Do you finish notes with the patient in the room? If not, how do you get out on time?

[Doctor Bagel]

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I'm revisiting this thread because on the whole, this has continued to get worse for me. I won't say exactly when I left the office today, but it was later than 6:30. Today marked a first in my time here: it was the first time that, for two days in a row, all of my new patients, of which I schedule 4 per day, showed up. So far, the vast majority of days, at least one new patient has no-showed. This made me realize that, as efficient as I can tell myself I'll become, I've still been counting on a certain percentage of no-shows.

Rereading the thread, it seems like the secret is not letting appointments take the full allotted time. Is that right? I vaguely remember, in residency, "hour" long appointments actually being 50 minutes, but because I'm such a pushover, I've gradually lapsed into allowing patients to take the full allotted time. So, should I just start pushing to finish the interview with a few minutes to spare, and kicking the patient out of the room early so I can finish my note? Is that what you guys do? If you spend 50 minutes of a 60 minute appointment with the patient actually in the room, how much do you spend for a half hour appointment? 25 minutes? What do you do when you get behind? In my clinic, we have a policy of seeing follow-ups, which are half-hour slots, as long as they arrive fewer than 10 minutes late. So, if your 2:00 shows up at 2:09, do you still kick them out at 2:25? If not, do you start getting behind? And what about patients who talk your ear off? You know the kind--people who try to answer every simple yes-or-no question by launching into an elaborate story from early childhood, or people who literally will never stop talking, telling a neverending story with absolutely zero pause in the narrative, unless and until you literally start talking over them to interrupt them? There have been times I start pushing to wrap things up at 2:25, launching into the end-of-visit discussion, and it seems like we're going to end on time, only to glance at the time again and see that it's 2:33 and they're droning on again, and when I interrupt them to make my final once-and-for-all statement, they launch into hand-on-the-doornob questions and bringing up new symptoms. Do you just be rude to them and terminate the visit? If not, how do you avoid getting behind?

So this is the upside of inpatient work. But yeah, the super efficient people I knew in community MH would end appointments 5 minutes early to finish notes and seemed pretty quick to cut patients off. So I guess you start wrapping up 10 minutes early to get them out of the door in time for the 5 minute finish up? Also while notes might be important, I would say your follow up progress note is less important than your initial eval note. How much time do you have for new evals? In my town, 90 minutes is the norm even in community MH but maybe that's rare?

 

[Jules A]

I'm revisiting this thread because on the whole, this has continued to get worse for me. I won't say exactly when I left the office today, but it was later than 6:30. Today marked a first in my time here: it was the first time that, for two days in a row, all of my new patients, of which I schedule 4 per day, showed up. So far, the vast majority of days, at least one new patient has no-showed. This made me realize that, as efficient as I can tell myself I'll become, I've still been counting on a certain percentage of no-shows.

Rereading the thread, it seems like the secret is not letting appointments take the full allotted time. Is that right? I vaguely remember, in residency, "hour" long appointments actually being 50 minutes, but because I'm such a pushover, I've gradually lapsed into allowing patients to take the full allotted time. So, should I just start pushing to finish the interview with a few minutes to spare, and kicking the patient out of the room early so I can finish my note? Is that what you guys do? If you spend 50 minutes of a 60 minute appointment with the patient actually in the room, how much do you spend for a half hour appointment? 25 minutes? What do you do when you get behind? In my clinic, we have a policy of seeing follow-ups, which are half-hour slots, as long as they arrive fewer than 10 minutes late. So, if your 2:00 shows up at 2:09, do you still kick them out at 2:25? If not, do you start getting behind? And what about patients who talk your ear off? You know the kind--people who try to answer every simple yes-or-no question by launching into an elaborate story from early childhood, or people who literally will never stop talking, telling a neverending story with absolutely zero pause in the narrative, unless and until you literally start talking over them to interrupt them? There have been times I start pushing to wrap things up at 2:25, launching into the end-of-visit discussion, and it seems like we're going to end on time, only to glance at the time again and see that it's 2:33 and they're droning on again, and when I interrupt them to make my final once-and-for-all statement, they launch into hand-on-the-doornob questions and bringing up new symptoms. Do you just be rude to them and terminate the visit? If not, how do you avoid getting behind?

