Telephone Medicine: A Guide for the Practicing Physician. (Book Reviews).

Editors: Anna B. Reisman, MD, and David L. Stevens, MD

Publisher: American College of Physicians, 2002

Physicians have to increasingly rely on the telephone to communicate with their patients. Phone triage is gaining popularity, and many institutions are adopting this system of responding to a large number of patients. Based on the telephone interview, physicians determine the best next line of action ranging from immediate visit to the emergency room to a routine referral to a specialist clinic. While this is a convenient and expedient way of exchanging information with the patient and patient's family, it is often a source of frustration because of the great potential for miscommunication.

Unlike the face-to-face interview when both parties can benefit from a number of non-verbal clues, during a phone conversation one has very few signals. It is often difficult to judge the subjective importance of what the other party is saying and whether or not the other party has understood what is being said. Telephone medicine is not part of the traditional curriculum in most medical schools and residency programs. It is no wonder that so many misunderstandings and frustrations can arise when medicine is being practiced over the phone.

In their book entitled Telephone Medicine: A Guide for the Practicing Physician, Drs. Reisman and Stevens provide a detailed framework to guide clinicians. The 429 page book is divided into three sections.

The first section is a general approach to practicing telephone medicine. Concrete advice is given as to how to determine the exact nature of the problem, and what are the common pitfalls to avoid. Readers are shown how to develop a therapeutic relationship with the patient, what the barriers are to developing a good rapport with the patient, and how to avoid miscommunication, misunderstandings, and frustration. Readers of the book learn how to educate patients and implement treatment plans over the phone. The authors also give specific and concrete examples of signal behavior and language that should be detected to optimize the outcome of the phone conversation. Effective behaviors to instill confidence in the caller are also reviewed. Readers will learn how to turn around a bad situation such as when the irritated patient states that "I called to speak to a doctor over an hour ago" or "You're not the doctor I wanted to talk to." Maneuvers to avoid frustration and to ensure a good outcome are clearly outlin ed. Medico-legal issues are addressed in the third chapter, including what the physician should document following a phone conversation.

In the second section of the book, various clinical scenarios are reviewed including chest pain, abdominal pain, diarrhea, dysuria, sore throat, emergency contraception, domestic violence, depression, and suicidality.

The last section of the book places telephone medicine in the broader context of office management issues, electronic advances, and teaching telephone medicine.

The book is instructive, easy to read, and very well organized. Many simulated interviews emphasize what can go wrong, how to avoid pitfalls and how to approach particular problems. Many tables highlight important features discussed further in the text. These tables act as a synopsis and a ready reference when consulting the book. The book is highly recommended for all practicing physicians and health care providers.