Friday, 1 September 2017

The eyes have it

I recently worked a one week locum in Scotland. All of the requests to see the doctor were triaged by a return phone call from the doctor. I've never been a fan of this system although I completely understand why it may be used in an attempt to manage workload. I have two main concerns.

1. The information over the phone is limited. This is especially an issue when trying to help patients with English as a second language. But it is also restricted in losing out on the 'extras'; that face to face conversation brings. After all what would you prefer if talking to your husband, daughter, bank our insurance company. Almost inevitably we prefer human physical contact. But in the context in a medical consultation there are particular disadvantages.

Bilateral congenital ptosis
I recall a 3 month old baby whom I saw recently. The complaint was of a cough persisting for one week. In itself this would usually not cause concern, especially if the baby was feeding ok and was generally well. But when I greeted the baby and mum as he was wheeled into my room, I recall commenting that the baby looked half asleep. 'Oh he's just woken up' was the reply. Having examined the babe and finding him perfectly well I was just about to dismiss him when it suddenly occurred to me that he still looked half asleep. Indeed his eyes were half closed throughout the consultation even though he was clearly wide awake. In fact I realised he has Congenital Ptosis. A condition in which the eyelids are partially closed and that if left untreated can lead to squint and even defective vision. He needed referral and I'm glad I saw him a phone consultation would not have helped.
2. I think it has the danger of creating an adversarial situation in which the doctor starts from the premise that they need not see the patient and the patient strives to justify the request rather than describing the problem. And of course for some patients (particularly men) it takes a fair bit of encouragement for them to seek medical help in the first place.

The telephone is indeed a mixed blessing.

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