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Doctoring by phone is a skill I never thought I'd have to learn.

Fam Pract Manag. 2020;27(3):4

The majority of my clinical care transformed from face-to-face encounters into telephone encounters amidst the COVID-19 pandemic. To keep healthy people out of the clinic, our organization began requiring that we handle all non-urgent visits as telephone encounters. I have now had a few weeks to experience this change in the way I take care of patients, and I've noticed some recurring communication challenges.

My main difficulty is assessing patients' reactions to what I'm saying. Do they accept my analysis of the situation? Is there some hesitation about the plan? Do they understand what I am explaining? I've also found it can be hard to end these phone calls. Without nonverbal cues, the pacing of our conversation lags, and it can be difficult to move toward a resolution. Who knew that I depended so much on nonverbal communication during patient visits? Showing empathy, which has always come naturally to me during face-to-face visits, has also required extra attention during these new visits.

Recognizing that it might take more than instinct to communicate effectively during a telephone visit, I set out to learn more, both from the medical literature and from the call center industry.13 Here are some tips we can all use to enhance our telephone communication skills.

  1. Speak slowly and clearly, and don't use medical jargon. In person we can usually tell if patients understand us, but over the phone it is not as obvious. To optimize comprehension during phone visits, we must be extra thoughtful about how we speak.

  2. Listen actively. It may seem cumbersome, but during phone visits it is particularly important to clarify what patients say. We may need to ask them to repeat themselves, ask a few clarifying questions, or restate what we heard, beginning with, “So I want to be sure I am understanding what you are saying. I heard you say that ….”

  3. Develop rapport. It is important to spend a few minutes at the beginning of the call establishing rapport, just as we do upon entering the exam room. Be sure to explain why the in-person visit (which some patients have waited months for) now has to be a telephone visit. Focus on why we want to keep patients out of the clinic right now.

  4. Give each call your full attention to help the patient know you are listening. We must resist doing anything else while talking on the phone. Try not to check your e-mail or read that text that just came through. Your divided attention is more obvious to the patient than you think.

  5. Be clear about the plan. Review what you discussed during the call, and establish what will happen after you hang up. If you have the capability, send an after-visit summary through the portal so the patient will have something in writing from the phone visit.

If we listen carefully and communicate clearly, we can optimize the effectiveness of telephone visits for us and for our patients.

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