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Telephone consultations

BMJ 2018; 360 doi: (Published 29 March 2018) Cite this as: BMJ 2018;360:k1047
  1. Louise S van Galen, research fellow in digital health1 2,
  2. Josip Car, director2 3
  1. 1Department of Internal Medicine, VU University Medical Centre, Amsterdam, Netherlands
  2. 2Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232
  3. 3Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
  1. Correspondence to: J Car{at}

What you need to know

  • Check that the patient can hear and understand you, and is in a suitable place to talk

  • In the absence of other cues, the tone and content of speech is important

  • Gain information from an indirect physical examination by asking the patient to describe signs such as breathing and vital signs and rashes

  • Provide strong safety-netting and remember that a face-to-face consultation or home visit may be needed

Up to a quarter of patient-physician interactions occur via telephone in settings such as US internal medicine and UK primary care.1 Telephone consultations have the potential to improve access, convenience, and choice and are the most common alternative to face-to-face consultations.2 Comparative studies show that patient are equally satisfied with both forms of consultation.345 However, randomised controlled trials and time series studies show that telephone consultations do not necessarily reduce workload for clinicians.56

There are times when they may be unsuitable. The lack of visual cues and inability to examine the patient are key disadvantages that necessitate careful consideration whether phone consultation is safe and effective.37 Phone consultations tend to narrowly focus on presenting symptoms, and patients are often not comprehensively assessed.8 A recent Cochrane review underlines the lack of training in phone consulting competencies, and audits suggest unwarranted variation in physicians’ behaviour on the phone.89 Based on best available evidence (sometimes expert opinion), we present an approach to telephone consultations in primary care that is largely applicable to other settings such as outpatient clinics. A subsequent complementary article will present a suggested approach to video consultations.

Sources and selection criteria

We searched PubMed and the Cochrane Library to identify original research studies (primarily randomised controlled trials and systematic reviews) evaluating the role of telephone consultations in medicine. We searched Medline using Mesh terms …

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