Usually reasonable
Stable follow-up, an established diagnosis, a concordant result, or a treatment-response check—if two-way communication, records, consent and a reliable follow-up plan are available.
Telephone Clinic
Ask, listen, decide whether the call is enough, and close the loop.
Practise the difficult calls
Six fixed patients. Hear one finding, choose the next question or action, then decide the destination and who owns follow-up.
Branching call: sudden hearing loss · Branching call: swelling after thyroid surgery · Branching call: bleeding after tonsillectomy
Patient questions & clinician responses
Practise 24 patient questions. Reveal model wording, essential safety points and a check of understanding. Symptom-specific questions are also included in each template below.
Difficult telephone conversations
Explore barriers, see the response to your words, and repair a poor choice.
Part 2: neck swelling and reluctance to call an ambulance
Part 3: persistent hoarseness, cancer worry and examination consent
Can this stay on the telephone?
Change to in person
A new or changing symptom that needs otoscopy, nasendoscopy, neurological or neck examination; conflicting information; hearing or communication barriers; or uncertainty that materially changes treatment.
Escalate now
Threatened airway, major ongoing bleeding, possible stroke, sudden unexplained hearing loss, rapidly worsening infection, or a postoperative complication. Match emergency service and timing to the actual physiology and local pathway.
Guidance: GMC · remote consultations · GMC · suitability of remote prescribing · NICE NG98 · hearing loss referral · NICE NG127 · dizziness and neurological referral
A call that sounds and works like a consultation
- Connect safely. “Hello, I’m [name], [role], calling from the ENT service. Is this [patient name]? Please confirm two identifiers. Are you somewhere private and safe to talk? Is anyone else with you, and would you like them involved?” Confirm location, a callback number and what to do if disconnected.
- Set the purpose. “What were you hoping we would resolve today?” Confirm referral reason, available records and whether the patient can hear and understand the call; arrange an interpreter or accessible format if needed.
- Screen immediate danger. Ask about breathing, swallowing saliva, significant active bleeding, new neurological symptoms, sudden hearing loss and recent postoperative deterioration before a long history.
- Explore one symptom. Let the patient describe it first, then pin down onset, duration, progression, laterality, associated symptoms, prior treatment, impact and expectations. Open a symptom template below.
- State the limit and recommend. “What I can establish by phone is… What I cannot check without examining you is… My recommendation is…” Give a definite destination and timeframe, not a vague “see someone if worse”.
- Confirm ownership. Check understanding, agreement, transport/access barriers and what should happen if an appointment or result is not received. Document the differential, missing examination, escalation decision, named owner and safety-netting.
Guidance: GMC · remote consultations · GMC · suitability of remote prescribing
Choose a symptom template
Open one branch. Each prompt is a question to ask, not a diagnosis to infer.
Hearing loss, tinnitus or blocked ear+
Opening question
“When did the hearing change—and did it happen suddenly or gradually?”
Ask next
- One ear or both? Exact onset, speed of deterioration and last time hearing was normal?
- New facial weakness, facial numbness, severe vertigo, imbalance or other neurological symptoms?
- Pain, discharge, fever, recent trauma, pressure change or ear surgery?
- Existing hearing aid, audiogram, wax history or known middle-ear disease? What is different now?
- How is the change affecting conversation, work and safety? Can the patient use the telephone effectively?
Telephone may be enough
Discuss a known, stable audiogram or agreed hearing-aid plan if the result and clinical history are concordant. Confirm the patient can hear the call and offer an accessible alternative.
Arrange examination
New, unexplained or asymmetric loss needs otoscopy and audiological assessment; a telephone description of “wax” does not establish a conductive cause.
Escalation pivot
Sudden loss over 3 days or less within the past 30 days, not explained by external or middle-ear causes: immediate ENT or emergency referral for assessment within 24 hours. New ipsilateral facial sensory change or droop: immediate assessment; use the stroke pathway if stroke is suspected. Apply NG98 timing to older or rapidly progressive loss.
