Telephone medicine: a general internal medicine experience.

While a substantial number of patient contacts with internists occur over the telephone, there is little information about the nature and content of these encounters. The authors surveyed patient-initiated phone calls that resulted in a physician response for seven general internists. Over a six-month period, 1,377 telephone encounters met inclusion criteria. Calls were generally short, 73% lasting 4 minutes or less; mean time per call was 3.4 minutes. The doctor spoke to the patient directly 79% of the time and to a relative in 15% of the calls. The most common reason for phoning the doctor was a symptom or medical complaint (45% of all calls), followed by questions about test results (16%) and medication queries (14%). Over 60% of calls dealt with chronic conditions. Diagnoses encountered over the telephone were similar in frequency to those seen in outpatient clinic visits; however, a notable proportion of calls dealt with topics beyond the scope of traditional internal medicine training programs. A medication response was the reason for 22% of the phone calls. The doctors recommended changes in follow up 12% of the time; these included early visits to the clinic, evaluation in the emergency room, and direct admission to the hospital. An appreciation of the scope of telephone medicine in terms of both medical skills applied and time committed is germane to trainees and practitioners alike.