Expanded physician and residency training in telephone medicine is needed

To prevent medical mishaps with patients caused by telephone communication failures, researchers at Yale School of Medicine and the VA Connecticut Healthcare System report in the October issue of Journal of General Internal Medicine that expanded physician and residency training in telephone medicine is needed.

In telephone communication, the lack of visual cues indicating emotions may lead a physician to assume that patients take news of test results better than they actually do, the authors write. To assess the accuracy of communication, the researchers developed case studies for common telephone situations physicians and patients might face. The cases include giving sensitive test results, handling requests for narcotics, dealing with the patient who is not sick enough for the emergency room, inappropriate late night calls, unintelligible patients and getting information from family members.

In one case study, a physician calls a patient to deliver test results. When the physician asks the patient if there are any questions, the patient says, "No." During a later in-person meeting the physician discovers the patient had not spoken freely during the call because others were in the room.

"Checking whether the patient can speak freely is a simple step in the communication process that could lead to patients asking informed questions that could potentially save their lives," said first author Anna B. Reisman, M.D., assistant professor in the Department of Internal Medicine at Yale and at the VA Connecticut Healthcare System. "Physicians should also take the time to listen and explain carefully."

Past studies have shown that although 25 percent of interactions between physicians and patients occur on the telephone, only six percent of residency programs teach telephone medicine.

Reisman said case studies, as part of a curriculum in telephone medicine or in medical errors, will result in better doctor-patient communication. "The many benefits include enhanced diagnostic accuracy and improved patient satisfaction," said Reisman who points out that poor communication has been associated with increased risk of malpractice lawsuits.

Reisman's co-author on the study was Karen E. Brown, M.D., of Yale School of Medicine.