Guidance: NICE NG98 · hearing loss referral · GMC · remote consultations
What might the patient ask?
Read the context, try your response aloud, then reveal an example. Adapt it to the patient and local pathway; nothing is recorded.
Patient: “It is probably wax. Can I try drops for a week?”+
Use this response when: Hearing became substantially worse yesterday; an external or middle-ear cause has not been established.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
Wax is one possibility, but sudden hearing loss can also come from the inner ear. I cannot tell which by phone. Because yours changed suddenly, we need urgent assessment rather than waiting for drops to work. I will arrange the appropriate ENT or emergency route so you can be assessed within 24 hours.
What a safe answer should include
- Establish exact onset and screen neurological symptoms.
- NG98 timing applies to sudden loss over three days or less within the past 30 days, not explained by external or middle-ear causes.
Avoid: Accepting the patient’s “wax” label as an examination finding.
Check understanding or explore further: “What is our assessment plan, rather than waiting for ear drops?”
Clinical and communication guidance: NICE NG98: hearing loss in adults · NHS: hearing loss
Patient: “Can you prescribe steroids now, and will my hearing come back?”+
Use this response when: Suspected sudden sensorineural hearing loss; examination and specialist treatment decision are pending.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
Steroids may be considered for some sudden inner-ear hearing losses, but first we need urgent assessment and a treatment decision based on your findings and medical history. I cannot promise how much hearing will recover. We should not delay the assessment while trying to settle treatment over the phone.
What a safe answer should include
- NICE says to consider a steroid for idiopathic sudden sensorineural hearing loss.
- Do not provide a blanket dose, guarantee or reassurance without assessment.
Avoid: “Steroids will definitely restore your hearing.”
Check understanding or explore further: “What have you understood about why the assessment is urgent?”
Clinical and communication guidance: NICE NG98: hearing loss in adults · NHS: hearing loss
Patient: “What if I develop a drooping face or feel much worse before the appointment?”+
Use this response when: Safety-netting while arranging sudden-hearing-loss assessment.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
A new drooping face, speech difficulty or weakness could mean a stroke. Call 999 immediately rather than waiting for the ear appointment. Tell the emergency team about the hearing change too. For any other deterioration, use the urgent contact route we agree before ending this call.
What a safe answer should include
- Differentiate immediate emergency symptoms from routine follow-up.
- Confirm a usable contact route and accessible written advice if needed.
Avoid: “Wait for ENT because this is an ear problem.”
Check understanding or explore further: “What would make you call 999 rather than wait?”
Clinical and communication guidance: NICE NG98: hearing loss in adults · NHS: hearing loss
Ear pain or discharge+
Opening question
“Where is the pain, and is there any swelling behind the ear?”
Ask next
- Onset, severity, laterality and fever or feeling systemically unwell?
- Discharge, hearing change, vertigo, facial weakness or severe headache?
- Swelling or tenderness behind the ear, or an ear that is starting to stick out?
- Diabetes, immune suppression, cochlear implant, previous ear surgery or recent treatment failure?
- Could the pain be referred from teeth, jaw or throat? Any persistent one-sided throat symptom?
Telephone may be enough
A previously examined, improving uncomplicated problem may suit planned review or result discussion when the diagnosis is already established.
Arrange examination
New pain or discharge usually needs otoscopy to distinguish canal, middle-ear and referred disease. Do not prescribe a disease-specific treatment when the relevant ear findings are unknown.
Escalation pivot
Post-auricular swelling/tenderness, protruding ear, facial weakness, neurological symptoms or systemic illness requires urgent in-person assessment; suspected mastoiditis needs prompt specialist evaluation. In an immunocompromised patient, otalgia with otorrhoea unresponsive after 72 hours meets the NG98 immediate referral recommendation.
Guidance: NHS · mastoiditis · NICE NG98 · hearing loss referral · GMC · suitability of remote prescribing
What might the patient ask?
