How to handle patients who won't stop talking??

[deleted128562]

We all have these patients, the ones who either don't know or don't care that there are 20 other people waiting to be seen in the department while the lobby swells by the minute. Most of them are very nice and well-meaning people, but they are dragging my efficiency into the gutter, and I still have not figured how to get out of the room without looking like a jerk. And the biggest problem for me is that most of these people don't seem to get social queues. I'll let them go on for a minute and then say something like, "alright, well I'll let you know as soon as I have your test results in" and start turning to go.... and they will just pick right back up where they left off or even say "oh hey doc, wait, before you go I gotta tell you about this one time....". I really don't want to act uncaring, and Lord knows I don't want to tank my Press-Ganey scores, but this has gotta stop. I find these patients come in 2 varieties:

1) The person who just wants to talk your ear off. About anything and everything. They start telling you their life story, their dreams and goals, about what each of their kids are doing. And you start wondering if they do the same thing to their mechanic, waitress, etc.

2) The person who won't give you any sort of history without telling a story. This one is much harder because you're actually trying to get information you need. For example, I might ask "do you have a history of cancer?", and they might answer with, "Why yes, it all started 3 years ago when I was walking my dog. I noticed that I was feeling a little off and thought maybe I'd better rest. Now back then I was still living in the east end of town where my brother was living, and so he...." And this goes on for 84 hours before they tell me that yes, they have a history of colon cancer.

Anyone have any suggestions for how to handle each of these types of patients? Would love to hear your tips and tricks!!

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[QuackaDO]

1. Simply say "let me run and go put those orders in for the tests so we can figure out what's going on and get you feeling better." If they say Ok, turn and run, lol! If they say OK, but I wanted to... blah blah blah... politely interject before they get through their first sentence "Mr./Mrs. so and so, I'm concerned that your abd px (or whatever) could be something serious and I'd really like to work that up quickly but as long as we're here talking I can't put the orders in to get that done. Can we chat again in a little while once I get those in and we get some more info?". 99 times out of 100 that works and if it's that 1/100... just run, lol.
2. At any point after they say "yes..." and start trailing off just quickly interject "Oh, so I heard you did say you have cancer, what kind?" If they start trailing off again then you interject "I'm sorry, what year did you say they found it?". Interjection becomes a powerful tool with these people because when you interject them before they get rambling off to Tuesday they went and blah blah they will take it as you're listening and interested in their condition, not that you're being rude and cutting them off. If you let them get knee deep in the story and then try to interject they they will think you are being rude and cutting them off. If they somehow do get to the rambling phase key in on something they said like "Now back then I was still living in the east end of town where my brother was living, and so he..." and say "oh, you were living on the east side of town? When was that?" and as soon as they answer immediately reply "is that when they found the cancer?". Interjection and redirection is kinda the thing with the ramblers.

 

[da8s0859q]

Yes sir, I know what you mean. Let me go put in some orders to help take care of that pain / nausea / hangnail / ingrown pubic hair so you're not uncomfortable while we're just talking.

Yes ma'am, how terrible. I would really hate for you to be stuck hanging out with us in the ER all day long. Let me get some orders put in your chart so we can make sure there isn't anything life-threatening going on / get you feeling better / [...].

Back on the east end of town, huh? I had some friends who lived out there. So what were you diagnosed with? Very sorry to seem like I'm in a hurry -- I'm just concerned and want to be able to have some answers for you as soon as possible.

 

[HarryPlopper]

We all have these patients, the ones who either don't know or don't care that there are 20 other people waiting to be seen in the department while the lobby swells by the minute. Most of them are very nice and well-meaning people, but they are dragging my efficiency into the gutter, and I still have not figured how to get out of the room without looking like a jerk. And the biggest problem for me is that most of these people don't seem to get social queues. I'll let them go on for a minute and then say something like, "alright, well I'll let you know as soon as I have your test results in" and start turning to go.... and they will just pick right back up where they left off or even say "oh hey doc, wait, before you go I gotta tell you about this one time....". I really don't want to act uncaring, and Lord knows I don't want to tank my Press-Ganey scores, but this has gotta stop. I find these patients come in 2 varieties:

1) The person who just wants to talk your ear off. About anything and everything. They start telling you their life story, their dreams and goals, about what each of their kids are doing. And you start wondering if they do the same thing to their mechanic, waitress, etc.

