Several issues need to be considered before all patients are followed up by telephone

Editor—Pal found that telephone follow up of outpatients can be effective for patients,¹ but several issues need to be considered before his results can be generalised.

Firstly, a detailed clinical assessment and investigations were undertaken to determine the patients’ suitability for follow up by telephone. It is important to take into account the extra time and resources devoted to this assessment, as it might partially account for the acceptability of subsequent follow up by telephone. Secondly, it is unclear how many patients were found to be unsuitable and were excluded in the initial assessment; hence the proportion of patients suitable for follow up by telephone is unknown. If the proportion is small the extra effort devoted to the initial assessment would become relatively important. Thirdly, all the general practitioners seemed to agree to prescribe new treatments. This might not apply to other districts or to specialties such as ophthalmology, dermatology, and rheumatology, in which physical signs may be relatively more important than symptoms in the assessment of follow up patients.