Read the context, try your response aloud, then reveal an example. Adapt it to the patient and local pathway; nothing is recorded.
Patient: “Can I use the ear drops left over from last time?”+
Use this response when: New ear pain and discharge; the ear has not been examined.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
Please do not restart leftover drops without checking with a clinician or pharmacist. We need to know what the drops are and whether the cause is the same. Looking in the ear helps us choose suitable treatment, especially if you have had a perforation or ear surgery. Let us check for urgent warning symptoms first.
What a safe answer should include
- Confirm previous surgery, perforation, medicines and allergy history.
- Do not assume all drops are suitable for every ear condition.
Avoid: Recommending an unidentified bottle of drops.
Check understanding or explore further: “Can you tell me the name of the drops and any previous ear operation?”
Clinical and communication guidance: NHS: ear infections · NHS: mastoiditis · GMC: deciding if it is safe to prescribe
Patient: “It is swollen behind my ear. Is that normal with an infection?”+
Use this response when: New post-auricular swelling or a protruding ear during an ear infection.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
Swelling behind the ear can be a warning sign that the infection needs urgent assessment. I would not treat that as routine over the phone. I will arrange an urgent in-person assessment. Tell me now if you also have a severe headache, feel very unwell or have weakness of the face.
What a safe answer should include
- Consider mastoiditis and arrange prompt medical assessment.
- Escalate further for systemic or neurological deterioration.
Avoid: “Finish the course and ring next week.”
Check understanding or explore further: “Where will you be assessed, and how will you get there?”
Clinical and communication guidance: NHS: ear infections · NHS: mastoiditis · GMC: deciding if it is safe to prescribe
Patient: “I have diabetes and the pain is worse despite treatment. Can I wait?”+
Use this response when: Persistent or worsening otalgia and discharge despite treatment in a higher-risk patient.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
Because the pain is worsening despite treatment and you have diabetes, I want you assessed urgently in person. I need to know how long you have taken the treatment and whether there is fever, swelling or facial weakness. We should not simply repeat the same medicine without checking what is happening.
What a safe answer should include
- Assess severity and arrange a clear urgent route.
- Diabetes or immune suppression increases concern; do not imply a diagnosis from risk alone.
Avoid: “Diabetes makes infections slow; just give it more time.”
Check understanding or explore further: “What will you do if you become more unwell before the assessment?”
Clinical and communication guidance: NHS: ear infections · NHS: mastoiditis · GMC: deciding if it is safe to prescribe
Dizziness or vertigo+
Opening question
“Tell me about one complete episode, from how it starts to how it ends.”
Ask next
- Continuous since onset, brief spells triggered by a position, spontaneous episodes, or light-headedness on standing?
- Can the patient stand and walk? Any new severe imbalance, double vision, speech change, weakness, numbness or headache?
- Any new hearing loss, tinnitus, ear fullness or ear symptoms?
- Was there a blackout, palpitations, chest pain, injury or medication change?
- What is the exact duration of each episode and what happens between episodes?
Telephone may be enough
Follow up a previously assessed stable vestibular condition, discuss test results or check response to an agreed rehabilitation plan, with a clear route back if the pattern changes.
Arrange examination
A first presentation or altered pattern may require gait, neurological, eye-movement, positional, hearing and/or cardiovascular examination. HINTS is not a telephone test and is for trained, experienced clinicians in the correct acute vestibular syndrome.
Escalation pivot
Sudden continuous vertigo with gait unsteadiness and no established benign explanation needs immediate stroke-pathway assessment when trained HINTS assessment is unavailable. Focal neurological features or new deafness strengthen that urgency; do not label it BPPV by phone.
Guidance: NICE NG127 · dizziness and neurological referral · NICE NG98 · hearing loss referral · GMC · remote consultations
What might the patient ask?
Read the context, try your response aloud, then reveal an example. Adapt it to the patient and local pathway; nothing is recorded.
