.
Wide rambling, misleading introduction or time-wasting preamble.
Irrelevant material, complicated explanation, unnecessary repetition.
Important and 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:
To find out when the person with whom one wants to telephone fairly frequently is most likely to be available.
To find 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.
Questions of professional 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 calls 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.
A written 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!)
Basically if 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.
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Linus Geisler: Doctor and patient - a partnership through dialogue
© Pharma Verlag Frankfurt/Germany, 1991
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