The telephone is an integral part of medical care, yet it ranks as the number one source of patient and clinician dissatisfaction. Problems fall into three categories: (1) volume overload with access difficulties, (2) staffing and telephone triage, and (3) the stress on clinicians of non-emergency night calls. This paper summarizes a telephone medicine satisfaction survey among HMO pediatric department chiefs, reviews the variables that influence the quality of telephone medicine, and discusses the importance of training in telephone management skills. A four-step approach to improving telephone medicine is presented along with a telephone quality-of-care checklist applicable to most practices.