Patient: “Is it just vertigo, or could it be a stroke?”+
Use this response when: New continuous dizziness with marked unsteadiness; no established benign explanation.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
Vertigo describes a feeling; it does not tell us the cause. An inner-ear problem is possible, but new continuous symptoms with difficulty walking can also have a more serious cause. I cannot safely exclude that by phone. We need immediate assessment through the local emergency or stroke pathway.
What a safe answer should include
- Do not use a normal conversation or absent FAST symptoms to exclude posterior circulation stroke.
- HINTS is not a telephone test.
Avoid: “You can talk normally, so it is not a stroke.”
Check understanding or explore further: “Why are we arranging immediate assessment rather than a routine dizziness review?”
Clinical and communication guidance: NICE NG127: dizziness and neurological referral · NHS: vertigo
Patient: “Can you talk me through the Epley manoeuvre instead of an appointment?”+
Use this response when: A new dizzy episode without a confirmed positional diagnosis or affected side.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
That manoeuvre can help a particular type of positional vertigo, but not every cause of dizziness. Before recommending it, we need to establish the pattern, check for warning signs and decide whether positional testing is appropriate. I would not ask you to copy movements when we do not yet know the cause or whether they are suitable.
What a safe answer should include
- Do not substitute a manoeuvre for assessment of a new or atypical presentation.
- A previously confirmed diagnosis and agreed treatment plan are a different situation.
Avoid: Treating all dizziness as BPPV.
Check understanding or explore further: “How long does each spell last, and what starts it?”
Clinical and communication guidance: NICE NG127: dizziness and neurological referral · NHS: vertigo
Patient: “Can I drive myself to the appointment?”+
Use this response when: The patient is currently dizzy or unsteady.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
Please do not drive while you are dizzy or unsteady. Let us arrange a safer way to get you assessed. If we suspect an emergency, we need emergency transport rather than you travelling alone. Longer-term driving advice depends on the diagnosis and any applicable licensing rules; we can review that after assessment.
What a safe answer should include
- Match transport to urgency rather than suggesting a taxi for an unstable patient.
- Avoid blanket long-term licensing advice before diagnosis.
Avoid: “Drive slowly and pull over if needed.”
Check understanding or explore further: “Who can help you, or do we need emergency services now?”
Clinical and communication guidance: NICE NG127: dizziness and neurological referral · NHS: vertigo
Nosebleed or nasal symptoms+
Opening question
“Is the nose bleeding now? Are you swallowing blood, faint or struggling to breathe?”
Ask next
- If bleeding: duration, volume, recurrence, injury, dizziness, weakness or vomiting swallowed blood?
- Anticoagulants or antiplatelets, a known bleeding disorder, or recent nasal surgery?
- If blockage: one side or both, progression, recurrent blood-stained discharge, facial symptoms or neck lump?
- Fever, facial or eye swelling, double vision or severe headache?
- What has already been tried and was the nose examined before?
Telephone may be enough
Give first-aid advice and review an already controlled, assessed bleed or stable known rhinitis when there is no new concerning feature.
Arrange examination
Recurrent bleeding, progressive unilateral symptoms or an uncertain diagnosis needs nasal examination, with endoscopy when indicated. A remote label of “sinusitis” cannot exclude a focal lesion.
Escalation pivot
An ongoing bleed lasting more than 10–15 minutes, excessive bleeding, weakness/dizziness, breathing difficulty or bleeding after head injury requires emergency-department assessment under NHS advice; severe instability warrants emergency services. Eye symptoms or severe illness with nasal infection need urgent assessment.
Guidance: NHS · nosebleed · GMC · remote consultations
What might the patient ask?
Read the context, try your response aloud, then reveal an example. Adapt it to the patient and local pathway; nothing is recorded.
Patient: “Should I tilt my head back or lie down?”+
Use this response when: An active nosebleed; assess severity before relying on first aid.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
Sit upright and lean forward, not back. Pinch the soft part of your nose just above the nostrils firmly for 10 to 15 minutes without releasing it to check. Breathe through your mouth. Tell me if you feel weak, dizzy, have breathing difficulty or are swallowing a lot of blood—those change the urgency.
