The decision on what type of consultation to have is best made by the patient and clinician together. This will depend, as in the section on choosing the most suitable medium for your consultation, on the patient and the condition.

Patient satisfaction is higher when they choose the type of consultation. However, this may not always be deemed appropriate by the clinician and an explanation as to why this may be the case is appropriate. Likewise, for a straightforward or follow-up appointment, the clinician may explain that a requested face-to-face appointment may not be necessary and the advantages to the patient of this. For example, a video consultation for follow-up of a mental health problem may be more convenient for the patient. There is little to be gained by having a telephone consultation with a patient for whom it is clear a physical examination is necessary, except for determining urgency or to provide management advice while waiting for the appointment. For example, a patient with osteoarthritis of the hip with a well-written referral from her GP, or a baby with a fever. 

In general, it is good practice to give the patient a time window during which the consultation will take place. Anxiety about missing a call was prominent among patients in one study.¹ Patients will not have the visual cues they would get in a waiting room that a doctor has been kept back and that there many people waiting ahead of them. Left waiting 'on-line' they get concerned that they have been forgotten or that there is a technical fault.² It is perhaps more important to let people know if you have been delayed.

When setting up appointments, clinicians need to exercise caution with voicemail, particularly if leaving a message on a house phone. Even a message that a doctor called can be thought too revelatory. This is less of a problem with mobile phones; however, it is good to get permission to leave messages, if possible, in advance. 

Notes

1. McKinstry B, Watson P, Pinnock H et al. Telephone consulting in primary care: a triangulated qualitative study of patients and providers. Br J Gen Pract. 2009 Jun;59(563):e209-18. doi: 10.3399/bjgp09X420941. PMID: 19520019; PMCID: PMC2688070.
2. Donaghy E, Atherton H, Hammersley et al. Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care. Br J Gen Pract. 2019 Aug 29;69(686):e586-e594. doi: 10.3399/bjgp19X704141. PMID: 31160368; PMCID: PMC6617540.