GPs 'should not diagnose over the telephone'

Telephone consultations should be used for follow-up appointments rather than for diagnosis and acute triage, researchers have recommended.

When Lothian GP Dr Brian McKinstry examined use of telephone consultations in Scotland, he found that urban GPs use telephone consultations to manage patient demand.

Instead, they should increase their use of the telephone to consult with patients with long-term or recurrent conditions, said Dr McKinstry, who is also a primary care researcher.

He added that routine consultations such as test results could be managed by telephone. 'We don't use the telephone for follow-up because we haven't got ourselves organised,' Dr McKinstry said.

GPs from Lothian and the Highlands told Dr McKinstry's team that they had 'well-established triage systems'.

But practices rarely had 'formal systems to provide routine telephone follow-up appointments to deal with continuing problems,' Dr McKinstry wrote in the June issue of the British Journal of General Practice.

Instead, rural GPs used the telephone to avoid long journeys while urban GPs 'mainly used telephone consulting to triage acute presentations'.

This led to 'uncomfortable decisions' when doctors were unable to examine patients.

Several GPs told the researchers that telephone consulting increased access to 'an already overstretched service'.

'Until the safe use of telephone triage is fully understood and agreed upon ... policy-makers and clinicians should consider using the telephone primarily for ... follow-up appointments,' Dr McKinstry concludes.

From focus groups and questionnaires, Dr McKinstry found patients and doctors felt the lack of visual information made telephone consultations less safe.

Br J Gen Pract 2009

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