Regarding the recent discourse in CMAJ on telehealth,1,2 recognizing that the ability to access information by phone is important to patients, I rarely find that what they describe fits with the model we use to make diagnoses and determine treatment. It would be useful to study the accuracy of this method of treatment. One of my most significant moments in practice was in attempting to make a diagnosis over the phone. In this case, I would easily have missed the diagnosis if I did not have so little faith in telephone consultation.
I had finished my first year of practice. At the end of a morning clinic I received a request for what type of lozenges would be best for a sore throat. This request came to me on a piece of paper with the caller waiting. The person calling had never been seen at our clinic nor had her son for whom she was calling. We had no medical information and she was more than 15 miles away. I spoke with her directly, as was my habit in all such instances.
She stated that her toddler had a sore throat. My response was based on rarely being able to get toddlers to say anything about their symptoms. How did she know it was sore? Her response was “It's obvious from his drooling.” With much effort and encouragement I was able to talk the mother into bringing in the child and able to make the diagnoses of epiglottis. He required intubation shortly after.
How can we expect a telephone response system bombarded with upper respiratory calls to separate out such isolated cases? What protocol can help a mother who does not think her child is significantly ill?
Patrick J. Potter Associate Professor Physical Medicine and Rehabilitation The University of Western Ontario London, Ont.
References
- 1.Lightstone S. Health-care-by-phone services spreading across country. CMAJ 2002; 166 (1): 80. [PMC free article] [PubMed]
- 2.Lane PL. Telehealth a mediolegal quagmire? [letter]. CMAJ 2002;166(8):1011. [PMC free article] [PubMed]