2) The person who won't give you any sort of history without telling a story. This one is much harder because you're actually trying to get information you need. For example, I might ask "do you have a history of cancer?", and they might answer with, "Why yes, it all started 3 years ago when I was walking my dog. I noticed that I was feeling a little off and thought maybe I'd better rest. Now back then I was still living in the east end of town where my brother was living, and so he...." And this goes on for 84 hours before they tell me that yes, they have a history of colon cancer.

Anyone have any suggestions for how to handle each of these types of patients? Would love to hear your tips and tricks!!

There are many ways to do this. First, apologize when you see the patient and begin by prefacing that the ER is packed and there are many other emergencies. This sets the baseline that you are busy as hell and don't got much time, but you are willing to spend whatever time you can with them.

Second, don't go for HPI first. Get to know them by asking for PMH/PSH/meds/allergies/ect and tell them it's important because you want to "get to know them" and show you that you care. When you go to ask for HPI, ask them "why today?" if HPI might be due to chronic problem. By doing this you take the lead for their life story and control the conversation. Should they go off in a tangent, subtly redirect the conversation. When you become good at this, you'll be able to take control of the conversation while letting them think that they are doing the talking. Try subtly repeating back some of their words while directing the conversation. Remember to smile.

Third, be blunt and tell them that some tests you are going to order will take a while and you must move to "secure a spot" for CT/XR ect. You can also say you want to get pain meds to them ASAP or need to gather materials --> Think of the "rate-limiting step" and let it be known. Give them a slightly exaggerated time that they could be in the ER to emphasize your point. It will help if you say you want them to get out of the ER ASAP so they have time to go see (kid's name or whatever).

Fourth, sometimes patients talk a lot simply because they want the attention so they don't feel that they're ignored. If you must cut them short, tell them that you will check up on them frequently. When popping your head in every once in a while, let them know they aren't forgotten but emphasize how crazy it is out there. Also remember to apologize for the wait and say you will be doing so and so for them right now so you have to go.

Fifth, tell them that what they may have could be serious and that you must act fast. Don't make it seem that it is definitely serious, just let them know that you are being cautious.

Sixth, tell them you think they really need to rest for a while so you don't want to stay long. You'll only come bother them when it's something really important. This works great when you have a lot of things on your plate. Make sure pain management is met or they'll complain; you can adjust morphine early on. Ask whether or not you can turn off the lights and hope they fall asleep.

 

[tartesos]

We all have these patients, the ones who either don't know or don't care that there are 20 other people waiting to be seen in the department while the lobby swells by the minute. Most of them are very nice and well-meaning people, but they are dragging my efficiency into the gutter, and I still have not figured how to get out of the room without looking like a jerk. And the biggest problem for me is that most of these people don't seem to get social queues. I'll let them go on for a minute and then say something like, "alright, well I'll let you know as soon as I have your test results in" and start turning to go.... and they will just pick right back up where they left off or even say "oh hey doc, wait, before you go I gotta tell you about this one time....". I really don't want to act uncaring, and Lord knows I don't want to tank my Press-Ganey scores, but this has gotta stop. I find these patients come in 2 varieties:

1) The person who just wants to talk your ear off. About anything and everything. They start telling you their life story, their dreams and goals, about what each of their kids are doing. And you start wondering if they do the same thing to their mechanic, waitress, etc.

2) The person who won't give you any sort of history without telling a story. This one is much harder because you're actually trying to get information you need. For example, I might ask "do you have a history of cancer?", and they might answer with, "Why yes, it all started 3 years ago when I was walking my dog. I noticed that I was feeling a little off and thought maybe I'd better rest. Now back then I was still living in the east end of town where my brother was living, and so he...." And this goes on for 84 hours before they tell me that yes, they have a history of colon cancer.

Anyone have any suggestions for how to handle each of these types of patients? Would love to hear your tips and tricks!!

It's a pain in the $$$.
A friend of mine schedules them at the end of the day, because she's lucky enough to know them by now.
It's a tough situation and I feel the same way.

I write a little of the patients personal life and hobbies on the note so I remember them on the social hx part and I can remember( hunter, mechanic, kids etc. ) you can then make some small talk so they know you remember and care and then they won't feel that bad when u have to leave.

 

[BoardingDoc]

It's a pain in the $$$.
A friend of mine schedules them at the end of the day, because she's lucky enough to know them by now.
It's a tough situation and I feel the same way.

I write a little of the patients personal life and hobbies on the note so I remember them on the social hx part and I can remember( hunter, mechanic, kids etc. ) you can then make some small talk so they know you remember and care and then they won't feel that bad when u have to leave.