What a safe answer should include
- Persistent bleeding beyond 10–15 minutes or excessive bleeding needs A&E assessment under NHS advice.
- Severe illness or breathing compromise needs emergency help; do not delay it for repeated first-aid cycles.
Avoid: Pinching the bony bridge or tilting the head backwards.
Check understanding or explore further: “Can you describe where you are applying pressure?”
Clinical and communication guidance: NHS: nosebleed · Hull NHS: adult nosebleeds and blood-thinning medicines · GMC: remote consultations
Patient: “Shall I stop my blood thinner because my nose has bled?”+
Use this response when: A controlled nosebleed in a patient taking an anticoagulant; a severe ongoing bleed needs emergency assessment instead.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
Do not change it on your own after a controlled bleed. The medicine protects against clots, so we need to balance that risk against the bleeding. Tell me its name, last dose and why you take it. We will obtain advice from the responsible clinician; ongoing heavy bleeding needs emergency assessment, not just a medication change.
What a safe answer should include
- Identify the medicine and indication; avoid a universal stop-or-continue instruction for major bleeding.
- Give an explicit assessment and medication-advice owner.
Avoid: “Stop all blood thinners for a few days.”
Check understanding or explore further: “Who will advise you about your next dose if we have not resolved this?”
Clinical and communication guidance: NHS: nosebleed · Hull NHS: adult nosebleeds and blood-thinning medicines · GMC: remote consultations
Patient: “One side is blocked and sometimes bleeds. Is it just sinusitis?”+
Use this response when: Persistent or progressive unilateral nasal symptoms; cause not established.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
Inflammation is possible, but a persistent problem on one side needs examination rather than assuming sinusitis. We may need to look inside the nose with a small camera. I will clarify the bleeding, duration and any facial or eye symptoms, then arrange the appropriate assessment. I cannot exclude a growth by telephone.
What a safe answer should include
- Ask about progression and concerning eye, facial or neurological features.
- Use local referral pathways; do not label every unilateral symptom as cancer.
Avoid: Repeated empirical treatment without a review or examination plan.
Check understanding or explore further: “What has changed, and when did the one-sided blockage begin?”
Clinical and communication guidance: NHS: nosebleed · Hull NHS: adult nosebleeds and blood-thinning medicines · GMC: remote consultations
Voice, throat or swallowing+
Opening question
“Can you swallow your saliva, and is your breathing noisy or difficult?”
Ask next
- Is there stridor, breathing difficulty, drooling or inability to manage secretions?
- How long has hoarseness lasted? Progressive or fluctuating; any recent intubation or neck surgery?
- Is swallowing painful, obstructed or causing coughing/choking? Solids, liquids or both?
- Any blood, weight loss, persistent one-sided pain, referred earache or neck lump?
- Smoking/alcohol history and functional impact; what is the patient most worried about?
Telephone may be enough
Discuss established findings, agreed voice-care advice or treatment response when the airway and swallow are stable and an examination plan is already documented.
Arrange examination
Persistent unexplained hoarseness, progressive dysphagia or a focal throat symptom needs examination and often flexible nasendoscopy. A normal-sounding voice on the call is not a laryngeal examination.
Escalation pivot
Stridor, respiratory distress, drooling or inability to manage secretions is an emergency airway pathway, not a routine clinic slot. Consider a suspected-cancer referral for persistent unexplained hoarseness in adults aged 45 or over, or a persistent unexplained neck lump, following NG12 and local arrangements.
Guidance: NHS · epiglottitis and airway warning signs · NICE NG12 · suspected head and neck cancer · GMC · remote consultations
What might the patient ask?
Read the context, try your response aloud, then reveal an example. Adapt it to the patient and local pathway; nothing is recorded.