For me having four intakes in a shift is doable but can definitely slow things down depending on the collateral I was able to gleen from the therapists documentation. There are always going to be the rare crisis that needs a bit more attention but yes I aim for actual time with the patient of 45min intake and 20 minute follow up when allotted 60/30. If you have groomed your patients to expect a full 1/2 hour it will take a bit of time and finesse to reset their expectations. My secretaries tell all my patients they are scheduled for 20/45 to set up a realistic expectation from the beginning. If they are late I make it a point to tell them we are going to have to fly through things and if they are not stable, unless the very rare med issue, they will need to be scheduled with their therapist and reschedule with me when we have adequate time. It is rarely medication management questions that monopolize my appointments, almost always psychosocial issues, so I don't consider it the least bit rude to direct them to their therapist. Unfortunately or fortunately depending on your style we are only being paid for med management.

 

[smalltownpsych]

I'm revisiting this thread because on the whole, this has continued to get worse for me. I won't say exactly when I left the office today, but it was later than 6:30. Today marked a first in my time here: it was the first time that, for two days in a row, all of my new patients, of which I schedule 4 per day, showed up. So far, the vast majority of days, at least one new patient has no-showed. This made me realize that, as efficient as I can tell myself I'll become, I've still been counting on a certain percentage of no-shows.

Rereading the thread, it seems like the secret is not letting appointments take the full allotted time. Is that right? I vaguely remember, in residency, "hour" long appointments actually being 50 minutes, but because I'm such a pushover, I've gradually lapsed into allowing patients to take the full allotted time. So, should I just start pushing to finish the interview with a few minutes to spare, and kicking the patient out of the room early so I can finish my note? Is that what you guys do? If you spend 50 minutes of a 60 minute appointment with the patient actually in the room, how much do you spend for a half hour appointment? 25 minutes? What do you do when you get behind? In my clinic, we have a policy of seeing follow-ups, which are half-hour slots, as long as they arrive fewer than 10 minutes late. So, if your 2:00 shows up at 2:09, do you still kick them out at 2:25? If not, do you start getting behind? And what about patients who talk your ear off? You know the kind--people who try to answer every simple yes-or-no question by launching into an elaborate story from early childhood, or people who literally will never stop talking, telling a neverending story with absolutely zero pause in the narrative, unless and until you literally start talking over them to interrupt them? There have been times I start pushing to wrap things up at 2:25, launching into the end-of-visit discussion, and it seems like we're going to end on time, only to glance at the time again and see that it's 2:33 and they're droning on again, and when I interrupt them to make my final once-and-for-all statement, they launch into hand-on-the-doornob questions and bringing up new symptoms. Do you just be rude to them and terminate the visit? If not, how do you avoid getting behind?

Ending sessions on time and in an effective manner is a skill. I am constantly working on it. Some patients need very explicit directions and will not respond to such subtle cues as standing up, opening the door, gesturing out the door, telling them "your time is up." and "You have to leave, the next person is waiting." or finally "Get the hell out now!"

 

[clausewitz2]

Ending sessions on time and in an effective manner is a skill. I am constantly working on it. Some patients need very explicit directions and will not respond to such subtle cues as standing up, opening the door, gesturing out the door, telling them "your time is up." and "You have to leave, the next person is waiting." or finally "Get the hell out now!"

I assume the major reason you don't simply turn out the lights and leave the office is the fear that they will still be there, ready to pick up where they left off, the next day.

 

[heysexylady]

I'm revisiting this thread because on the whole, this has continued to get worse for me. I won't say exactly when I left the office today, but it was later than 6:30. Today marked a first in my time here: it was the first time that, for two days in a row, all of my new patients, of which I schedule 4 per day, showed up. So far, the vast majority of days, at least one new patient has no-showed. This made me realize that, as efficient as I can tell myself I'll become, I've still been counting on a certain percentage of no-shows.

