Medical appointments and older patients: keeping the telephone at the heart of booking

Insee, France’s national statistics institute, measures illectronisme, that is, the situation of people who have not used the internet in the last three months or who lack basic digital skills. According to its 2021 ICT households survey (enquête TIC ménages), carried out in spring among people aged 15 or over living in ordinary housing in France excluding Mayotte (Insee Première no. 1953, June 2023), 15.4% of this population is affected: 13.9% had not used the internet in the last three months and 1.5% had used it without having the basic skills.

The gap between generations is clear: again according to Insee, 61.9% of people aged 75 or over are in a situation of illectronisme, compared with 2.4% of 15-24 year-olds. These figures date from 2021 and do not cover people living in institutions; above all they remind us that a purely online journey leaves part of the patient base behind, especially the oldest.

In its survey on telephone reception at four public services, published in 2023, the Défenseur des droits writes that the telephone remains an essential solution, notably for people excluded from the digital world, including older people, and that going digital must be an additional offer, not a substitute for the counter, the post or the telephone. It also finds that users are very often sent to the organisation’s website, including those who say they have no equipment for it.

These findings concern public services, not medical practices, and should be read as such. But the principle transfers easily: if your online diary is a good option, it must not be the only way in, and a patient who phones should never be told to go to the website.

A few simple gestures make a real difference. Speak at a measured pace and reword the request before acting: “You would like an appointment with the doctor, is that right?”. Offer two slots rather than a list, repeat the date, the day of the week and the time out loud, then ask the patient to say them back. Give the address and access instructions (floor, lift, parking) without waiting to be asked.

Avoid jargon and acronyms, allow time for the patient to look for a number or a piece of paper, and be willing to repeat without showing irritation. Offer to call back rather than putting the patient on hold, and ask whether the patient would like a relative to be informed. Above all, never send them to an online procedure as the only solution.

Train stand-ins and occasional colleagues in these habits too: an older patient can quickly sense whether the person on the line is in a hurry. A confirmation reminder the day before, when the organisation allows it, avoids forgotten appointments without asking the patient to go through a screen.

Telephone reception books appointments, gives practical information and passes on messages; it gives no medical opinion, does not interpret symptoms and does not decide how urgent a case is. Provide a clear greeting message: in a medical emergency, the patient must call 15 (the Samu, France’s emergency medical service, which provides round-the-clock medical listening 24 hours a day according to the service-public.gouv.fr directory) or 112, the European emergency number.

Think, too, about the information you collect. Article L1111-8 of the Public Health Code (Code de la santé publique) provides that anyone hosting, on a digital medium, personal health data collected in the course of prevention, diagnosis, care or social and medico-social follow-up, on behalf of those who produce or collect it (or of the patient themselves), must hold a certificate of conformity. Depending on its content, the reason for a consultation may fall within this framework: limit the initial contact to what is strictly necessary (identity, contact details, type of appointment) and have the scope validated by your data protection officer or your adviser.

A practice can perfectly well offer the online diary to patients who want it and full telephone reception to the others. What is essential is that the information is the same on both channels (hours, waiting times, instructions) and that the telephone is answered: a call that rings unanswered, outside the secretariat’s hours, may be a patient who gives up or turns up without an appointment.

Whatever organisation you choose, measure what really matters: how many patients call after giving up on the online diary, which reasons keep coming up, which appointments are forgotten. These observations, from your own practice, are worth more than a national figure.

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