Dr Michael Devlin
There are innovative ways of eliminating error and misunderstanding from GP-consultant telephone consultations
Most doctors recognise that telephone contact with patients and colleagues is a compromise. A face-to-face meeting allows you to pick up on the non-verbal and para-verbal cues that are a major part of oral communication, but time and circumstances usually mean a phone conversation is more practicable.
A challenging area of current clinical practice is the advice a GP obtains from a consultant colleague. What if you note the dose of a suggested drug inaccurately, or misinterpret what is said about the need for the patient to be referred to the specialist? Can technology help where contact has to be by telephone?
An innovative solution suggests it can.
Bristol-based GP federation, GP Care, won the Best Use of Media and Technology category in the GP Enterprise Awards 2014 for Consultant Link, a new system that facilitates GP-consultant telephone contact and then stores the conversation in the patient's records.
The system allows GPs direct and near-instant access to consultants via mobile phone. The service routes calls to local hospital consultants. Each call is digitally recorded, and the digital files are then automatically uploaded into the GP record and sent to the consultant's employing hospital for medico-legal purposes.
Rather than a brief note of the discussion in the GP records, there is a full recording available
In the pilot, calls lasted an average of three minutes, so allowed consultants to respond during their normal work schedule. More than 65% of calls did not lead to a hospital referral or admission.
The benefits are easy to see. Rather than a brief note of the discussion in the GP records, there is a full recording available. Still in doubt about the dose recommended by the consultant? Easy - go into the digital file and it will be recorded, removing any error that could be caused by inaccurate transcription of the discussion.
Until this scheme is adopted widely, the MDU has practical advice for GPs.
1. When you call a colleague for advice, try to make sure you get their details:
- Contact numbers (telephone and bleep)
- Consider asking for their email address (see later)
2. Consider having a dedicated notebook to record discussions with colleagues if you are away from your desk, perhaps on visits. Make sure the discussions are then entered into the patient's clinical records.
3. An email confirming the advice could be helpful - perhaps the advice was detailed and technical. There can be no question of advice being misheard in an email and a copy could be kept in the clinical records.
4. How do you safety-net such calls? What agreement is there on when further advice might be necessary?
5. Are there circumstances where you feel telephone advice is inappropriate? Does the patient need to be seen by the consultant, rather than simply being discussed?
6. Think about auditing the quality of telephone advice consultation. You can use it as part of your evidence of quality improvement activity to support revalidation.
7. Good telephone communication technique needs practice, as with other skills. There may be benefit in ensuring GP registrars develop these skills using role-play or similar.
Even the best systems sometimes go wrong, and mistakes happen. If a patient suffers harm as a result of telephone communication, or for any other reason, try to put that right and tell them what happened. An apology is usually appropriate; it should be given early and be sincere.
Be aware that for practices in England registered with CQC a statutory duty of candour may apply to certain categories of patient safety incidents, particularly those that are serious. Follow your practice's clinical governance procedures for patient safety incidents, and contact the MDU for advice and support.
Dr Michael Devlin
Head of professional standards and liaison
Michael was an MDU medico-legal adviser for 15 years, latterly as head of medico-legal services, before taking up the new role of head of professional standards and liaison. He sat on the FFLM's academic committee and was previously treasurer, and an examiner for the MFFLM. He has published widely on medico-legal matters, and has significant experience in teaching and assessing knowledge in medico-legal subjects.
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