Rereading the thread, it seems like the secret is not letting appointments take the full allotted time. Is that right? I vaguely remember, in residency, "hour" long appointments actually being 50 minutes, but because I'm such a pushover, I've gradually lapsed into allowing patients to take the full allotted time. So, should I just start pushing to finish the interview with a few minutes to spare, and kicking the patient out of the room early so I can finish my note? Is that what you guys do? If you spend 50 minutes of a 60 minute appointment with the patient actually in the room, how much do you spend for a half hour appointment? 25 minutes? What do you do when you get behind? In my clinic, we have a policy of seeing follow-ups, which are half-hour slots, as long as they arrive fewer than 10 minutes late. So, if your 2:00 shows up at 2:09, do you still kick them out at 2:25? If not, do you start getting behind? And what about patients who talk your ear off? You know the kind--people who try to answer every simple yes-or-no question by launching into an elaborate story from early childhood, or people who literally will never stop talking, telling a neverending story with absolutely zero pause in the narrative, unless and until you literally start talking over them to interrupt them? There have been times I start pushing to wrap things up at 2:25, launching into the end-of-visit discussion, and it seems like we're going to end on time, only to glance at the time again and see that it's 2:33 and they're droning on again, and when I interrupt them to make my final once-and-for-all statement, they launch into hand-on-the-doornob questions and bringing up new symptoms. Do you just be rude to them and terminate the visit? If not, how do you avoid getting behind?

It depends how fast you can type and how soon you have to have your notes completed.

In my program we have to have the notes completed before we could leave for the day and so I end up ending the interview early and typing notes during the interview. I always let my patients know that I will be typing during the interview. I'm also an excellent typist and so I can still type and maintain eye contact. It also depends on what type of EMR your program has because you should be able to populate some items automatically without typing. The only time that I do get behind if I have 3 new patients back to back and my attending is busy doing something that I can't staff with them immediately.

the only time that I don't type during my clinic is if I am doing psychotherapy and I just wait later do it it.

For example if I have a new intake at 12 pm ( most intakes are scheduled for two hours). I will wrap about by 1:30. Between 130 and 145 I'll staff with my attending . I'll type up my notes if I didn't type during the initial intake from 1:45 to 2:00 pm. You don't have to get everything on the first intake, just the pertinent things and doing subsequent visit you could ask more probing questions. For follow-up which are about 30 minutes, let's say the appointment starts at 12 pm, I'm usually done by 12:20 with the interview if its simple follow-up and from 12:20-12:30 Ill discuss the case with my attending and wrap up ( making appointments and getting labs/rx/extra info ready for the patient). Usually I type doing my follow-ups but not much because I can populate things on my EMR rather quickly and from 12:20-12:30 I would discuss the case with my attending. If its more complicated or serious, obviously it will take longer unfortunately I do run over but I tend to be done with everything by 5:30 and home by 6 pm.

 

[smalltownpsych]

I assume the major reason you don't simply turn out the lights and leave the office is the fear that they will still be there, ready to pick up where they left off, the next day.

🤣

 

[MLT2MT2DO]

I'm revisiting this thread because on the whole, this has continued to get worse for me. I won't say exactly when I left the office today, but it was later than 6:30. Today marked a first in my time here: it was the first time that, for two days in a row, all of my new patients, of which I schedule 4 per day, showed up. So far, the vast majority of days, at least one new patient has no-showed. This made me realize that, as efficient as I can tell myself I'll become, I've still been counting on a certain percentage of no-shows.

Rereading the thread, it seems like the secret is not letting appointments take the full allotted time. Is that right? I vaguely remember, in residency, "hour" long appointments actually being 50 minutes, but because I'm such a pushover, I've gradually lapsed into allowing patients to take the full allotted time. So, should I just start pushing to finish the interview with a few minutes to spare, and kicking the patient out of the room early so I can finish my note? Is that what you guys do? If you spend 50 minutes of a 60 minute appointment with the patient actually in the room, how much do you spend for a half hour appointment? 25 minutes? What do you do when you get behind? In my clinic, we have a policy of seeing follow-ups, which are half-hour slots, as long as they arrive fewer than 10 minutes late. So, if your 2:00 shows up at 2:09, do you still kick them out at 2:25? If not, do you start getting behind? And what about patients who talk your ear off? You know the kind--people who try to answer every simple yes-or-no question by launching into an elaborate story from early childhood, or people who literally will never stop talking, telling a neverending story with absolutely zero pause in the narrative, unless and until you literally start talking over them to interrupt them? There have been times I start pushing to wrap things up at 2:25, launching into the end-of-visit discussion, and it seems like we're going to end on time, only to glance at the time again and see that it's 2:33 and they're droning on again, and when I interrupt them to make my final once-and-for-all statement, they launch into hand-on-the-doornob questions and bringing up new symptoms. Do you just be rude to them and terminate the visit? If not, how do you avoid getting behind?