Good advice for outpatient practice, but this isn't really an option in the ED.

 

[tartesos]

Good advice for outpatient practice, but this isn't really an option in the ED.

True!! Didn't realize it was for Ed.
For Er, have someone page you in 2 mins after you are in and leave!!

Or use any overhead announcement and say you have to attend that!

 

[NinerNiner999]

Geodon.

 

[Spinach Dip]

I've heard intubation tends to cut down on both conversation frequency and duration.

 

[diphenyl]

I would arrange to have a nurse listen in and when the patient started going long and off track, they would just call my in house phone with an "emergency"

 

[GeneralVeers]

I would arrange to have a nurse listen in and when the patient started going long and off track, they would just call my in house phone with an "emergency"

I like your approach. I do this frequently when I re-evaulate "talkers" who waste my time. We carry a cordless phone with us. I will tell the nurses that I am going to see a particularly boring patient, and that they should call my phone within 3 minutes if I don't come out of the room. This works perfectly as you can pretend it's whatever emergency you want, excuse yourself, then rush out of the room as if you are going to save a life.

 

[deleted547339]

sucs or rocc depending on duration desired

 

[Daiphon]

I taught myself the button sequence on my pager to change the alert... but tell the patients that I'm being paged and have to answer it. d=)

 

[The White Coat Investor]

Every patient gets to control the first two minutes to use as they see fit. I ask, "How can I help you?" and then just sit and listen for two minutes with minimal prompting if required. After that, the conversation is mine. If they blew their two minutes talking about Aunt Sally's barn, and I can't get the info I need out of them once I take over, I wouldn't be surprised to learn their medical care is worse than someone who knows how to shut up when socially appropriate. The truth is that we are all used to taking care of a patient without any history at all, and we can certainly do so if we have to. So if they talk too much, they get the "veterinary care" option. A few more tests, a little longer observation, I rely more on info from family, EMS, nursing home etc.

On a related note, has anyone ever checked the ROS box that says "Unable to obtain because..." and then put "Patient too talkative/rambling/unredirectable"? Or is that just a form of altered mental status?

P.S. Can you imagine what patients think when they read this thread?

 

[TooMuchResearch]

There are many ways to do this. First, apologize when you see the patient and begin by prefacing that the ER is packed and there are many other emergencies. This sets the baseline that you are busy as hell and don't got much time, but you are willing to spend whatever time you can with them.

Second, don't go for HPI first. Get to know them by asking for PMH/PSH/meds/allergies/ect and tell them it's important because you want to "get to know them" and show you that you care. When you go to ask for HPI, ask them "why today?" if HPI might be due to chronic problem. By doing this you take the lead for their life story and control the conversation. Should they go off in a tangent, subtly redirect the conversation. When you become good at this, you'll be able to take control of the conversation while letting them think that they are doing the talking. Try subtly repeating back some of their words while directing the conversation. Remember to smile.

Third, be blunt and tell them that some tests you are going to order will take a while and you must move to "secure a spot" for CT/XR ect. You can also say you want to get pain meds to them ASAP or need to gather materials --> Think of the "rate-limiting step" and let it be known. Give them a slightly exaggerated time that they could be in the ER to emphasize your point. It will help if you say you want them to get out of the ER ASAP so they have time to go see (kid's name or whatever).

Fourth, sometimes patients talk a lot simply because they want the attention so they don't feel that they're ignored. If you must cut them short, tell them that you will check up on them frequently. When popping your head in every once in a while, let them know they aren't forgotten but emphasize how crazy it is out there. Also remember to apologize for the wait and say you will be doing so and so for them right now so you have to go.

Fifth, tell them that what they may have could be serious and that you must act fast. Don't make it seem that it is definitely serious, just let them know that you are being cautious.

Sixth, tell them you think they really need to rest for a while so you don't want to stay long. You'll only come bother them when it's something really important. This works great when you have a lot of things on your plate. Make sure pain management is met or they'll complain; you can adjust morphine early on. Ask whether or not you can turn off the lights and hope they fall asleep.

As I imagine your fourth suggestion, I cannot help but picture an exhausted doc popping his head through the curtains, telling the patient "Hey, sorry things are taking so long today. It's crazy out there," as other staff stand in the hallway banging pots and pans together while making howling noises.

