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Education Research: Patient telephone calls in a movement disorders center

Lessons in physician-trainee education

From the Parkinson’s Disease Center and Movement Disorders Clinic (O.R.A., J.M.F., L.G.A.T., M.M.N., J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; and Department of Sociology (M.N.), University of California at Davis.

Address correspondence and reprint requests to Dr. Octavian R. Adam, Parkinson’s Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Department of Neurology, 6550 Fannin, Suite 1801, Houston, TX 77030 oradam{at}bcm.tmc.edu

Objective: Telephone medicine is part of clinical practice, but there are no published data on the volume, nature, and time allocation of patient-related telephone calls received in a movement disorders center. Such data might provide insights which augment patient care, and may be instructive regarding medical education, since patient-related telephone calls are often addressed by physicians-in-training.

Methods: Characteristics of patient-related calls to a movement disorders center were prospectively recorded during a 2-month period.

Results: A total of 633 calls were generated by 397 patients. The average time per call was 6.6 ± 4.7 minutes. Disease-related questions (35.1%), treatment-related questions (21.3%), and side effect reports (15.3%) represented the majority of calls. Patients with Parkinson disease, Tourette syndrome (TS), and atypical parkinsonism (AP) called more frequently, while patients with dystonia and tremor called less frequently.

Conclusion: Patient telephone calls contribute substantially to the patient care in a movement disorders center and represent an important aspect of training, providing an opportunity for movement disorders fellows to develop independent decision-making skills and monitor effectiveness of their physician-patient counseling. Parkinson disease, Tourette syndrome (TS), and atypical parkinsonism (AP) contribute disproportionately to the total patient telephone volume, possibly due to coexisting obsessive-compulsive and impulse-control comorbidities in patients with TS, and complications or a change of diagnosis and prognosis in patients with AP. Emphasis on the management of these specific diagnostic groups early in fellowship training may be warranted.

Abbreviations: AP = atypical parkinsonism; ED = emergency department; ET = essential tremor; PD = Parkinson disease; PDCMDC = Parkinson’s Disease Center and Movement Disorders Clinic; RLS = restless legs syndrome; TS = Tourette syndrome.

Disclosure: Author disclosures are provided at the end of the article.