Given I have a few sharp edges but if a patient shows up after 1/3rd of their appt is over do you feel you're actually the one being rude?

Sent from my SM-G900V using SDN mobile

 

[Seroquelled]

No one has trained me in the proper writing of notes. What is important for billing? What makes a good assessment? What should be included in the HPI and what is superfluous? Is there a good resource for this?

 

[st2205]

No one has trained me in the proper writing of notes. What is important for billing? What makes a good assessment? What should be included in the HPI and what is superfluous? Is there a good resource for this?

Just look up requirements for specific codes. emuniversity.com has a good psychiatry curriculum that goes through all the codes and requirements.

As far as guidelines for what should or shouldn't be in your notes:

 

[Trismegistus4]

So this is the upside of inpatient work. But yeah, the super efficient people I knew in community MH would end appointments 5 minutes early to finish notes and seemed pretty quick to cut patients off. So I guess you start wrapping up 10 minutes early to get them out of the door in time for the 5 minute finish up? Also while notes might be important, I would say your follow up progress note is less important than your initial eval note. How much time do you have for new evals? In my town, 90 minutes is the norm even in community MH but maybe that's rare?

Yeah, I think it's inevitable that I'm going to wind up returning to inpatient work. When I did inpatient locums I was really frustrated when I had the occasional extra-busy day, but, while this may be a case of the grass being greener on the other side of the fence, I think the ability to do your work at your own pace outweighs the supposedly more predictable (but not really) schedule of outpatient. Doing inpatient, no matter how badly your day is going--or perhaps especially if it's going particularly badly--you can always run away, get a cup of coffee, and sit in your office for 15 minutes to decompress. That certainly beats my current situation of having to weigh how badly I need to go to the bathroom vs. how far behind I'm willing to get. Not to mention not having to deal with all this crap like adult patients being referred because they want to get diagnosed with ADHD and put on stimulants, disability evals, return-to-work forms, patients calling saying their med isn't working and asking if there's anything you can do before their next follow-up, etc.

We have 60 minutes for new evals, and I thought that was pretty standard. I haven't seen too many job offers that say 90.

Ending sessions on time and in an effective manner is a skill. I am constantly working on it. Some patients need very explicit directions and will not respond to such subtle cues as standing up, opening the door, gesturing out the door, telling them "your time is up." and "You have to leave, the next person is waiting." or finally "Get the hell out now!"

LOL. We all know there are people who would be oblivious to even "Get the hell out now!"

Doctor: "Get the hell out now!"
Patient: "Well, you know, it's funny you put it that way, doc, because let me tell you, isn't it the darndest thing, my husband got into it with me the other day, he was yelling and cussing up a storm, and our daughter was over, and you know, of course, she just hates for our grandbaby to be around that, but it's been going on the longest time, and some people never change, you know, he's quit smoking 5 times now, and always picks it back up, even though his father died of emphysema--and now there's a nasty disease, it wasn't pretty watching him go, we put him in hospice and they gave him 6 months, and wouldn't you know it, he was gone in 3 weeks..."

Given I have a few sharp edges but if a patient shows up after 1/3rd of their appt is over do you feel you're actually the one being rude?

When you put it like that, no, but like I said, I seem to have an innate tendency to be a pushover, so I need to be constantly reminded to think of things that way.

I'm glad you brought this up, because even as a medical student I've had this problem multiple times. I don't know if it's that I'm a complete pushover (probably this) or if it's that I'm too subtle in making people wrap-up. I've had at least one encounter where I told the patient MULTIPLE times that I would be leaving the room now and would come back later (this was on inpatient). I turned around to leave each time, only to have him ask a question or mention another symptom/expression of desperation just to keep me in the room. It would have felt rude to just walk out, but talking to him and giving him reassurance was not resolving anything... and honestly, I felt that what he was doing was also "rude", in a way. It felt like he was taking advantage of my patience. It's tough, with people like that. It feels like a tightrope-walk, and it leaves me feeling a little drained.