Patient: “You mentioned an urgent referral. Does that mean I have cancer?”+
Use this response when: Persistent unexplained hoarseness meets the clinician’s threshold for a suspected-cancer pathway.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
It means we need to investigate promptly, not that cancer has been diagnosed. Several conditions can change the voice. Examining the voice box helps us understand the cause and avoid missing anything important. I will explain the appointment and how you will receive the results. What worries you most about the referral?
What a safe answer should include
- Explain uncertainty without false reassurance.
- Apply NG12 criteria and local routes; do not invent an individual cancer probability.
Avoid: “It is definitely not cancer” or “an urgent referral means cancer”.
Check understanding or explore further: “How would you explain the reason for the referral to someone at home?”
Clinical and communication guidance: NICE NG12: suspected cancer referral · NHS: epiglottitis and airway warning symptoms · GMC: remote consultations · NHS: laryngeal cancer diagnosis
Patient: “Will the camera hurt, and can I say no?”+
Use this response when: Discussing possible flexible nasendoscopy, not obtaining blanket consent for an unseen procedure.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
The clinician can explain how a thin flexible camera is used to look at the throat and voice box, what you may feel and the options to make it more comfortable. You can ask questions and decide whether to proceed. If you do not want it, we should discuss alternatives and what may remain uncertain without that examination.
What a safe answer should include
- Give a balanced explanation; consent remains voluntary.
- Discuss individual concerns and local examination arrangements, not guarantees.
Avoid: “It is completely painless and you have no choice.”
Check understanding or explore further: “What is your main concern about the examination?”
Clinical and communication guidance: NICE NG12: suspected cancer referral · NHS: epiglottitis and airway warning symptoms · GMC: remote consultations · NHS: laryngeal cancer diagnosis
Patient: “I cannot swallow my saliva and my breathing sounds noisy. Can I wait until morning?”+
Use this response when: Current secretion difficulty and noisy breathing, not a stable chronic swallowing complaint.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
No—those symptoms can mean your airway is at risk. We need emergency help now: call 999, or I will help activate emergency services according to our service procedure. Stay upright if that helps your breathing and do not drive yourself. Tell me exactly where you are and whether someone is with you.
What a safe answer should include
- Confirm location and activate emergency help without a prolonged routine history.
- Do not ask the patient to lie flat or examine deep in their throat.
Avoid: “Try a drink and call the clinic tomorrow.”
Check understanding or explore further: “Has emergency help been contacted, and is someone able to stay with you?”
Clinical and communication guidance: NICE NG12: suspected cancer referral · NHS: epiglottitis and airway warning symptoms · GMC: remote consultations · NHS: laryngeal cancer diagnosis
Neck lump or postoperative concern+
Opening question
“Is the neck swelling changing now, and is it affecting breathing, voice or swallowing?”
Ask next
- For a lump: duration, growth, site, firmness, pain, infection symptoms and previous imaging or sample results?
- Any persistent voice change, swallowing difficulty, one-sided earache, mouth lesion, weight loss or night sweats?
- For a recent operation: procedure and date, new swelling, bleeding, fever, wound discharge or changed voice?
- Can the patient swallow saliva and breathe comfortably? Is the swelling expanding?
- Who owns the result, wound review and next contact if the planned appointment fails?
Telephone may be enough
Communicate a confirmed result, explain the next appointment or check a stable wound already assessed, provided uncertainty, access and a named follow-up owner are addressed.
Arrange examination
A new or enlarging neck lump needs examination and an appropriate investigation route; a negative or inadequate sample does not automatically close a persistent concern. New postoperative changes usually need direct assessment.
Escalation pivot
Expanding postoperative neck swelling, bleeding with airway symptoms, stridor or secretion difficulty requires emergency response. A persistent unexplained neck lump or concerning thyroid lump needs a suspected-cancer pathway as appropriate; do not promise that a phone call has excluded cancer.
Guidance: NICE NG12 · suspected head and neck cancer · NHS · epiglottitis and airway warning signs · GMC · remote consultations
What might the patient ask?
