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Do you discuss results over the phone?

Recently, two patients contacted my office to be seen because they were unhappy about the communication with their original doctor. I know those doctors well and am aware what a great service they provide to their patients.

Both patients said that they felt “rushed” and “fobbed off” when the doctor explained results over the phone to them.

One patient had a slightly abnormal PAP smear and the cervical biopsy came back negative. The doctor rang to reassure her. The patient requested further tests, which the doctor dismissed as unnecessary.

The other patient had a CT scan for ovarian cancer follow up and raising markers. Not unexpectedly a lesion was found consistent with persistent disease. The doctor rang the patient to confirm that a lesion was found and to discuss management options. The patient felt “rushed” on the phone.

I explained to both patients that their doctor probably just wanted to save them time and money. Both specialists probably felt that they had a relationship with the patient that was strong enough to discuss test results.

I routinely phone husbands or family members after surgery. Relatives and friends often will experience an agonising wait while we are operating on their loved ones. They are very anxious to hear how their wife/mum/sister/relative/friend did at surgery and how the procedure went.

Listening to myself during these phone calls, I notice that I am more generic than when I communicate results in person. I try to focus on positive, encouraging and optimistic aspects. I notice that I steer away from bad news or uncertainty.

On the phone after surgery I emphasize that the patient is well, tolerated the anaesthetic well, the blood loss may have been minimal. She will go to recovery and can be seen in a couple of hours on the ward.

Deliberately I shy away from discussing any great detail, such as residual tumour (if applicable), suspicious lesions that may or may not turn out to be metastasis in the final histopath reports or prognosis.

Not too long ago, I phoned an elderly husband to let him know that his wife had great surgery and was doing fine when she was just waking up from surgery. He was profoundly hearing impaired, which I did not know. “Your wife is well”, I shouted repeatedly. He seemed not to hear me properly. “What, my wife is dead?” he shouted in disbelief. I repeated that his wife was doing very well, indeed and there are no concerns. He started sobbing “Why is my wife dead?”

I did not know what to do now, as he seemed to get himself worked up. I screamed into the phone – and everyone in the operating theatre could hear me clearly – “Your wife is doing well, she is alive!!!!!”

This is just another example of a difficult phone conversation, and why doctors like me are uncomfortable with such patient/ relative contacts over the phone.

Can technology help us to make mobile conversations more patient friendly? I do book video or skype consultations; however they need to be booked like any other consultation and they are put in the diary. I do that because some patients have great difficulties getting to my clinic physically.

The ideal patients for online consultations are those who live remotely and are not sure if they require surgery or need to see me. Take the young woman who would require a day and a half of travel to see me. She posted me her medical imaging files, we got hold of the pathology results and I was able to review those beforehand. During the skype consultation we found that she will not need to see me. Instead she will have some repeat tests and can check the results with her local doctor. I felt really good about this consultation because it saved my patient a lot of time and money for travel and accommodation.

Other than that I avoid discussing results over the phone. Often patients don’t answer the phone. You leave a message but hope that no one else than the patient herself will have access and listen to it. When the patient returns the call, will you be free and in the right frame of mind to converse emphatically?

The same is true for the patient answering the phone.  Will you tell her about an abnormal test result when she checks out at the supermarket, lots of people around her and the kids screaming? You simply would not know.

Generally, I prefer a face-to-face consultation. Under special circumstances I will agree to phone-results but will book the consultation in the diary as if it would be a regular consultation in the surgery. This will ascertain that we both are prepared to take the call in a setting that suits both of us.

What is your experience?

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