Recently I had lunch with two retired physician friends and during our chit chat about past and present medical practices, we touched on the rise of telephone consultations. Calling a doctor on the phone is nothing new. In my time in general medical practice in the 1950s to the late 1960s, patients usually called me directly at my home after office hours or left messages with my dedicated telephone answering service. Most of those calls were short, reporting some acute symptomology, or even an emergency, like a fall. In those days, emergency departments were not used like they are today and our usual answer to the caller was, “Okay, I shall be making a house call shortly.” In my time, two to four house calls per day was a normal part of a general medical practice. Some of the house calls were prearranged visits following a stay at the hospital, but other calls usually had some urgent components, particularly with children getting sick, or elderly patients requiring attention. In retrospect, the practice style led to a relationship of mutual trust or emotional affinity with the patient and the family. Understanding a family’s living situation was of great assistance in managing patients with chronic conditions, and house visits often provided a gentle but significant opportunity to offer health-related guidance to the whole family.
Hardly anyone would expect a doctor to make a house call now. What has emerged is a nonurgent telephone visit, arranged by the doctor to replace, for whatever reason, an office visit. Recently, I had such a prearranged phone call at 7 a.m., initiated by the doctor’s office, to review my status over the phone, instead of my previous, usually 6-monthly office visit. I had no problem with this arrangement. With my medical background, I more or less knew what the doctor wanted to know, and I certainly knew what I wanted to ask him. I was also quite aware of the time limitations of the phone call.
In contrast, I have heard about disappointing experiences with these prearranged phone visits from several friends, including one who is now 90 years old. The complaints were similar. My friends were caught off guard. On one hand, they did not quite follow or understand what the doctor wanted to know and thus did not have well-organized answers to the doctor’s often pointed questions. On the other hand, they often had too many unorganized questions to the doctor, some not relevant to the main point of the phone call, yet to the patient, certainly of importance. Not surprisingly, some of the phone visits were quite disappointing to my friends, and some could also have been quite disappointing to the doctors.
My retired doctor friends at our lunch have had a great deal of experience with preoperative evaluations of many patients, both short durations (as in emergencies) and longer durations (as with preoperative clinic bookings). They sympathized with the potential frustrations of both the patients and doctors. They thought that with modern technology the doctor’s office perhaps could forewarn patients about a couple of things to help ensure the phone conversation is as useful as possible for both parties.
Here are our combined suggestions, which we present from our points of view (as both physicians and patients):
- When booking phone appointments, the MOA should ask the patient, “What is the most important thing you want to discuss with the doctor?” and explain that the call would last X minutes. Similarly, if the doctor is initiating a call, there should be a reason given.
- Patients should be advised to write down a short list of the key points to be covered in the conversation, starting again with the most important point, by focusing on the question, “What matters to me?”
- If patients have access to a confidential patient portal, then that list could be sent in anticipation of the call. The list would also help the doctor organize the phone meeting’s agenda.
As I was walking home from our lunch, I wondered if medical student and resident teaching programs include rehearsals of phone visits. Nothing is simple, including changing how medicine is practised, but we must find acceptable solutions to an emerging medical care style and the problems related to it.
I wish to acknowledge with many thanks that the idea, and much of the content for this post, came from my lunch colleagues.
—George Szasz, CM, MD
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This post has not been peer reviewed by the BCMJ Editorial Board.
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