Abstract
While a substantial number of patient contacts with internists occur over the telephone, there is little information about the nature and content of these encounters. The authors surveyed patient-initiated phone calls that resulted in a physician response for seven general internists. Over a six-month period, 1,377 telephone encounters met inclusion criteria. Calls were generally short, 73% lasting 4 minutes or less; mean time per call was 3.4 minutes. The doctor spoke to the patient directly 79% of the time and to a relative in 15% of the calls. The most common reason for phoning the doctor was a symptom or medical complaint (45% of all calls), followed by questions about test results (16%) and medication queries (14%). Over 60% of calls dealt with chronic conditions. Diagnoses encountered over the telephone were similar in frequency to those seen in outpatient clinic visits; however, a notable proportion of calls dealt with topics beyond the scope of traditional internal medicine training programs. A medication response was the reason for 22% of the phone calls. The doctors recommended changes in follow up 12% of the time; these included early visits to the clinic, evaluation in the emergency room, and direct admission to the hospital. An appreciation of the scope of telephone medicine in terms of both medical skills applied and time committed is germane to trainees and practitioners alike.
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References
Gorrell RL. Taming the terrible telephone. Physicians Management. 1978;18:40–4.
Gilmore A. How good is your office telephone system? Can Med Assoc J. 1984;130:1047, 1049.
Samuel O. What annoys me most. The telephone. Br Med J. 1983;297:1599–600.
Murphy D, Dineen E. Nursing by telephone. Am J Nurs. 1976;75:1137–9.
Strain JE, Miller JD. The preparation, utilization and evaluation of a registered nurse trained to give telephone advice in a private pediatric office. Pediatrics. 1971;47:1051–5.
Perrin EC, Goodman HC. Telephone management of acute pediatric illnesses. N Engl J Med. 1978;298:130–5.
Brown JM, Helling DK, Alexander MM, Burmeister LF. Comparative evaluation of clinical pharmacists and physicians in the management of medication-related telephone calls in family practice offices. Am J Hosp Pharm. 1982;39:437–43.
Hessel SJ, Haggerty RJ. General pediatrics: a study of practice in the mid-1960s. J Pediatr. 1968;73:271–9.
Spencer DC, Daugird AJ. The nature and content of physician telephone calls in a private practice. J Fam Pract. 1988; 27:201–5.
Hallam L. You’ve got a lot to answer for, Mr. Bell. A review of the use of the telephone in primary care. Fam Pract. 1989;6:47–57.
Curtis P, Talbot A. The telephone in primary care. J Comm Health. 1981;6:194–203.
Mendenhall RC, Lloyd JS, Repicky PA, Monson JR, Girard RA, Abrahamson S. A national study of medical and surgical specialties. Description of the study instrument. JAMA. 1978;240:1160–8.
Jones J, Clark W, Bradford J, Dougherty J. Efficacy of a telephone follow-up system in the emergency department. J Emerg Med. 1988;6:249–54.
Wood PR. Pediatric residency training in telephone management; a survey of training programs in the United States. Pediatrics. 1986;77:822–5.
Fleming MF, Skochelak SE, Curtis P, Evens S. Evaluating the effectiveness of a telephone medicine curriculum. Med Care. 1988;26:211–6.
Dunn EV, Norton PG, Dunn RC. Using simulated patients to teach family practice residents to manage patients by telephone. J Med Educ. 1987;62:524–6.
Barker LR. Distinctive characteristics of ambulatory medicine. In: Barker LR, Burton JR, Zieve PD. Principles of ambulatory medicine, 2nd ed. Baltimore: Williams and Wilkins, 1986;3–16.
Greenlick MR, Freeborn DK, Gambill GL, Pope CR. Determinants of medical care utilization: the role of the telephone in total medical care. Med Care. 1973;11:121–34.
Fischer PM, Smith SR. The nature and management of telephone utilization in a family practice setting. J Fam Pract. 1979;8:321–7.
Sloan PD, Egelhoff C, Curtis P, McGaghie W, Evens S. Physician decision making over the telephone. J Fam Pract. 1985; 21:279–84.
Brown JM, Helling DK, Burns EA, Burmeister LF, Rakel RE. Patient care telephone calls received in family practice offices. J Fam Pract. 1982;14:527–32.
Westbury RC. The electric speaking practice: a telephone workload study. Can Fam Phys. 1974;20:69–76.
Harr E, Halitsky V, Stricker G. Factors related to the preference for a female gynecologist. Med Care. 1975;13:782–90.
Cooke M, Ronalds C. Women doctors in urban general practice: the patients. Br Med J. 1985;290:753–5.
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Received from the Division of General and Geriatric Medicine, Department of Medicine, and the Department of Family Practice, University of Kansas Medical Center, Kansas City, Kansas.
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Johnson, B.E., Johnson, C.A. Telephone medicine. J Gen Intern Med 5, 234–239 (1990). https://doi.org/10.1007/BF02600541
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DOI: https://doi.org/10.1007/BF02600541