Stages of the Telephone Consultation

Learning objectives

• To enable Trainers to understand some of the issues relating to teaching effective telephone consultation techniques to their Registrars
• To increase knowledge about the differences between face to face and telephone consultations
• To explore issues relating to:
• GP/patient expectations styles techniques on telephone consultations
• To produce simple guidelines on methods of teaching and practising safe & effective telephone consultations.

The stages of the telephone consultation

Stage 0	PREPARATION	any available information about the caller anticipate time delay note taking
Stage 1	TRUST	identify yourself tone of voice acknowledging caller’s emotions acknowledging caller’s previous experience of health services letting the caller know that they are being heard * empathy
Stage 2	EXPLORATION	questioning choosing open or closed forms probing through reflection
Stage 3	CLARIFICATION	caller’s agenda caller’s understanding reflecting summarising and paraphrasing allow time for the caller to talk including silences
Stage 4	ACTION	empower the caller to take action where possible clarify what action you will take on their behalf check that agreed plan is understood
Stage 5	END	when the caller feels heard, respected and understood end the call for the caller not for yourself
Stage 6	AFTER THE CALL	time to reflect note taking other action

Improving The Telephone Consultation

Some Simple Guidelines

• use any available records
• try and answer call in quiet place
• introduce yourself: who : where from (surgery: co-op etc.)
• establish identify of caller, relationship to patient
• patient details: name: age etc.
• try to talk to patient
• remain calm/polite: voice tone: speed of speech: right frame of mind
• enquire about reason for call
• elicit any other relevant information
• find out patients (callers) expectations/worries
• clarify mutual agreement
• make a plan with patient
• check advice understood/ask caller to repeat
• summarise/reflect
• offer follow upland how/when to access it
• end positively and clearly
• make notes and housekeeping

Communication Style

An individual’s personal style of communication can be considered as their preferred way or ways of interacting. Each of us will have a different range or repertoire of skills which we are inclined to draw upon in combination during any interpersonal interaction. In relation to patient consultations and telephone consultations in particular this can be thought of in a number of ways. For example, Heron’s framework of types of interaction can be used to analyse the range of different types of interaction employed during a consultation and to review alternative ways of handling specific types of calls. Furthermore, our inclination to initiate certain types of interaction during a consultation may be influenced by the communication techniques we are skilled in using.

Heron’s six category intervention analysis (adapted)

AUTHORITATIVE	Simple Informational seeks to impart or gather straightforward knowledge and information Prescriptive or advisory seeks to direct the behaviour of the client Confronting seeks to raise the consciousness of the client about some limiting attitude or behaviour of which he is relatively unaware
FACILITATIVE	Cathartic seeks to enable the client to discharge, to abreact painful emotion, primarily grief, fear and anger Catalytic seeks to elicit self-discovery, selfdirected learning, living and problem-solving in the client Supportive seeks to affirm the worth and value of the client’s person, qualities, attitudes or actions
SPECIFIC TECHNIQUES	Summarising to reassure the caller that you are listening to clarify what you have heard to signal moving on to another phase of the call Reflecting the caller’s own words as a verbal nod to probe gently to offer a challenge Questioning choosing open constructions to allow a wide exploration of the caller’s concern or closed questions to narrow the focus by ruling in or out specific options