Also, this is an area I know that I'm weak in (putting the foot down), so I've asked others... the advice mostly consists of, "Just do it." 🙂

I was at the VA one day when one of my attendings had a patient very much like mine, and he simply walked out of the room while the patient was still talking/coming up with a new symptom. It definitely seemed rude, but it was also effective. He had exhausted all the other options at that point. He explained to us afterwards that he wasn't going to allow one patient to monopolize all his time and take away focus from all the other patients he still needed to see and treat.

I remember how one of the first things we were told in our touchy-feely/soft skills course in MS1 year was "never interrupt the patient." LOL! It seems like medical schools try too hard to guard against the supposed errors of the past when doctors were supposedly all stern, paternalistic, authoritarian jerks who ordered patients around and lorded it over them, by having these touchy-feely/soft skills courses where medical students are taught to be meek and mild and obsequious. I suppose there are some naturally arrogant people who need to be told to turn it down, but I think people like you and I could have benefited from the opposite: being taught to act confident and authoritative, to be firm with a demanding patient, to say "no" in no uncertain terms to unreasonable requests, and yes, to interrupt the patient and tell them to answer the damn question.

 

[birchswing]

Maybe this is so obvious that it isn't thought about, but psychiatry, as as far as I know is the only medical specialty where you see the doctor in the doctor's office rather than a patient room.

In a patient room, often the doctor is coming and going and quite often I've ended up having a nurse come in with discharge paperwork not even having realized the appointment was over. Which makes the "how do I get the patient to leave" problem moot. You just disappear into another patient room.

How much more efficient could a psychiatrist be if patients were seen in patient rooms? And would there be anything for a nurse to do (like how in most non-psychiatrist offices nurses take vitals)? The only time I've had vitals/weight taken at a psychiatrist's office was when I used to go to a service board. They don't do that in private practice for some reason. They would also ask me a few preliminary questions (suicidality, medication changes, health changes, etc.) and then walk back with me to the psychiatrist and hand him a clipboard—so he still had his own office where I saw him, but there was a different office where I saw someone else first.

 

[Ceke2002]

Maybe this is so obvious that it isn't thought about, but psychiatry, as as far as I know is the only medical specialty where you see the doctor in the doctor's office rather than a patient room.

Wow, really? Is that how it works in the US? I honestly did not know that. Unless you're in the ED here, or a specific outpatient hospital environment, I honestly cannot think of one single Doctor's, or Specialist's appointment I've had where the appointment has taken place in a patient room rather than a Doctor's office.

 

[birchswing]

Wow, really? Is that how it works in the US? I honestly did not know that. Unless you're in the ED here, or a specific outpatient hospital environment, I honestly cannot think of one single Doctor's, or Specialist's appointment I've had where the appointment has taken place in a patient room rather than a Doctor's office.

Well to make sure we're using the same terminology, when I say doctor's office I mean the doctor's actual personal working office. So, when I go to my PCP or my cardiologist for example, a nurse takes you back to a room with an exam table etc, and the doctor comes into the room. But it's not his office (that is no bookshelves, no desk, etc.). All the rooms are the same and have the same equipment. Whereas, when you see a psychiatrist, it's their personal office where they do non-patient work as well as where they see patients. But the entire building itself I guess is also called the doctor's office, which makes it a bit confusing, as in "The doctor's office called and rescheduled my appointment."

EDIT: I guess practice is another name for the building. The medical practice. Although, I don't think you'd say, "I got a call from the doctor's practice."

EDIT 2: I just did a Google image search for patient room, and that looks more like a hospital room where you're intended to stay for some time. I should have written exam room.

 

[Ceke2002]

Well to make sure we're using the same terminology, when I say doctor's office I mean the doctor's actual personal working office. So, when I go to my PCP or my cardiologist for example, a nurse takes you back to a room with an exam table etc, and the doctor comes into the room. But it's not his office (that is no bookshelves, no desk, etc.). All the rooms are the same and have the same equipment. Whereas, when you see a psychiatrist, it's their personal office where they do non-patient work as well as where they see patients. But the entire building itself I guess is also called the doctor's office, which makes it a bit confusing, as in "The doctor's office called and rescheduled my appointment."

EDIT: I guess practice is another name for the building. The medical practice. Although, I don't think you'd say, "I got a call from the doctor's practice."