Read the context, try your response aloud, then reveal an example. Adapt it to the patient and local pathway; nothing is recorded.
Patient: “The needle sample was clear. Can I forget about the lump?”+
Use this response when: A persistent neck lump with a reportedly negative or inadequate sample; the actual report and clinical concordance are not yet checked.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
We need to check exactly what the report says. Sometimes a sample is reassuring; sometimes it has too few cells or does not explain the lump. If the lump persists, the examination, scan and sample must fit together before we close the investigation. I will confirm the next step with the team and who will contact you.
What a safe answer should include
- Distinguish benign, non-diagnostic and discordant results.
- Do not turn a patient’s paraphrase into a definitive pathology result.
Avoid: “A negative needle test rules out all cancer.”
Check understanding or explore further: “Has the lump changed, and what follow-up were you told to expect?”
Clinical and communication guidance: NICE NG12: suspected cancer referral · GMC: remote consultations · NICE NG36: head and neck investigation · CUH NHS: thyroid surgery and warning symptoms
Patient: “My neck is swelling after surgery. Can I send a photo and wait?”+
Use this response when: New rapidly increasing neck swelling after thyroid surgery, with neck tightness or a change in voice, swallowing or breathing.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
A photograph cannot show whether swelling is affecting your airway. With this rapidly increasing swelling and the changes you describe, we need emergency help now. Call 999; I will help arrange the emergency response under our service procedure. Do not wait for a photograph to be reviewed or drive yourself. Tell me your exact location.
What a safe answer should include
- Prioritise emergency response over photographs and routine callbacks.
- Do not instruct a patient or relative to open a surgical wound.
Avoid: “Send a picture and we will look tomorrow.”
Check understanding or explore further: “Who is with you, and has emergency help been activated?”
Clinical and communication guidance: NICE NG12: suspected cancer referral · GMC: remote consultations · NICE NG36: head and neck investigation · CUH NHS: thyroid surgery and warning symptoms
Patient: “Can you tell my family the biopsy result before telling me?”+
Use this response when: A patient requests a different arrangement for a planned result discussion.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
We can discuss how you would like information shared. Please tell me exactly who you want involved and what you want them to know. I will check and document your wishes, confirm the right contact details and arrange the discussion appropriately. You can change your mind, and we should still agree how you will be involved in decisions.
What a safe answer should include
- Verify identity and specific permission before disclosure.
- Do not make an unplanned sensitive disclosure to whoever answers the phone.
Avoid: Assuming that “next of kin” automatically authorises disclosure.
Check understanding or explore further: “What would you like us to tell you directly, and what may we share with your family?”
Clinical and communication guidance: NICE NG12: suspected cancer referral · GMC: remote consultations · NICE NG36: head and neck investigation · CUH NHS: thyroid surgery and warning symptoms
Trust, access and agreeing the plan
Six questions that can arise in any call+
Patient: “Can you really tell what is wrong without seeing me?”+
Use this response when: Opening a planned, non-emergency telephone consultation.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
We can discuss what has happened and review your results, but I cannot examine your ears, nose or throat on this call. If an examination could change the plan, we will arrange one. Let us first establish what has changed and what you are most concerned about.
What a safe answer should include
- Explain what telephone assessment can and cannot establish.
- Change consultation mode if it cannot safely meet the patient’s needs.
Avoid: “I can diagnose everything over the phone.”
Check understanding or explore further: “What were you hoping we could resolve today?”
Clinical and communication guidance: GMC: remote consultations · GMC: deciding if it is safe to prescribe
Patient: “Can my daughter speak for me?”+
Use this response when: The patient is present and wishes a relative to help.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
Yes, if you would like her involved. I will first check with you what you are happy for us to discuss. I would also like to hear from you directly where possible. If language is a barrier, we can arrange a professional interpreter so important details are not lost.
What a safe answer should include
- Confirm identity, consent and the relative’s role.
- Do not assume permission to disclose because someone answers the phone.
Avoid: Discussing confidential results before checking consent.
