Telephone patient management by primary care physicians

Medical telephone calls in which clinical and/or counseling services are provided to patients or their families account for onefifth of all physician-patient contacts in the United States. Among primary care specialties, telephone calls account for 19.4% of all patient encounters in family/general practice, 24.6% in general internal medicine, 28.5% in pediatrics, and 19.6% in obstetrics/gynecology. 1 Research on the role of telephone calls in primary care has focused on the potential adjunctive role of telephone care in patient management: the degree to which telephone consultation serves as the sole management for certain problems, e.g., acute, self-limiting conditions, as opposed to merely a prelude to an office visit. A review of a number of studies of telephone calls in primary care revealed that "close to 70% of the medical calls are managed solely by use of telephone."2 The ability to deal with problems solely by telephone is somewhat greater for physicians in private practice (aided by their greater familiarity with the patient and his/her family) than compared with house officers.3 While experience gained during residency training has not been shown to affect the proportion of problems handled solely by telephone,4 the average length of those calls does decrease.5