Monday, 30 April 2007

Hanging on the telephone

I'm slowly getting used to blogging, which is just as well because since this blog was mentioned on NHSBlogDoctor on Saturday I've been getting quite a few visitors and lots of interesting comments. Thanks for the mention, Dr Crippen. Some of the most interesting comments come from lay people, because they don't share the “medical” view of things. You are all most welcome.

While commenting on the “Skipping and Singing” blog I talked about acting:
Doctors have to "act" more than many other people. This doesn't mean pretending to be something that you're not: it means finding elements inside yourself which will be useful, and projecting them outside. My children know when I have my "doctor's voice" on, which happens when I am giving medical advice to someone at home or on the phone. By nature I am a little unsure of myself and not very bossy, but when necessary I reach inside and pull out the confident and self-assertive part of me.

For some time I have been aware that I tend to shy away from ringing up colleagues on the phone, preferring to communicate by letter. I wondered whether this was because I was not being sufficiently assertive, and so recently I tried ringing again. An elderly gentleman with bad chronic obstructive pulmonary disease had been discharged from the respiratory clinic but was still considerably incapacitated. He told me that COPD nurses used to visit him at home, and wondered whether this could happen again. My first try reached an answerphone, but on the second occasion I got through to a most helpful nurse who volunteered to go and see him the very next day. Not bad for a first attempt.

Next I faced the problem of a patient with interesting things going on in his chest, where the language and cultural barriers have made hospital assessment almost impossible. His recent chest X-ray suggested the possibility of tuberculosis, so I spoke to his chest consultant. This involved ringing the secretary and sending an email, following which the consultant rang me back. We discussed our patient in some depth and I told the consultant that he was coming to see me in surgery today, with an intepreter. The consultant offered a clinic appointment on Friday and suggest that I “just ring the clinic” when the patient was with me, to fix an appointment time for him while the interpreter was there. What could possibly go wrong?

So he turned up this morning with an interpreter and we had a very jolly conversation, I explained what a diagnosis of tuberculosis might mean and he agreed to go along to the clinic on Friday. I said “please wait for a few minutes in the waiting room while we find out the time of your appointment”. I delegated this task to Myrtle, our practice manager who is wise and wily in the ways of hospital administration. It took her half an hour to try and make the appointment, and she eventually found out that the only person in the entire world who could allocate an appointment for Friday's clinic was not available. The best we could arrange was to have my patient return tomorrow (without an interpreter) in the hope that we have managed to make an appointment by then, and that he will understand what we tell him.

This was so annoying. After an efficient consultation with me, the patient and the interpreter had to hang around for another half hour and still nothing had been arranged. It was a waste of my practice manager's time and a waste of the interpreter's time. And it reduces the chances of the patient turning up for his appointment.

I now recall what put me off ringing my hospital colleagues in the first place.


Anonymous said...

People who are comfortable 'acting' in a role when necessary - as you pointed out doctors need to do on occasion - are generally pretty good at picking up contextual clues. And you gave very sound advice to the med student about 'body language', which indicated to me that it's something that you're sensitive to. The dearth of such feedback is probably one of the reasons why you are so uncomfortable when dealing with issues on the phone.

Anonymous GP said...

Thank you so much for your wise comment on my blog. I hope I can put the advice into practise. Thank you for posting about your experiences, it is very interesting.

Dr Andrew Brown said...

Thanks for your kind remarks, Janeway. It's true that I'm not keen on telephone transactions unless I know the other person very well and can assess the tone in their voice. But doctors are increasingly under pressure to consult using the telephone, particularly out of hours. There may be evidence to show this can be done safely, but I think it's second-class medicine.

Skinnyminny8 - you're most welcome. As you grown in experience and knowledge and confidence your body language will change, but if you can speed up those changes then so much the better.
I'm glad you find my stories interesting. Our job may be stressful but it's rarely dull. :-)