Tips for a Graceful Exit

[rubyness]

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This was posted in another thread and it got me wondering if anyone else has advice for how to stop a very long winded patient from talking, in a polite way, and get the hell outta the room. I have a patient now who is very kind, but just will not stop talking, whether it be about her dying son or the food they served her that day. I would love to stay and chat, but I'm so busy that staying with her is putting me behind in my work!!

quote:
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Originally posted by Sessamoid
Getting to Quinn's anecdote, I think that tactfully redirecting and gracefully exiting an interview with a rambling patient is one of the hardest skills to learn. I've used all sorts of weird redirection techniques, and even weirder exit techniques. I've listened to faint overhead messages or pages in the hospital as if they were for me and excused myself after I had all the information I needed. During medical school and residency, I've had friends page me out of rooms I knew would be prolonged and painful interviews. If none of those above present itself, I'll use the excuse that I need to put in the orders to expedite the workup, with the promise to return later. If the patient is visibly uncomfortable or has expressed some immediate need during the interview, I'll excuse myself to find the nurse to attend to the patient. The possibilities are endless!
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[doc05]

press the buttons on your pager until it beeps.

 

[oldandtired]

When they go off on a tangent, interrupt with a focused question with an asserive tone. This took me years to perfect but your patients will not mind. As a resident you will not have time for small talk. Just do your job.

 

[Flipchick]

Say something to the effect of, " You know what, I'd love to stay and chat, but I've really got to do something (insert: check on labs, another patient, go to xray) for my resident/attending. You have a great day okay?"
Then book it outta there.

 

[Scott_L]

Try this... When you go to see the patient start off by stating that you are checking in on them but need to be with another patient in X amount of minutes or at a certain time. This will give you enough time to meet with the patient and at the same time you have established a timeframe for your depature.

This also works well for long winded relatives 🙂.

Good luck!

 

[Singh]

Hello,

As a supplement to the good advice given here, I'd like to add the importance of non-verbal communication. Since 3/4 of all communication is regarded to be non-verbal, it can be used effectively in the situation you describe (which by the way is very common, esp. in our field).

When you feel like ending a conversation, try showing it with your body language.. perhaps saying something conclusive while getting ready to exit the room. Bring a change about in your body language, which marks a decision on your behalf to "change" the situation (i.e. leaving the room).

This is the advice which I have recieved from my seniors, but I must say, sometimes it is really difficult to end a conversation.

Best of luck
Best regards Singh

 

[Galaxian]

I have a friend who's kind of burning out, so it was kind of funny when he went to round on a patient (I happened to be there), and the patient asked him for some ice chips. He took one look at the guy and told him "I don't do that." and proceeded with his examination. It was actually kind of funny, because I know I don't have the balls to do that. I'd be like, okay, let me look into that, or at least get a nurse. But I agree, I hate it when you walk into a room, and people see that short coat and think you're the hired help.

 

[RuralMedicine]

My approach tends to be a quick summary statement and then to excuse myself often with an explanation of I need to do X. This seems to work pretty well.

Interestingly a few months ago one of my interns admitted that they were having trouble getting through an admission efficiently and with all the needed information. I conceded that the process of working through the differential as you interview and adding in pertinent positives and negatives as you go is one that can take time but offered to observe the intern doing the full admission interview. Our next team call was extremely hectic at the outset and we adopted the divide and conquer approach as we received several admissions at once. Around 11 things settled down enough for me to finally join the intern for an admission. Our patient was a rather poor historian who was more interested in expressing her views on George Bush (let's say she wasn't a fan) than anything remotely related to her health. We did eventually manage to extort sufficient information, do a physical exam, and explain the admission plan. We were about to leave when she started in again. I was about to use my "I'd love to stay and talk more but I need to go check on a patient in the ICU" when suddenly in synchrony our code pagers went off. Not my recommendation for egress but oh well. Interestingly when we returned to the ED post code to write some admission orders we found the student nurse trapped at bedside as our patient explained the communist plot that had led to GW's election.