 

[Mad Jack]

 

[GeneralVeers]

I squarely blame the show House MD. Every patient believes that they have a rare disease that can ONLY be diagnosed through extensive history, including every activity they have done in the past week, and when Grandma Suzie had her last colonoscopy. Patients don't understand that we are not there to diagnose. Do I care if you have a cold or the flu? No. I am there to make sure you are not dying of a deadly disease. That is all. If you're not dying then I'm going to discharge you to follow-up with your PCP. What kind of cheese you had on your sandwich for lunch last Tuesday is irrelevant to me and will probably make me hate you if you tell me.

 

[Birdstrike]

I squarely blame the show House MD. Every patient believes that they have a rare disease that can ONLY be diagnosed through extensive history, including every activity they have done in the past week, and when Grandma Suzie had her last colonoscopy. Patients don't understand that we are not there to diagnose. Do I care if you have a cold or the flu? No. I am there to make sure you are not dying of a deadly disease. That is all. If you're not dying then I'm going to discharge you to follow-up with your PCP. What kind of cheese you had on your sandwich for lunch last Tuesday is irrelevant to me and will probably make me hate you if you tell me.

Classic!

 

[Spinach Dip]

What kind of cheese you had on your sandwich for lunch last Tuesday is irrelevant to me and will probably make me hate you if you tell me.

But doctor, it was swiss cheese. Now, my aunt Ethyl--God rest her soul--had swiss cheese on her sandwich only one week before she was diagnosed with lupus. Now, I came here 'cause I got this rash on my face just like she had. Well, hers was redder around the edges and her eyes got all puffy. Have you ever seen someone who was punched in the eye, doc? Well that's what her eyes looked like. I remember this one guy in the Navy--I was an underwater welder in the Vietnam war--and he had eyes that looked like....um.... where was I?....Oh yes....So....do you think the swiss cheese might have caused the lupus?

 

[Rendar5]

But doctor, it was swiss cheese. Now, my aunt Ethyl--God rest her soul--had swiss cheese on her sandwich only one week before she was diagnosed with lupus. Now, I came here 'cause I got this rash on my face just like she had. Well, hers was redder around the edges and her eyes got all puffy. Have you ever seen someone who was punched in the eye, doc? Well that's what her eyes looked like. I remember this one guy in the Navy--I was an underwater welder in the Vietnam war--and he had eyes that looked like....um.... where was I?....Oh yes....So....do you think the swiss cheese might have caused the lupus?

IT'S NEVER LUPUS

 

[deleted547339]

IT'S NEVER LUPUS

I had a lupus patient today....d@mnit.

 

[da8s0859q]

I miss House. Still hate the series finale.

Witty dialog, kernels of occasionally interesting medical content interspersed with laughable inaccuracies, Cameron, and Thirteen. Obviously in no particular order.

 

[Bostonredsox]

We all have these patients, the ones who either don't know or don't care that there are 20 other people waiting to be seen in the department while the lobby swells by the minute. Most of them are very nice and well-meaning people, but they are dragging my efficiency into the gutter, and I still have not figured how to get out of the room without looking like a jerk. And the biggest problem for me is that most of these people don't seem to get social queues. I'll let them go on for a minute and then say something like, "alright, well I'll let you know as soon as I have your test results in" and start turning to go.... and they will just pick right back up where they left off or even say "oh hey doc, wait, before you go I gotta tell you about this one time....". I really don't want to act uncaring, and Lord knows I don't want to tank my Press-Ganey scores, but this has gotta stop. I find these patients come in 2 varieties:

1) The person who just wants to talk your ear off. About anything and everything. They start telling you their life story, their dreams and goals, about what each of their kids are doing. And you start wondering if they do the same thing to their mechanic, waitress, etc.

2) The person who won't give you any sort of history without telling a story. This one is much harder because you're actually trying to get information you need. For example, I might ask "do you have a history of cancer?", and they might answer with, "Why yes, it all started 3 years ago when I was walking my dog. I noticed that I was feeling a little off and thought maybe I'd better rest. Now back then I was still living in the east end of town where my brother was living, and so he...." And this goes on for 84 hours before they tell me that yes, they have a history of colon cancer.

Anyone have any suggestions for how to handle each of these types of patients? Would love to hear your tips and tricks!!

Don't have this problem in MICU. Everyone is intubated and sedated. I've found it's actually the most quiet and relaxing place to practice medicine in the hospital.

 

[Old_Mil]

>So if they talk too much, they get the "veterinary care" option. A few more tests, a little longer observation, I rely more on info
>from family, EMS, nursing home etc.

Just had one of these last shift.

 

[Alvarez13]

sucs or rocc depending on duration desired

I like this guy thinks.