Addressing telephone medicine in medical school education

With the shift to ambulatory and managed care, physicians spend hours a week on the telephone with patients, pharmacies, and consultants, yet medical students rarely receive training in the use of the phone in medicine. To expose students to the challenges of practising medicine over the phone, we have incorporated phone medicine into UCLA's longitudinal third year Doctoring Curriculum. In Doctoring, medical students meet every two weeks throughout the academic year in small groups of 8 students with two faculty tutors. Each classroom has a speakerphone. Throughout the year, simulated patients, pharmacies, and doctors' offices call the students at designated times. The students discuss the limitations of not seeing the patient in person and must decide what can be done over the phone and how soon the patient should be seen in the office. In each of these cases, students deal not only with practice management issues but also with issues of ethics, doctor-patient communication cost-effectiveness, billing, and documentation surrounding the use of the phone in the practice of medicine.