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Original Paper - Full-length version

Comparison of face-to-face and telephone consultations in primary care: qualitative analysis

Heather Hewitt, Joseph Gafaranga and Brian McKinstry
British Journal of General Practice 2010; 60 (574): e201-e212. DOI: https://doi.org/10.3399/bjgp10X501831
Heather Hewitt
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Joseph Gafaranga
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Brian McKinstry
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  • Article
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Article Figures & Data

Tables

  • D:doctor
    P:patient
    ?rising intonation
    .a stop indicates the micro-interval between segments of speech
    (.)a stop in round brackets indicates a pause of less than one second
    (2)a number in round brackets indicates a pause timed to the nearest second
    ::a colon indicates lengthening of a sound with additional colons indicating further lengthening
    nounderlining indicates a word spoken louder than those around it
    pres-a dash immediately after an item indicates that the speaker has broken off before completing the utterance
    [square brackets on successive lines indicate the beginning of simultaneous
    [speech
    = =equals signs indicate that there is no interval between adjacent utterances
    {mhm}curly brackets enclose brief utterances made during another speaker's turn, which show acknowledgement of what is being said
    ((sighs))text in round brackets indicates either contextual information or non-verbal vocalisations
    (?guess)text in round brackets preceded by a question mark indicates an educated guess
    hh/haindicate units of laughter
  • 1P:hello?
    2D:hello . it's Dr Macintyre here from the health centre . I got a message to phone
    3
    4P:oh right . yeah . who . who's this?
    5D:about Leslie Kirkness
    6P:yes . that's right . aye
    7(1)
    8D:it's Dr Macintyre here
    9P:right . e:rm . what it is is . I've just come back from holiday this morning
    10
    11(.)
    12D:aha
    13P:and . my ankle . from m- . well ((several words unclear)) for another reason is . is really swollen up
    14
    15D:aha
    16P:and . I seem to have . the . the . the (?likes) o'mosquito bites and everything
    17
    18D:aha
    19P:but it is really swollen and pretty painful
  • 20D:and where were you on holiday?
    21P:erm . we were in Greece . e- in . er . an island
    22D:right
    23(.)
    24D:and it's just the one ankle that's swollen?
    25P:yes
    26D:right
    27P:it's just when I got off the plane it . it really . it was throbbing a bit and . I noticed it was swollen
    28
    29D:aha
    30(.)
    31P:I thought I'd better just find out what's wrong wi'it
    32(1)
  • 33D:yeah . well . I think probably we want to have a look at that . erm
    34((inbreath)) right . if we (.) if I get you to come down at erm .
    35eleven fifty?
    36(.)
    37P:yes . that sounds [alright
    38D: [is that okay? . and er we'll have a look at you
    39then . not giving you very long is it . I'm giving you five minutes .
    40right . will you pop down in about five minutes
    41P:yeah . I'll just come across then . [(?doctor who?
    42D: [okay . that's great
    43P:Dr Macintyre? . eh
    44D:it's Dr Darwin
    45P:Darwin . [right . okay
    46D: [okay . right
  • 47P:right . fine . bye
    • View popup
    Table 1

    The different types of consultation.

    1 concern2 concerns3 concerns
    Consultation topicFtFCaTCaFtFCTCFtFCTCTotal
    New symptoms only912––1–22
    Ongoing treatment3–344–14
    New symptoms and ongoing treatment––8–2–10
    Administrative needs–7–1––8
    Treatment problem29––––11
    Total14281157–65
    • ↵a FtFC = face-to-face consultation. TC = telephone consultation.

    • View popup
    Table 2

    The different ways a first patient concern is introduced.