EDIT 2: I just did a Google image search for patient room, and that looks more like a hospital room where you're intended to stay for some time. I should have written exam room.

This is what I mean by a Doctor's office. This is a pretty standard looking GP's office in South Australia. The Doctor comes out to the waiting room and calls you into the office. If the medical centre also doubles as an urgent care medical centre (somewhere that can treat minor to moderate non life or limb threatening injuries or other conditions) then there will be nurses in a separate treatment room triaging patients for the doctor who's working that area on a particular day - although that doesn't really happen in just a general Doctor's office where they don't cater as an urgent care centre as well.

This is a fairly standard treatment area in an urgent care medical centre (again patients only end up in here if they're being treated for non life or limb threatening injuries or if they're experiencing something like an uncomplicated asthma attack, in general nobody starts out in this room, and then sees the Doctor, it's only reserved for specific cases and the rest of the time you wait in the waiting area, the Doctor comes out and calls your name when it's your turn/appointment time, and then takes you into their office, and that's pretty much it).

This photo is kind of similar to my Psychiatrist's office in the CMHC I used to attend, only this room's a bit more fancy.

 

[Ceke2002]

How much more efficient could a psychiatrist be if patients were seen in patient rooms? And would there be anything for a nurse to do (like how in most non-psychiatrist offices nurses take vitals)? The only time I've had vitals/weight taken at a psychiatrist's office was when I used to go to a service board. They don't do that in private practice for some reason. They would also ask me a few preliminary questions (suicidality, medication changes, health changes, etc.) and then walk back with me to the psychiatrist and hand him a clipboard—so he still had his own office where I saw him, but there was a different office where I saw someone else first.

They did actually try something like this at the CMHC I was attending, it didn't last long, and it wasn't exactly popular with the patients who were already regular clients. My Psychiatrist's response when I asked him what was going on, why did I suddenly have to fill out pre-session questionnaires and speak to one of the nurses beforehand, was a rather eyerolling, 'Ugh, yeah, I think they call it "efficiency".

 

[Ceke2002]

Five Ways To Gracefully Rein In Talkative Clients.

Specifically psychological strategies used when talking to prospective business clients, but could also be used for patients as well, I'd assume.

https://psychologyforphotographers.com/rein-in-talkative-clients

1) Raise your hand a little, palm towards them but hand angled downward, and say: “Hang on, let me summarize what I’ve heard so far to make sure I understand.”

It feels impolite to interrupt, but consider that it may also be impolite to just waste their time when you know you’re going to have to come back with more questions. In that case, a calm interruption is totally appropriate.

Pair your interruption with a physical movement – like a nonthreatening raise of the hand as described above, or if it’s gender/culturally/situationally appropriate, touch three fingers (briefly, lightly) on the top of their arm or elbow.

Some people are skilled at simply talking louder and faster when someone tries to verbally interrupt, but they may respond to a gesture that gently says “pause, please.”

Keep your facial expression warm and your body language relaxed (even if you feel stressed).

Once you have their attention, you can reflect back to them what you heard, and redirect the conversation to the parameters you need to know about.

For example, if the person is giving you scattershot information about the ad campaign, you can say “Hang on, let me summarize what I’ve heard so far to make sure I understand. You want this product to appeal to young athletes, but more than one kind of athlete. It sounds like you’re looking for someone to come in for two days, once to work with the soccer players and once to work with the basketball players – does that sound right to you?”

This veers the conversation away from extraneous details and back to, say, the number of hours they expect from you.

2) Give yourself an “out” for interrupting again:

“Wait, I’m sorry, I’m not sure I’m with you. Let me ask you three quick questions so I’m sure I have all the information I need. The first question is: ________________“

There are two parts to this.

First, if someone keeps changing subjects and throwing topics wildly all over the place, sometimes you simply have to apologize and let them know you’re not with them.

Whatever the reason for their chattiness (ego, haste, fear), people usually want their audience to be “with them” and tracking what they’re saying. So “I’m not sure I’m with you” is a foolproof way to get them to stem the verbal tide.

Second, once you’ve got their attention, pivot to saying you have three quick questions for them.

“Let me ask you three quick questions” are the magic words for getting testimonials, but it also helps here.

By letting them know you have a specific number of questions, you give yourself license to redirect or interrupt them a couple more times. You’re letting them know in advance that you’re going to need the floor so you can get all three questions asked.

