title: A qualitative study examining tensions in interdoctor telephone consultations.
abstract: OBJECTIVE
  Communication skills have gained increasing attention in medical education. Much of the existing literature and medical curricula addresses issues of doctor-patient communication. The critical importance of communication between health professionals, however, is now coming under the spotlight. The interdoctor telephone consultation is a common health care setting in which health professional communication skills are exercised. Breakdowns in this communication commonly occur and, surprisingly, this skill is not formally addressed in medical training. This study sought to clarify the communication issues that can occur during interdoctor telephone consultations in order to inform future educational initiatives in this domain.
  
  
  METHODS
  Data were collected and triangulated among 3 sources: documentation of 129 telephone consults received; 51 hours of field observations of consultants, and semi-structured interviews of 12 callers and 12 consultants. Analysis was performed using grounded theory methodology.
  
  
  RESULTS
  Overwhelmingly, participants described tensions with telephone consultation communication. Recurrent theme analysis revealed 5 key sources of tension: discursive features; context; fragmented clinical process; reason for call, and responsibility. Often, callers and consultants viewed similar instances in different and opposite manners, contributing to difficulties in the exchange. Further, a vicious cycle in which a participant's strategies to mitigate tension actually increased tension for the other participant was identified.
  
  
  CONCLUSIONS
  Interdoctor telephone consultation has become an integral part of medical practice; however, tensions within this exchange can undermine its effectiveness. The results of this study provide a preliminary theory upon which an educational intervention to improve this communication skill can be based.
authors.affiliation: Wilson Centre for Research in Education and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. wadhwa@mcmaster.ca
authors.forename: Anupma
authors.initials: A
authors.lastname: Wadhwa
authors.forename: Lorelei
authors.initials: L
authors.lastname: Lingard
mesh_terms: D003142:Communication; D004502:Education, Medical, Continuing / Q000379:methods*; D005194:Family Practice; D006776:Hospitals, Pediatric; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008505:Medical Staff, Hospital / Q000592:standards*; D009864:Ontario; D010372:Pediatrics; D011361:Professional Competence / Q000592:standards*; D012017:Referral and Consultation; D019114:Remote Consultation / Q000592:standards*; D013689:Telephone