    ExampleFace-to-face consultation, n (%)Telephone consultation, n (%)
    Doctors make direct enquiries
    “Example24 (75)17 (52)
     D:come in
    (4)
     P:hi
     D:have a seat
    (4)
     D:well (.) what can we do for you?
     P:well (.) you know I was up here before . I had the Morton's neuroma
    Doctors give indirect signals
    Example3 (9)10 (30)
     P:hello
     D:hello . it's Dr Macintyre here from the health centre
     P:[oh yes
     D:[got a message to pho:ne Olivia McDonald
     P:right . aye . it's . it's for my daughter . she's e:m (.) I spoke to the health visitor this morning [she suggested I speak to you
     D:[oh right
     D:aha
     P:em . she had a wee eye infection
    Patients initiate disclosure
    Example5 (16)4 (12)
     P:hello?
     D:hello: . Mrs Haston?
     P:oh hello do[ctor Devine
     D: [hi there
     P:[thank you for calling me back
     D:[hi there
     D:[no problems
     P:[((inbreath)) . e- . I'm just wondering if you've had any: more progress in . in . erm (.) you know . in in . [in getting me the: patches for the Lide .
     D:[about the patches
     P:Lidocaine patches
    Doctors give test results
    Example–2 (6)
     ((opening missing))
     D:whether or not you would mind if we record . the conversation
     P:no probl[em
     D: [is that alright with yo[u?
     P:   [ye:s
     D:is that alright? . [(alri(h)ght hh hh hh hh)
     P:  [(?that's oka:y)
     D:well . having done that then . I . I just wanted to catch up with you . two things really . cos your bloods results are back
     P:right
     D:I was pleased with them all really
    Total3233
    • View popup
    Table 3

    The different ways additional concerns are introduced.

    ExampleFace-to-face consultation, n (%)Telephone consultation, n (%)
    Patient discloses additional concern in response to additional enquiry by doctor after first problem has been dealt with
    Example7 (28)1 (20)
     D:[we'll just leave your medicines as they are
     P:[well I thought I'd better let you see
     D:so that's okay . and what's happened with your neuroma then?
    (.)
     P:well . it's fine
    Patient announces two concerns in response to opening enquiry by doctor and additional concern is reintroduced by doctor or patient after first problem has been dealt with
    Example6 (24)–
     D:what can I do for you?
     P:ahm . basically ahm . just wanted to come in for a check-up and I'm also on the last packet of my Microgynon pill
    Patient discloses additional concern after first concern has been dealt with
    Example12 (48)4 (80)
     D:with anything like this . keep an eye on it if there's changes happening there in the skin or on the foot
    (1)
     D:or it's changing just . or anything that happens elsewhere in the body for example let's have another look at it
    (2)
     P:that's . really got nothing to do with it . see that wee bump there?
     D:yeah
     P:I've had that for about 4 years
    Total255
  • D:and is the e:ye itself red or anything?
    (1)
    P:e:m . no
    D:no
  • D:okay . so I- you- you're not taking ibuprofen now and you've had no chest pains since you . er . stopped the . omeprazole
    P:nope
    D:fine .
    • View popup
    Table 4

    Safety-net and follow-up arrangements.

    ExampleFace-to-face consultation, nTelephone consultation, n
    Follow-up arrangements only
    Example1916
     D:right . so . I'll leave a prescription at the desk?
     P:right
     (.)
     D:and . shall we: . talk this whole thing through again: . what? . late September?
     P:right . okay
    Follow-up arrangements and safety-net advice
    Example–5
     D:yeah . I mean . th- . th- then I would probably say y- . you know . that it . you know . getting a stool sample kind of and probably having a wee look there as well would be worthwhile . just having a feel of her tummy and things like that but . (unclear) very much on how she is in herself and if there's any concerns particularly with . you know . any acute pain
     P:yes
     D:anything abnormal in the stool . [any blood or mucus or
     P:   [right
     D:anyth[ing like that . and . any . if there's any problems
     P: [aha
     D:with her drinking . you know . any kind of dehydration .
    obviously you need to get back in touch with us
    Safety-net advice
    Example105
     D:well . we'll just . go with that . I don't think you'll need antibiotics . [eh (unclear)
     P:    [alright . should I put Sudocrem on it just to
     D:yeah . that would be fine . [I was gonna say see how it is
     P:   [yeah cos
     D:over the next twenty four [or forty eight hours . if you
     P:   [right
     D:think it's recollecting or you think there's more problems with it . then please please please speak . eh . back to me
    • View popup
    Table 5

    Closing consultation stages.

