Phone consultations

'Telehealth' consultations can be by video or by phone.  The GP Colleges, Medical Defence Organisations, and Medicare recommend video in preference to phone.  

Telephone consultations are only eligible for a Medicare benefit (or rebate) if video is 'unavailable'.

Dr Baird prefers video to phone for consultations with patients for the following reasons:

• Seeing the patient enhances rapport, and enables facial expressions and body language to be observed

• Clinical assessment is superior with video (general appearance, limited physical examination is possible by observation)

• Clinical management is superior with video (explanation, use of notes/diagrams)

• Many patients prefer to see the doctor whom they are consulting (may improve trust, confidence, understanding, and satisfaction with the consultation)

• Doctor and patient can exchange messages, files, and photos/images securely during the 'video call'

• The doctor can examine you by observation (eg appearance, breathing rate, movements, spots and rashes) 

• You can provide self-measurements (eg temperature, blood pressure, blood glucose, data from smartphone apps)

• A support person (friend, relative) can be present in the video consultation, either with you in your room, or somewhere else

• Video consultations are suitable for patients of all ages. If the patient is a child, a parent must be present with the child (except if the child is deemed to be a ‘mature minor’)

• In contrast, a consultation by phone is limited to communication by voice - which may be satisfactory for some medical problems

• A phone consultation is instead of a video consultation or instead of an in-person consultation

• Please phone St Kilda Medical Group (9525 5200) to book an appointment for a phone consultation. 

• Please confirm your phone number for the phone consultation.

• Dr Baird will phone you at your scheduled appointment time, or as soon after your scheduled appointment time as possible, depending on earlier consultations that have run over time, emergencies, and other delays.  

• If Dr Baird has not phoned you within 15 minutes of your appointment time, please phone St Kilda Medical Group (9525 5200) to find out the reason for the delay, to find out when he will be expected to phone you, and to reschedule if necessary. 

• For the phone consultation, please go to a private room where you will not be disturbed and where the consultation will not be overheard. 

• You must be alone for the consultation, unless you are attending as a parent or a carer.  You must tell Dr Baird if anyone else is in the room, or if anyone else will be involved in the consultation. 

• You may use speakerphone. 

• You must not record the phone call.  You must not stream the call to another device. Dr Baird will not record the phone call. 

• If the reason or reasons for the consultation are not appropriate for a phone consultation, Dr Baird will ask you to arrange a video consultation, or an in person consultation, or to go to hospital, as appropriate. 

• The time required to address the reasons for your consultation may exceed the time booked for the consultation.  In this situation, you may be asked to book another appointment to address the reasons that cannot be not covered in the consultation.

• When the phone consultation is completed, please phone St Kilda Medical Group to make payment.

Pre-consultation check.  I will:

• Confirm your identity (name, date of birth, Medicare number, phone number, other)

• If the phone call disconnects or drops out, I will phone you back immediately.  If you have not received a call within five minutes, please phone St Kilda Medical Group, (9525 5200)

• Ask you to tell me your location (this is necessary, in the unlikely event that the emergency services need to be called in relation to the consultation)

• Confirm that you are alone, and that you are in a quiet, private room (you will need to tell me if anyone else is present)

• Obtain your consent for a consultation by phone (accepting that there are limitations to a phone  consultation as there can be no physical examination)

• Obtain your consent for the fee (if any) for the consultation

During the consultation, I will:

• Refer to your medical record which is displayed on a computer in the consulting room

• If you have the relevant equipment, I may ask you to check your temperature, your pulse, and your blood pressure.  

• Ask questions about 'red flag' symptoms which may indicate serious disease

• Discuss with you a management plan, including 'safety nets' for actions to take in the event that symptoms get more severe, or new symptoms develop

At the end of the consultation, I will:

• Check if there's anything else you would like to discuss (it may be necessary to arrange another consultation to address this)

• Discuss with you a 'follow up' plan for review of your symptoms, and/or for management of any ongoing disease, and/or for preventive activities.  The 'follow up' plan may involve making an appointment to see another GP for assessment and physical examination.  It is essential that you follow this advice.