Check understanding or explore further: “Is there anything you would prefer to discuss privately?”
Clinical and communication guidance: GMC: remote consultations · GMC: deciding if it is safe to prescribe
Patient: “I cannot hear you properly. Can you just tell my family?”+
Use this response when: Communication is unreliable because of hearing difficulty.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
Thank you for telling me. I do not want you to miss important information. Let us agree a better way to communicate, such as an accessible appointment or a suitable written summary through the service. We can involve someone you choose with your permission. First, has your hearing changed suddenly?
What a safe answer should include
- Check whether the communication problem is itself a new symptom.
- Do not complete consent or safety-netting when understanding is unreliable.
Avoid: Speaking louder and assuming the problem is solved.
Check understanding or explore further: “Which way of communicating works best for you?”
Clinical and communication guidance: GMC: remote consultations · GMC: deciding if it is safe to prescribe
Patient: “Why will you not just give me antibiotics?”+
Use this response when: The cause of a new ENT symptom has not been established.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
I understand you want relief. The right treatment depends on the cause, and antibiotics may not help this problem. I need enough information to prescribe safely; that may mean examining you first. We can discuss appropriate symptom relief while arranging the assessment and explain what would make it urgent.
What a safe answer should include
- Check records, allergies and relevant medicines before prescribing.
- Give a positive assessment plan, not simply a refusal.
Avoid: “Antibiotics never help ENT problems.”
Check understanding or explore further: “What treatment have you already tried, and what effect did it have?”
Clinical and communication guidance: GMC: remote consultations · GMC: deciding if it is safe to prescribe
Patient: “I cannot get to hospital today. Can I wait?”+
Use this response when: The clinician has identified a time-sensitive need for in-person assessment.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
I understand getting there may be difficult. I am concerned that waiting could be unsafe because of the symptoms we have discussed. What is preventing you attending? Let us work out a safe route and involve the receiving team. If this is an emergency, we need emergency help, not a routine booking.
What a safe answer should include
- Identify transport, caring, disability or other barriers.
- If the patient declines, assess understanding and decision-making capacity, discuss risks and alternatives, document and escalate appropriately.
Avoid: “It is your choice” followed by ending the call without a plan.
Check understanding or explore further: “Can you explain the reason for today’s assessment in your own words?”
Clinical and communication guidance: GMC: remote consultations · GMC: deciding if it is safe to prescribe
Patient: “Nobody has contacted me. Does that mean the test was normal?”+
Use this response when: A planned investigation result or appointment has not reached the patient.
Try answering aloud before opening the example. Nothing is recorded or scored.
Reveal model clinician response+
No—silence does not tell us whether a result is normal. I will check whether the result is available and who is responsible for reviewing it. Before we finish, we will agree who will contact you, by when, and which number to use if that does not happen. Have your symptoms changed?
What a safe answer should include
- Distinguish a result not received from a result reviewed and communicated.
- Replace vague promises with a named team, real timeframe and fallback contact.
Avoid: “They would have called if it was serious.”
Check understanding or explore further: “Who will you contact if the agreed update does not arrive?”
Clinical and communication guidance: GMC: remote consultations · GMC: deciding if it is safe to prescribe
Close the call without losing the patient
Useful phrases
“I do not want to give you false reassurance without looking in the ear / nose / throat.”
“Because this changed suddenly, I want you assessed today through [agreed route]. I will arrange the handover, not leave you to book an ordinary appointment.”
“Can you tell me what you will do if [specific warning sign] happens before we speak again?”
Record in the clinical system
Identity and privacy check; mode and limitations; symptom timeline and positives/negatives; available records; interpretation and differential; why telephone was or was not sufficient; recommendation and agreed timeframe; referrals and recipient; safety-net; result/review owner; patient understanding and preferences.
No patient data are stored on this page. Use your organisation’s approved record and communication channels.
Guidance links checked. Check current guidance and local pathways before use. Report an error or suggest an improvement.