Last week I posted some incredibly powerful videos on how to conduct effective online consultations so this week I thought it fitting to review a qualitative analysis paper that looks at why telephone consults are failing. Written by Heather Hewitt, Joseph Gafaranga and Dr Brian McKinstry FRCGP from the General Practice Section at the University of Edinburgh and published in the May 2010 British Journal of General Practice the paper is titled “Comparison of face-to-face and telephone consultations in primary care”.
This paper is the first I’ve ever seen that compares the communicative practices of doctors and patients in face-to-face and telephone consultations in order to generate more understanding on the contrasts between the two consulting modes.
I’d thoroughly recommend it to anyone interested in consulting with patients remotely, and I’d be really keen to see the team take a look at the revolutionary potential for Interactive Patient History Taking tools to enhance these consultations (find out more about these by watching these educational videos from the Mayo Clinic’s John Bachman MD).
Here’s the key points (comment below to request a scan of the paper) or join the RCGP/BJGP discussion forum here:
“it was found that telephone consultations were typically shorter than face-to-face meetings, and included less disclosure by patients, less questioning by doctors, and less discussion of problems”
“(the findings) suggest that telephone consultations are typically treated by both doctors and patients as an appropriate medium for discussion of single non-complex problems, but casts doubt on the suitability of the telephone for discussion of new acute problems, since they are almost always referred on for discussion face-to-face”
“the study analysis… …raises questions about levels of attention when patients call to discuss self-diagnosed conditions or treatment concerns”
In the 72 telephone consultations that made up the study not a single patient “presented more than two problems”
“The most interesting aspect of the question use in the study sample is its low incidence when patients discuss self-diagnosed or treatment problmes over the telephone or raise new concerns opportunistically at the end of face-to-face consultations”
“low levels of elicitation of additional concerns in the telephone channel suggest that they (=Doctors) expect (telephone) consultations to be mono-topical”
“Patients also contribute to the shorter length of telephone consultations by treating them as mono-topical… …patients consulting by telephone do not introduce additional health-related topics or small talk”
The study also points to a published paper: Telephone Consulting in Primary Care: a triangulated qualitative study of patients and providers (Br J Gen Pract 2009;59(563):e209-e218) by Dr Brian McKinstry that is worth a more detailed analysis as it also shows “that both Doctors and Patients consulting by telephone expect to pursue limited agendas”
“there was evidence that Doctors carried out only cursory verbal examination when patients consulted by telephone about self-diagnosed conditions or treatment problems”
If we want to do anything with phone call consultations with Doctors that is more than “mono topic” or “refer to a physical meeting” we need to empower patients and their doctors with history gathering tools.
In 2005 it was from this appreciation that we decided to integrate the Instant Medical History Questionnaire tools (from Primetime Medical) into the 3G Doctor consulting process.
In 2010, we have an internet awash with high quality rich video content and communities of patients educating one another, I fail to see any other cost effective way of serving the varied, multi topic Doctor advice needs of the informed patient.