Experts weigh value of telephone medicine

ALBANY, N.Y., Oct 5, 2005 (UPI via COMTEX) -- Doctors and patients generally prefer face-to-face meetings when bad medical news is involved, but some experts think such interactions also could be conducted over the telephone -- if done carefully and doctors have been trained in the practice.

Researchers at the Yale University School of Medicine in New Haven, Conn., attempted to assess the accuracy of communicating medical information over the telephone by developing case studies illustrating common situations physicians and patients might face.

"Breaking bad news is preferred face to face, but sometimes the patient is far away or may not have transportation, so sometimes bad news is given over the telephone," lead researcher Dr. Anna B. Reisman told United Press International.

On the other hand, the "lack of visual cues indicating emotions may lead a physician to assume that patients take news of test results better than they actually do," Reisman and her Yale colleague Dr. Karen E. Brown wrote in the October issue of the Journal of General Internal Medicine.

"At least on the telephone, we can hear a person's voice, but e-mail is even less appealing than telephone because you can't see the expression or reaction and there is the issue of privacy of e-mail -- we don't send a letter with private medical information, because we don't know who will open it," Reisman and Brown added.

Reisman, who is an assistant professor in the university's Department of Internal Medicine, said one problem with telemedicine is that a physician may not know how a particular patient will react. For example, some patients may regard a diagnosis of high blood pressure as extremely bad news, while their doctor may fail to appreciate such a reaction to something he or she considers a manageable problem.

The case studies Reisman and Brown developed included disclosing sensitive test results and handling requests for narcotics.

In one standard situation, a physician calls a patient to deliver test results. When the physician asks the patient if there are any questions, the patient says, "No." During a later in-person meeting, however, the physician discovers the patient had not spoken freely during the call because other people were nearby.

"Checking whether the patient can speak freely is a simple step in the communication process that could lead to patients asking informed questions that could potentially save their lives," Reisman said. "Physicians should also take the time to listen and explain carefully."

Doctor-patient communication skills currently are taught in all U.S. medical schools, but few include telephone situations.

"It comes up in the first year -- the med students meet with a real patient who is dying -- that's a very powerful experience," Reisman explained. "Later, the students practice giving bad news to standardized patients -- actors playing patients -- and they also spend an afternoon in a hospice."

Bad medical news has a profound effect on somebody's life and most people can repeat such conversations verbatim years later, said Catherine Dube, who teaches clinical interviewing skills to first-year medical students at Brown University Medical School in Providence, R.I.

"We teach med students and doctors that when patients break eye contact and look at the floor, the patient is drifting away and that they should pause and give them a minute or touch their hand," Dube told UPI. "One year, a resident in surgery was practicing telling a standardized patient that she needed another biopsy to check for breast cancer, and when she put her eyes down, instead of giving her a minute, he shouted at her, 'Listen to me!'"

Past studies have shown that although more than 25 percent of interactions between physicians and patients occur over the telephone, only 6 percent of U.S. residency programs teach telephone communications skills. Reisman suggested that more medical schools teach doctor-patient telephone skills.

"Much of medicine is communication, and in 2005 a great deal of communication occurs over the phone -- fundamental training in telephone medicine is a very good idea," Dr. Thomas Payne, clinical associate professor at the University of Washington School of Medicine in Seattle, told UPI. "We teach our residents how to handle common scenarios of phone calls with patients, and supervise their early experience in this area."

Dube said doctors should arrange a time to deliver test results in person to a patient, before the test is administered.

"The trouble is that once you have the results of a test and it's negative, if you tell a patient to come to your office with a friend or relative, they know right away it's bad news," she said. "HIV tests require the patient to come to the office for the result, and that could be done for other tests as well. A doctor could say, 'You have the biopsy Wednesday, (so) come to my office Thursday."

Reisman said there is another important reason for better doctor-patient communications: It leads to improved patient satisfaction, while poor communications are associated with an increased risk of malpractice lawsuits.

Alex Cukan covers healthcare technology for UPI. E-mail: sciencemail@upi.com

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