If you ask your first question and they keep yammering on like a human freight train, you can say, almost jokingly, “wait, I still have two more questions” or “wait, sorry, the next/last thing I need to know is _____.”

That way they can’t think of you as rude for interrupting – you good and warned them that you were going to need more information, and they’ll realize that they hadn’t been letting you get that information.

3) Crack a joke.

Jokes are a socially acceptable excuse for an interruption, because they depend on the real-time context of what they just said:

Bride: So I want to make sure we get some shots of Johnny and Susie playing together because my husband-to-be’s grandmother lives all the way in Altoona and we only see her once a year –

You: (smiling, laughing a little) Yes, we want to make sure we keep the in-laws happy! :: casual laugh ::

Then if she laughs too, you can take advantage of that brief pause and jump in with a follow up question.

This is my go-to way to deal with hypertalkers. The key is to laugh at your own joke, because even if it’s a bad joke they’ll feel like they need to offer at least an obligatory chuckle, and that’s when you jump in. Bam.

4) Redirect them with your energy.

If someone is speaking loudly, sometimes adopting a “loud” and joking tone yourself can help you interact with them, or interrupt them with a joke. That way your interruption feels casual and friendly rather than unprofessional.

But sometimes, people whip themselves up in an energy vortex and you almost fear you’re going to get stuck in a shouting match to be heard.

In these cases, do the exact opposite – quiet down.

Relax your shoulders, breathe slowly, and when you speak, speak calmly with a low, even tone.

Have you ever watched a good elementary school teacher calm down a class of wiggling kids? They usually lower their voices and lean in – and the kids do, too.

Sometimes people will sense the huge contrast between the way they’re speaking/acting and the way you are, and it makes them calm down too.

Speaking at a frenetic pace might seem like a positive thing to them (look at me! I’m so smart and in charge!) until you contrast it with low, even words, and then they see they’re coming off as “out of control” and not powerful. It’s a non-confrontational way to pull them back.

5) See if you can figure out what need the nonstop talking is filling – and fulfill that need some other way.

Some people use constant talking as a way to feel powerful or ‘in charge’ – after all, you can’t negotiate with them if they’re the only one talking. If you suspect this is an ego or power play, you can still make them feel ‘in charge’ with your responses:

Show them that you’re on their team and have the same goals they do, and the information you’re asking for serves them in getting there.

On the other hand, some people keep talking because they don’t know what they want but they’re afraid of looking stupid, so they fill the air to try and seem confident.

In these cases I’d use tip #4 heavily, and bring your energy down to speak calmly. Believe it or not, clients often look to you for cues about how the meeting is going, and how it should be going. Setting a relaxed tone gives them permission to feel and be relaxed, too.

I’d also do lots of reflective listening so they feel increasingly confident that they’re doing a good job explaining themselves and that you ‘get’ them.

If all else fails, abandon ship – but follow up with an email.

If you tried tips #1-5 and you still didn’t get everything you needed, your last resort is to simply wait out the meeting and then send a follow-up email.

 

[SeniorWrangler]

At my institution, we use AIDET: acknowledge, introduce, duration, explanation, and thanks. You can Google it.
It often helps to let people know up front how much time you're going to have together.
Also, especially for a new intake, I truthfully tell the patient, "we need to move on, there's a lot to cover."
I guess every doc gets to decide if they're going to keep up with charting or spend longer with patients -- my experience is that the longer I wait after a visit, the worse the note gets and the longer it takes, so I try to keep up.

 

[cookymonster]

Inpatient is nicer in that you can always set your own pace and walk out of the patient's room when it simply gets to the point of an intractable Xanax negotiation. The worst encounters of all though are family meetings... avoid those at all costs. They are so difficult to terminate. I've gotten in the habit of just doing phone calls, even though I don't get paid for them.

This is the one thing that appeals to me about doing telepsych. All you have to do is turn off the camera.

 

[Jules A]

The worst encounters of all though are family meetings... avoid those at all costs. They are so difficult to terminate.

Yeah thats what I have social workers for. Although I loathe them because of the time suck I will make phone calls to family. On the plus side it seems to inflate their perception of the quality of care and I sometimes gleen a useful nugget from the collateral.