THE TELEPHONE CONSULTATION 

A FORMAT FOR A PM TEACHING SESSION FOR VTS REGISTRARS

 (PLUS SOMEONE GETTING ANGRY)

Introduction

We have now covered the main sections of the consultation and many if the skills you need for consulting in general practice in the sessions we have had so far this year.

Summarise with overheads

However, we have not dealt specifically with building the relationship, nor closing the session, nor any specific issues such as interviewing the depressed patient, the angry patient or multi cultural issues.

Today we are going to look at the telephone consultation;

it’s a good one and hopefully will let us cover a number of issues

Like last time we have got two actors to help us

Introduce them.

Let them do a quick tel consultation in front of the group which goes wrong

Large group

 (?tea around 15.30 depending where the group has got to with the scenarios)

Initial pairs exercise

 Think of a telephone consultation you have done or witnessed lately where there was a problem - for the patient or the doctor

 Pairs exercise 3 minutes each way

·        What are the main problems for you on the telephone in general practice?

 Flip chart the responses

They may produce a number of difficulties not only with patients, but hospital doctors, being interrupted by a tel call in surgery etc.

 Patient - centred exercise

Now can we turn things around a bit and think what patients might feel when they need to speak to a doctor on the telephone

Sit and think for about a time when either you or someone close to you needed to talk with a doctor on the telephone for a moment:

  either:

Or, if the call didn’t go well,

what did you need from the doctor to help the call go well?

Flip chart the responses

and construct an agenda for the session ? on two flip charts for both small groups

 Mandy

5 minute mini lecture on Tony Males’ research

 2.0 pm

Split into two small groups

Mention that we have a number of telephone roles up our sleeves. Could we pick one which would allow rehearsal of skills which participants need to practise?

Pick a role and someone willing to play it whose needs fit in with the scenario

Clarify exact needs of the learner and what he or she needs help with

Remind everybody that it is an opportunity to work something out rather than get it right first time.

Allow time for discussion of overall objectives and difficulties that the role brings up.

Allow enough time for patient and doc to get into the role

Identify observers and clarify how they will record their observations of the teaching process and how and when they will feed back

List of possible scenarios:

Print out and distribute to the participants

Explain that these are just suggestions and we can tweak the roles, but these are ones that the actors have thought about;

We could however quickly work out any new roles which people would like to do.

·      mother or father whose child has earache who wants a visit (unrealistic expectations) and gets angry if the doctor doesn’t want to visit (could be out of hours -7 pm or middle of the night, coop or a call at say 3.00 pm)

·      wife or husband whose spouse has suddenly “collapsed” while the doctor is in surgery

(receptionist interrupts the doc in the middle of surgery;  patient on further questioning of spouse is sitting in the chair, staring vacantly and not able to speak, poor colour but breathing)

·      depressed patient who is under treatment but can’t wait until Monday to see his own doctor  (Coop session at the weekend)

·      mother whose child has had a fever/vomiting and for two days and isn’t getting any better and is anxious; the child has now developed a rash on the trunk (should the doctor come out of surgery or not?

·      an angry relative who wants to know whether her 22 year old daughter has attended the surgery this morning and the receptionist won’t tell the relative whether she has or not.

And any other roles which the registrars raise. (Mandy and Pixie will have thought of some)

Roleplay scenarios

analyse as for ALOBA and feedback as for SET-GO

Summarise the skills learned and ask the group to work out a framework and skills for a telephone consultation.

Which are core skills and which add - on or issue-specific skills?

Again use the actor for insights

FRAMEWORK AND SKILLS

for the telephone consultation

1.      preparation, orientating yourself, having the records if possible

2.      initiating the call

            introducing yourself

            discovering what the patient or relative wants to talk about

            assessing the emotional “climate” of the call

            developing rapport

3.   gathering information

            disease/illness model

            accurate clinical /patient’s and relatives ICE feelings and expectations

4.   explanation and planning

            explain thinking re diagnosis/prognosis

            check patient agrees with you

            suggest management options

            check that patient agrees

5.   offer follow up/safety net

“Add on”  skills include:

·        offer to visit early and then ask for clarification of the problem takes the heat out of whether to visit or not.

·        give advice on management e.g. get an ambulance/ try analgesia etc.

·        challenging constructively

16.45

convene in large group

Closing rounds of what learnt from using actors

Hand out written framework and skills for them to take away

Feedback

References

Curtis P., Evens S.  (1995) The Telephone interview.  In The medical interview.  eds Lipkin et al  Springer-Verlag  New York

Hopton J., Hogg R., McKee I.  (1996) Patients’ accounts of calling the doctor out of hours: qualitative study in one general practice  Brit Med J.  313, 991-987

Males T, Experiences and perceived learning in out -of-hours telephone advice: interview study of ten GPs in a co-operative Education for General Practice Nov 1998 vol 9 pp 470 - 477

Telephone scenarios

·      mother or father whose child has earache who wants a visit (unrealistic expectations) and gets angry if the doctor doesn’t want to visit (could be out of hours -7 pm or middle of the night, coop or a call at say 3.00 pm)

·      wife or husband whose spouse has suddenly “collapsed” while the doctor is in surgery

(receptionist interrupts the doc in the middle of surgery;  patient on further questioning of spouse is sitting in the chair, staring vacantly and not able to speak, poor colour but breathing)

·      depressed patient who is under treatment but can’t wait until Monday to see his own doctor  (Coop session at the weekend)

·      mother whose child has had a fever/vomiting and for two days and isn’t getting any better and is anxious; the child has now developed a rash on the trunk (should the doctor come out of surgery or not?

·      an angry relative who wants to know whether her 22 year old daughter has attended the surgery this morning and the receptionist won’t tell the relative whether she has or not.

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