One of the first things I learned at medical school was that about 80% of diagnoses are made on the history (patient story) alone. Examination and diagnostic tests are often only used to confirm the initial clinical suspicion and both carry their own risks.We have accepted the need to undertake a clinical “telephone triage” of a patient during out of hours services as appointments are scarce. If this is the right model (which it is) so that the patient can be offered the most appropriate service, why, when appointment time is also scarce in hours, is this not a routine way of providing rapid access to primary care support?
For the last few years we have provided a “telephone triage” GP assessment for ALL patient or carer calls for a new or worsening concern. It has TRANSFORMED our service for the better. Patients and carers LOVE the rapid access (within 30 minutes and quicker when needed) to senior clinical (GP) advice, our receptionists love it because they always have something to offer and our clinical staff love it because we are finally managing and meeting patient need and demand.
We find in many cases (about 60%) we are able to provide the advice, reassurance, information, prescription, certification or even referral the patient requires over the telephone, to the satisfaction of doctor and patient. In the remaining 40% or so of cases either the doctor suggests the patient should be seen in a face to face appointment or the patient prefers to be seen face to face (we would never refuse a face to face assessment). When a face to face assessment is required we are able to personalise the time of the appointment, the length of the appointment and who the appointment is with to the needs and preferences of the patient.
We now even have empty appointment slots – unheard of before.
IT WORKS! So why is it not being adopted? Well, there are clinical barriers – “I don’t like assessing patients on the phone” “I prefer to see the person” “what if I missed something” “won’t it just increase demand”.We find actually, it is safer (doctors assess ALL new health needs which present to the practice and we can always see people of required) and it is by rewarding system to work in – patients get, in the words of Professor Al Mulley – “what they need and no less, what they want and no more”.
Patient have busy lives too and if they are able to get what they need and want over the telephone they will often prefer this, despite what doctors think, patients would probably rather not spend time seeing us in clinic if they can help it.
And there are patient barriers “I want to see my doctor” “I don’t want to tell the receptionist what is wrong with me” ” I don’t like talking on the phone” – actually we find the patient barriers come up much less than the doctor barriers and patients always have a choice, we will ALWAYS see the person if they prefer to be seen.
So, let’s catch up with the rest of society and start with a senior clinical assessment of the patient’s need on the phone and then find the most appropriate service to meet their needs and preferences – in many cases this starts and end with a phone call, and a happy patient at the end of it
Dr Steve Laitner
Clinical Director, GP Access
Salaried GP, Parkbury House, St Albans