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Telephone Consultation Skills

the good, the bad and the ugly

A Workshop for GP Trainees
by Dr Ramesh Mehay

Telephone consultations made up about 10% of all GP consultations before COVID (2020).   During Covid, they because 95%.  And after COVID – telephone and remote consultations are now part of the new norm.     We reckon roughly 40% of all consultations will be face-to-face and 50% telephone and perhaps 10% remote video.  This will change as IT platforms improve.  The future, within 5 years, may well be 30% f2f, 30% telephone, 40% remote video.

So, this is a skill to learn, polish and master.   It’s here to stay.   We need to become more confident at data gathering, diagnosising and managing things remotely.   Once we are more confident, the fear of missing something or mismanaging a condition need not be so great. 

You will find all your resources for this workshop here.
In the future, if you want to come back to this page: Go to Bradford VTS > Teaching & Learning > Workshops by Ram

Exercises

black corded telephone
Exercise 1: Poll (Telephone experience)

Let’s see how many of you have had IMG experience and what it was like.

Exercise 2 - WordGram (FEELINGS about DOING telephone consultations)
Exercise 3 - Patient with Back Pain
Exercise 4 - WordGram (What percentage of the Diagnosis comes from History and Examination?))

10 Key Points

1: Keep desk clutter free.
2: Headsets make it easier.
3: Before you call, think of something nice & SMILE.
4: Patient annoys you? Stop your primitive brain.
5: Follow your natural curiosity.
6: Signpost throughout the consultation.
7: Empathise.
8: Objective scales 1-10 can help.
9: Explore the patient's circumstances.
10: If unsure of something - stay there and clarify.
Ram's 8-point Telephone Consultation Framework
  1. Opening
  2. Story & Clinical History
  3. PSO + ICE  (IE)
  4. Examination (preliminary)
  5. Diagnosis & Differentials
  6. Further Examination & Test
  7. Management Plan
  8. Safety Netting & FU

OSPEDEMS

Ram's EDF method of Safety-Netting

Ram’s EDF

  • EXPECTED natural course
  • DEVIATION from the natural course
  • FOLLOW-UP: what to do


FOLLOW-UP

  1. Who   (GP, A&E, 111, 999)
  2. How  (phone, go there, make appt)
  3. Time-frame  (next 3 days, 5 days, 7 days.  If within 2 weeks, 3 weeks, 4 weeks…)

Practise, practise and practise. Skills are only every acquired through repeated practise and reflection.

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