Zara Aziz: The hidden dangers of phone consultations

What makes general practice both interesting and challenging is that patients do not come in neat little packages. Most days there is usually an uncertainty (or two) in store.

Sometimes the toughest encounters for GPs are the ones that are not face to face. We have recently started online GP consultations in our practice, and although it is early days there are limitations similar to any non face-to-face consult.

Nevertheless, it has still been a useful exercise to trial – patients are less inhibited and voice their concerns and expectations more readily than in a surgery or telephone consultation. This is is no bad thing, although not all expectations are realistic – I struggle to get my head round a page-long description of a rash or undertake an asthma and hypertension review online.

There are hidden dangers. Although many patients will ask for a face-to-face appointment if they are very unwell, there are a considerable number who will use telephone or the internet to get medical advice.

I speak to a patient on the telephone with symptoms of a simple urinary tract infection. She is well otherwise, except for something in her voice - perhaps it is the misery of cystitis that I can hear - that I couldn’t quite fathom.

I am hesitant to prescribe antibiotics over the phone; first she declines to come in citing work commitments. But uncertainty has set in and I do not budge. She agrees reluctantly for the last appointment of the day.

I see her with a medical student sitting in my surgery. It has been an ordinary sort of afternoon, with little in the way of interest or drama – until now. My ‘well’ lady with ‘uncomplicated cystitis’ is not well at all – she is tender in her loin, having full blown rigors and the thermometer reads 40.

‘But you said on the phone that you were fine,’ I say to her, confused.

‘My boss was listening and I am not allowed any more time off sick. He already said he would dock my pay because I’ve had so many loo breaks today.’ She is in tears and I don't know what to say.

I pick up the phone to call the hospital, thankful for my sudden wave of medical intuition.

  • Dr Aziz is a GP partner in north-east Bristol

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