Bad Practice Telephone Triage
Case Study Patient Presenting With Suspected Chest Infection
Key: PT= Patient, GP= GP
Transcript
GP
Hello, I’m Doctor X, I hear that you’ve got a chest infection?
PT
Yes, that’s right, I get it every year at this time
GP
Ok, is that right?
PT
Yes, once I got pneumonia you see
GP
I see, how long has it gone on for this time?
PT
Since yesterday, it’s terrible…
GP
Ok, well maybe you could…
PT
It’s just that once I didn’t get the antibiotics in time, and that’s when I ended up in the
hospital with double pneumonia. I was off work for weeks and nearly lost my job
GP
Oh, I see
PT
And I’m going on holiday tomorrow so I can’t afford to be ill
GP
(Weakly) oh, ok..
PT
So Dr. McBean always says he has to sound my chest before he can give me the
antibiotics, you know?
GP
Right... so when would you like to come down?
PT
Well I’m at work now, so I can’t possibly come down any time before 5.45, would 10
to 6 be ok?
GP
Yes, that will be fine..
PT
OK, doc, see you then. You will sound my chest won’t you? And it’s the red and
black ones I always get.
Why It’s An Example of Bad Practice in Telephone Triage
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The patient wasn’t identified
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The GP didn’t introduce himself and check it was convenient to talk
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Whilst hearing the patient’s concerns, the GP didn’t ascertain details of the patient’s
symptoms and as a result allowed the patient to arrange a face-to-face consultation
which may not have been necessary, especially as the patient was well enough to be
at work and had only developed symptoms the day before.
Please note – the patient and doctor’s identity was concealed for confidentiality.
Bad Practice Telephone Triage
Case Study Patient Presenting With Suspected Chest Infection
Key: PT= Patient, GP= GP
Transcript
GP
Hello Mrs Bloggs, I’m Dr Self Help, I’m phoning from xxx, can I just check that I’ve got
the right person, is your dob …..?
PT
Yes, that’s right, thank you for calling back
GP
That’s fine, good, now tell me what it is that’s bothering you today..
PT
Well, I had this awful cold last week, and now I seem to have ended up with a horrible
cough and I wondered if I might have a chest infection?
GP
OK, what made you think that was what the problem was?
PT
I’ve been coughing up this green spit, and that’s not normal is it?
GP
Well, sometimes it can actually be part of a virla illness, like a bad cold.. How long
has the cough with the spit been going on for now?
PT
Well it only started yesterday actually!
GP
Ok, well it’s early days yet then, isn’t it? Often at the end of a cold you will get this for
a few days, and it doesn’t necessarily mean that you need an antibiotic, with all the
side effects that can cause.
PT
OK, it’s just that I got pneumonia once, and I ended up in hospital, and I was scared
that might happen again
GP
Ah, I see. Well, do you feel particularly unwell with your cough? You don’t sound at
all breathless on the phone, but is it hard to get your breath when you’re outside?
PT
I feel OK really, and I’m not wheezy or short of breath
GP
Are you a smoker? Or do you have a history of asthma, or any other chest problems?
Any pain or swelling in your legs?
PT
Well I used to smoke, but I stopped after I had that pneumonia, it gave me a fright.
But I’ve never had any other troubles with my lungs. My legs feel fine.
GP
Good, that all sounds fine, and it’s great you managed to stop smoking – well done!
PT
Thanks…
GP
So, this sounds to me as if you’ve had a nasty viral infection, a sort of cold, and it’s
going through a coughing stage. It’s likely that the green stuff is coming from the
upper part of your chest rather than right down in your lungs, and the cough will
probably settle down over the next few days
PT
Oh, that’s good
GP
Yes, so I don’t think you need any particular treatment apart from simple paracetamol
or ibuprofen (as long as that doesn’t give you nasty side effects) or you could seek
advice from the pharmacist about cough medicines you could take
PT
Don’t you need to sound my chest just in case?
GP
No, I don’t think there’s any need for that at the moment. If you feel worse in any way
over the next few days, or if after a few days the could isn’t settling down, then just
get in touch again, just like you did today
PT
Yes, OK
GP
And if you need to talk to someone in the evening or at the weekend just call NHS24
on 111
PT
Right then
GP
So, are you clear what you need to do today then? Is there anything else you need
help with today?
Yes, I think so, I’ll just take paracetamol and wait and see for the moment, but I can
PT
call back if I need to
That’s absolutely right. And whatever you do, don’t start smoking again!
GP
Why It’s An Example of Bad Practice in Telephone Triage
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xxxx
Please note – the patient and doctor’s identity was concealed for confidentiality.