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So when doing telephone triage, I guess that a lot of the information you get is just from listening. How do you deal with that?

You are right, because... So obviously, you cannot physically see the patient unless you are using the video conferencing facility, and sometimes it is beneficial if you get a third party involved, as long you have got consent from the patient to discuss with their other half, etcetera, the wife or the husband who is present, and it may be the patient is too breathless to actually speak, maybe getting quite anxious or agitated about being asked questions, which can sort of increase anxiety, increase heart rate, make them feel more unwell and it may be better to actually speak to the relative who they can give you their opinion of what the patient looks like, you may be able to elicit from the relative as well is, are they behaving normally? Is this how they would normally behave quite anxious and agitated? Are they normally quite breathless? And it may be that you have got a... There may be a language barrier, then you need to speak to somebody else to make yourself understood, but it is very important that you, whoever you are speaking to, that you allow them to actually tell you what the problem is, do not interject. Do not come to your own conclusion. Get enough information to make an informed decision and if you are not 100% that you can sort of determining what the main problem is, we need to see this patient face-to-face.

So it must be difficult to convey active listening. How did you overcome that where the line is dead on the other when someone is trying to tell you something really important and... Are there vocal things you can do or...

Yeah, you can reassure, lots of reassurance using sympathy as well and allowing the patient to speak, but then stopping them when... If they are speaking for too long and say, "So can I just summarise by saying this is not normal for him. So what you are telling me is this is new, and this is new." And then sort of you are condensing it down, but still allowing the relative to speak or the patient to speak, you are still accepting the information they are giving you, but summarising it.

"This is what we discussed, this is the plan, are you happy with everything we discussed?" And make sure the patient understands and is happy with the plan.