    ExampleFace-to-face consultation, nTelephone consultation, n
    Closing of reason for attendance stage
     (a) Patient initiates closing by restating problem
     Example2925
      P:so . em . I just wondered rather than . come in hh em .
    if you could write a prescription for anything?
      D:mm yea:h . I'm sure we can . I'm sure we can . w-what sorta what way are they
    . the:y . bothering you. Fiona?
     (b) Patient initiates closing by falling silent
     Example176
      D:(inbreath) now . you said there's something else as well?
      P:aye
      D:aha
      P:the- . p- . it's been swelling up
    (1)
      D:right . is that your left leg? (face-to-face consultation))
    Closing of verbal/physical examination stage
     (a) Doctor initiates closing by giving decision
     Example3819
      P:(patient responds to doctor's question) but . I don't have any problems
      D:right . no . well that's fine . well . it's . it's . if you are still . if you're still having a regular . bleed
      P:mh[m
      D: [the chances are you are still ovulating so
      P:right . [right
      D:  [you still need protection [(unclear)
     (b) Patient initiates closing by restating problem
     Example–6
      P:so I was just ringing up to see if I actually needed to be seen or if I needed a . a course of [antibiotics or what
      D:[we::ll . same story of like a boil anywhere in the body
    Closing of decision-making stage
     (a) Doctor initiates closing by repeating advice and checking
     Example2932
      D:[I kno:w . but I think . cos the other one's specifically for your skin so ((repeats advice)) see what's going on . but
      P:ye:s
      D:is that . is that oka:y?
      P:yeah . oh that sounds fine (?doctor)
     (b) Patient initiates closing by restating arrangements
     Example31
      D:yeah . [yes
      P:  [yeah we had two or three holidays there . it's beautiful . e:rm . so I'll come back and see you a week on Tuesday
      D:yes . and we'll . we'll go through the x-ray and [see what it [shows
      P:   [right [see what it impl[ies
      D:    [yeah
    • View popup
    Table 6

    Subtopic curtailment.

    ExampleFace-to-face, nTelephone, n
    Doctor closes subtopic
    Example399
     P:and he said ehm (.) ‘so what happened this time?’ .
    I says ‘somebody was up against my door again’. [I
     D:[yeah . yeah
     P:I says ‘I I I . I can't live like this’
     D:no
     P:you know I [can't . i- . it
     D:[how long has it been going on for?
     P:sin- since I moved in
     D:which was . how long ago now?
    Patient closes subtopic
    Example509
     D:the pill won't . e:r . affect that [specifically
     P:[right
     D:so you'll kn[ow in that sense when
     P:  [okay . so all is . all is . fine at the moment
    [then
     D:[yeah . yeah
     P:right
  • (Doctor completes examination and the patient explains how leg pain is reducing her independence)
    (7)
    P:see I don't like to hang about and and (.) just do nothing . I dinnae like everybody to do anything for me . I like to do wee things for myself {D: mhm} like going to the shops and that . but it's getting now that I'm even feared to go to the shops
    (2)
    D:well I think we'll get some nice . support stockings for you
  • (Elderly patient is having a check-up)
    D:so what've you got planned at the moment then? . are you?
    P:we're home for a bit now . we've just been away in the caravan
    D:right . [did you . go to the s-
    P: [we were away in May
    D:s:outh west was it?
    P:tha- . yea- . no the south east . we went to Kent=
    D:=south east . right
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British Journal of General Practice: 60 (574)
British Journal of General Practice
Vol. 60, Issue 574
May 2010
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Comparison of face-to-face and telephone consultations in primary care: qualitative analysis
Heather Hewitt, Joseph Gafaranga, Brian McKinstry
British Journal of General Practice 2010; 60 (574): e201-e212. DOI: 10.3399/bjgp10X501831

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Comparison of face-to-face and telephone consultations in primary care: qualitative analysis
Heather Hewitt, Joseph Gafaranga, Brian McKinstry
British Journal of General Practice 2010; 60 (574): e201-e212. DOI: 10.3399/bjgp10X501831
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Keywords

  • communication
  • consultation
  • qualitative analysis
  • telephone

More in this TOC Section

  • Advance care planning for cancer patients in primary care: a feasibility study
  • Non-pharmacological intervention for gastro-oesophageal reflux disease in primary care
  • Self-monitoring and other non-pharmacological interventions to improve the management of hypertension in primary care: a systematic review
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