Is seeking telephonic advice worth?

Social media and mobile have become an integral part of our life. We are connected to our family, friends and to market places by internet and social media all the time. Doctor is a crucial person in every one’s life. Being connected with the doctor makes everyone feel secure and safe. Naturally patients use social media like WhatsApp or mobile for quick advice when in need. The two commonest questions that are asked are “Is this worrisome?” “Can you suggest some medicine on phone?”
Here I share a real life story. A nine month pregnant patient’s mother called me on a Sunday afternoon stating that her daughter has slight bleeding but no pain and indicated that she may bring her to the hospital if pain increases. She wanted my nod to the plan. On the face of it the symptoms seemed “No worries” type… However knowing the case I simply told her to come to the hospital. No sooner she reached the hospital we diagnosed that it was a serious problem called “Abruption”. A life was saved only because we could examine the patient and not rely on the mother’s version.
Here are some fundamental problems with telephonic consultations.
• Detailed history, verbal and non-verbal clues which are picked up during face to face consultation and examination are necessary for accurate diagnosis. Had that been untrue, software could have diagnosed medical conditions! Just key in the complaints or symptoms and software gives you the diagnosis. Thus telephonic consultations to “quick fix” the problem can go miserably wrong some times.
• A doctor may or may not recollect the complete and minute details of the history (Say history of allergy to a particular drug) while on phone.
• While attending to some other important work and simultaneously speaking on phone there may be lack of attention.
• Both parties may not hear correctly on phone.
• Name of medications can go completely wrong when taken down on the phone. Even today while I write this article I saw a patient who had taken down a wrong spelling of a medicine during telephonic conversation.
Social media or phones are not basically meant for a serious professional conversation ( exception: pre decided conference call or pre-decided telephonic consultation). So what is the solution? How to seek help in emergency? How to stay connected with the healthcare provider without compromising on safety?
Here are some tips:
1 Ask your doctor what is the preferred mode of communication. In my experience I have found email to be the best. They are usually written and read by certain degree of seriousness.
2 You must have all the contact details of the hospital. You must know how the hospital has organised emergency medical service or “out of hour” service.
3 In case you call the doctor, keep your medical papers handy. Keep a pen and paper ready so that you can quickly write down.
4 You may remember this simple acronym “N-C-C-Q” and give the details accordingly .This can make the conversation productive and safe.
• Name: Full name
Resist conversations such as “Hi Doctor! Recognised me? I am Shilpa” You are not calling the doctor to test his/her memory. Are you?
• Case details:
Resist Conversation such as “Last time you gave me red coloured tablet…”
Instead say important things like you are pregnant, six months pregnant or not pregnant. You had visited for XYZ symptoms or was diagnosed as “ABC”. You have diabetes or blood pressure etc.
• Current problem:
Explain the current problem. Say “ I have got cough since two days.”
• Question
Do not ask vague question like “ Is this worrisome? ???? ???? ?? ?????” Instead ask specific questions like “What should I do next?” It is preferable not to ask for medications on the phone. The medical council guidelines prohibit telephonic advice on medications.( Over the counter products are exception)
You have to understand the limitations of the doctor and not expect a very detailed advice. Doctor can at the most give some temporary solution.
When in doubt it is always better to go to the hospital, Even if your doctor is not available, there will be medical personnel, doctor or a nurse who can make basic assessment and inform your doctor so that your doctor get the correct picture to help you out.
In conclusion, telephonic advice is not the best advice. Don’t underestimate your concerns by casual talks on phone, they need serious attention!