CSA troubleshooting: 8 - Telephone consultations

The CSA can include performing consultations over the telephone.

Just as in real life, telephone consultations are a regular feature of the CSA. Not every exam day will have a telephone consultation, but each room on the CSA exam circuit is equipped with a telephone.

How it is covered in the CSA exam

If your next case is a telephone consultation, this will be indicated on your case list.

When the case starts, you will use the phone to communicate with your patient on the other end. The examiner will be listening in to both sides of the conversation.

The patient could be ringing for advice only, or to request a visit. Your case notes will tell you whether you are in normal daytime surgery or in the out-of-hours centre. The caller may be ringing on behalf of a patient. Urgent or emergency situations could be covered, as well as simple requests for advice about medication or self-limiting illnesses.

What to do in the exam

Listen to the patient's story and find out what they are expecting you to do. Do not jump to conclusions - not every patient wishes to come to the surgery or the out-of-hours centre, and suggesting they will receive an immediate visit for a trivial complaint will not impress the examiner.

You will not have visual cues to go by, so take particular note of verbal cues and other indicators, such as tone of voice. Conversely, as the patient cannot see you, you will need to let the patient know they are being heard, so be verbally empathic.

Because you cannot examine the patient, checking for red flags and giving clear messages about safety-netting are important. If it is a third party consultation, remember to think about patient confidentiality.

If you put the phone down and terminate the consultation before the end of the exam, but then decide you want to say something else to the patient, you may pick up the phone and continue the conversation.

How to prepare

Carry out as many telephone consultations as possible, where you can get accurate feedback from a GP trainer or a telephone triage nurse in the surgery or out-of-hours centre.

It is preferable for the trainer listening in on your consultation to hear both sides of the conversation. If you have the facilities for this, the out-of-hours centre could be an ideal place to practise cases where you will have no past medical records, and there is a high likelihood of acute illness.

Learning Points
  • The patient could be ringing for advice only, or to request a visit but emergency cases may also be covered.
  • Listen to the patient’s story and find out what it is that they are hoping or expecting you to do.
  • Take particular note of verbal cues and other indicators such as tone of voice.
  • Because you will be unable to examine the patient, checking for red flags and giving clear messages about safety-netting are particularly important.
  • Dr Denney is an MRCGP examiner, and a GP in Edinburgh

Read more from this series and find other information for GP registrars

Photo: JH Lancy

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