• Discuss the arrangements for payment of the fee (or for bulk billing).  After the consultation, please phone St Kilda Medical Group (9525 5200), to make payment (by credit card via phone), or to confirm bulk billing (for those patients who are eligible for bulk billing)

Ensure that the consultation will be appropriate for a phone consultation. 

Do not arrange a phone consultation for any of the following problems:  

• ·                     chest pain, 

• ·                     severe breathlessness (unable to talk normally), 

• ·                     feeling faint, 

• ·                     injuries 

• ·                     bleeding, 

• ·                     drowsiness, 

• ·                     seizure, 

• ·                     reduced consciousness, 

• ·                     weakness of the face or of one or more limbs, 

• ·                     altered speech, 

• ·                     or a sick child or infant (one or more of: drowsy, lethargic, floppy (infant), limp (child), persistent vomiting, working hard to breathe, pale skin, blue colour around mouth, purple rash, has a fit or has had a fit).  

In any of the above situations, call 000 for an ambulance.  

Here are some examples of appropriate reasons for a phone consultation (this list is not exclusive): 

• ·         Minor illness

• ·         Repeat prescriptions

• ·         Discussion about pathology results and imaging reports 

If you are unsure if your health issue is appropriate for a phone consultation, please phone the receptionist at St Kilda Medical Group (9525 5200).  If you have the symptoms of an emergency, your call will be put through to Dr Baird immediately.  This applies when Dr Baird is at St Kilda Medical Group.  At other times, calls of an urgent nature will be put through to one of the other GPs.   For non-urgent issues, a message will be left for Dr Baird's attention when he next attends St Kilda Medical Group.

Optional:

Items to bring to a phone consultation (if available)

Pen and paper

Medications (in their packs or containers)

Prescriptions

Tape measure

Thermometer

Scales (to check your weight)

Blood pressure monitor

Blood glucose machine

Oximeter

Smartwatch (if it does physical measurements, eg pulse rate)

Yes, you can, however, Dr Baird asks that you do not record your video consultation or your phone consultation.

The consultation is a private conversation.  

Recording a private conversation without both persons' consent is illegal.

Dr Baird does not consent to recording of the consultation.

This is standard practice for medical consultations.

This is to avoid the potential risk of a recorded consultation being used in an unauthorised way: for example, if the recording is played/shown to someone else, if the recording is posted to social media, or if the original recording is altered in some way. 

The advantages of phone consultations:  

• • ·         Convenience:

    • o   no need to travel to the Clinic 

    • o   no need to arrange transport (eg private car, taxi) , no need to find a parking space, no parking fees, no parking fines

    • o   no need to arrange assistance for those who need help to get to the Clinic (eg relative or friend) 

    • o   less of a problem to get medical care for those who have difficulty with mobility 

    • o   timesaving (no need to travel, park car, etc)

    • o   can attend the phone consultation from anywhere (home, overseas, in bed, etc)

  • ·         Social distancing is observed as you can stay at home  for the consultation 

  • ·         No risk of transmitting infection to others

    • • • No risk of getting infection from others

  • ·         No need for ‘Personal Protective Equipment’ (which is in short supply) 

  • ·         Simple to use a phone; no technology required (computer, webcam, apps, signing-in, etc)

 The disadvantages of phone consultations: 

•     ·         Phone connection may be poor quality

  • ·         Not possible to observe facial expression, or non-verbal cues

  • .         No non-verbal feedback 

  • ·         Limited social connection (voice only)

  • .         Overall appearance cannot be assessed (general appearance is a key feature in determining the cause and severity of disease)

  • ·         Physical examination is not possible (it may be possible to assess pulse and breathing rate, but this may be inaccurate)

  • ·         Physical treatment is not possible (eg vaccination) 

  • ·         Not appropriate for serious illness 

  • ·         A follow-up face-to-face consultation with another GP may be required for physical examination or physical treatment 

  • ·         The phone consultation may not be secure

No non-verbal cues or non-verbal feedback

No facial expression

No physical assessment (appearance etc)