Consultation Skills

Telephone Consultations

Telephone consultations are a core part of a GP's work

Yes, telephone consultations are a part of General Practice.   You will do all sorts of things over the telephone…

  1. Do normal consultations (but clearly without the face-to-face contact)
  2. Triage
  3. Prescribe/Investigate or even refer!

And of course, you are even tested in the way you do telephone consultations by the way of the Audio-COT!   But depending on what you are doing on the telephone requires different skills and that is what this section is focused on.  Even though you cannot see the patient, there is a lot of things you can do on the phone other than just asking the patient questions!   For example, if a patient complains of tummy pains and you want to make sure they don’t have peritonitis, did you know that you can ask them to sit/lie on the floor and then try and get up (and listen for incredible pain when doing so).   This is just one example; there’s lots more.  Got you interested?

And just like face-to-face consultations go well if you work on your communication skills, the same goes for telephone consultations.

Hints & Tips for doing telephone consultations

I’ve included some wonderful helpful documents in the DOWNLOADS section above.  Please read them – especially the document called “Important Things About Telephone Consulting and Triage”.

  1. Take five deep slow breaths before you pick up that phone.   
  2. Always introduce your self and ask how you can help.
  3. Let the patient speak
  4. If the patient says anything that pisses you off – put it to one side.   Any negative thoughts – put to one side (for example a patient wanting antibiotics, you might thing “I don’t think so”.  
  5. Instead, say something like “Okay, that’s possible but before anything else, do you mind if I ask you a few more questions about what’s going on?”.  Develop a story, develop a rapport and believe me, it will be ten times easier to say “Do you know what, I think things will probably settle in the next 5 days and I think you might find you’ve gone through the worst of it”.  
  6. When you say or explain something, you need to sound confident.
  7. But at the same time be interested in the patient – genuinely interested – and show empathy where appropriate “Oh goodness, it sounds like you’re having quite a bad time aren’t you?”
  8. If something is important, then signpost to say it is important.  “Now, there are two really important things I want you to watch out for”.
  9. In terms of a parent ringing about an ill child, in order to assess how ill that child is, ask them “What’s little Jack doing at the moment mum?”.  If she says “sat on the floor watching Dr Khan”, then you know he’s okay.   But if “laid on sofa, just asleep all the time, sometimes waking up when I feed him”, then he clearly needs to be seen.
  10. Don’t assume just because a patient is at work that they are okay.   Would you say a patient at work but experiencing tight chest pains going up the neck and down the left arm is okay?
  11. Do all your usual stuff that you would do in surgery.  What I mean by this is that the history taking has to be equally thorough.  If someone is depressed – ask about all the ‘biological’ features of depression (not just some of them) as well as doing a suicidal risk assessment.
  12. And finally, when giving advice – be very clear.  Don’t say “ a few days”.  And don’t say “in about 2 or 3 days”.   Instead say “I expect you to improve over the next 7 days.  I tell you what, if things aren’t better by Monday, come and see me.  But in all probability you’ll hopefully have made a great recovery.  How does that sound?”

How do they test telephone consultations in the CSA?

Some of you will get a telephone consultation to do in the CSA.      You will be basically in a room with no one there.   You will be given a brief on the table to read.  You then call the patient using the telephone provided.  And the examiner will be somewhere else listening in.

An example

Here’s and example of how to do a telephone consultation.  Please note, the set up in this scenario is not the same as described above – because these are trainees practising.  

I’ve provided this as an example of how you might practice telephone consultations in your CSA groups.   

The most important thing is to turn your backs to each other so that you cannot see each other’s facial expressions and behaviour – because that is what is absent in telephone consultations.  You have to work things out from the speech – the content of that speech, the tone and pitch of that speech, the nuances and so on.  

Please leave a comment if you have a tip, spot an error, spot something missing or have a suggestion for a web resource.
And of course, if you have developed a resource of your own, please email it to me to share with others.

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