Effective triaging in general practice receptions: a conversation analytic study

When patients call to make appointments at the doctors, the relative urgency of their healthcare needs is something that ‘triaging’ systems are designed to establish. This chapter investigates how receptionist-led triage unfolds in patients’ calls to general practice surgeries. We collected 2780 audio-recorded telephone calls from three UK surgeries, transcribed them and used conversation analysis to study the real-time interaction between receptionists and patients. We focused on receptionists’ initial responses to patients’ requests to make a doctor’s appointment, and how receptionists established whether patients’ medical needs require (i) a same-day appointment with a doctor, (ii) a call-back from a doctor or nurse, or (iii), if not urgent, an appointment on a future date. We show how variation in the way receptionists initiated the triaging, i.e., how they sought to establish whether or not the request was urgent enough for a same-day appointment, was consequential for the smooth progress of the interaction. First, when receptionists initiated triaging with a polar interrogative asking patients to (dis)confirm their problem as ‘routine’ (‘is it just a routine appointment?’), or when contrasting ‘routine’ and ‘urgent’ (‘is it urgent or routine?’), patients were reluctant to confirm either way. Second, triaging progressed more smoothly when receptionists asked questions that solicited accounts. Interrogatives that were effective in soliciting an account from the patient included both polar interrogatives (‘is it something (urgent) for today?’), and wh- interrogatives (‘may I ask what the problem is?’), but the latter was more problematic for patients who wish to withhold their reason for seeing the doctor. Third, when patients, in their initial inquiries, did not describe their problem as urgent, they readily accepted a future appointment – suggesting that receptionists need not ask about urgency at all, in the first instance. Our findings have implications for GP receptionist training and wider practice policies.