Family Medicine: The Talkers

This morning, the Talkers came in droves to my humble outpatient care facility (the nurses would have a bitchfest followed by withdrawal of all tetanus immunization privileges if they heard me calling it a clinic).

Who are the Talkers? Talkers are just like other patients, but they are afflicted with a special condition which makes them entirely unable to shut up. Quite apart from that, they may be either incredibly nice people or horrible jerks; sick, sick puppies or perfectly well. Dealing with them simply takes a different tactic from what our training teaches us.

In school, we learn to elicit a detailed history from the most stubborn patient. I have an armory of talking points to force every piece of information out of any patient who doesn't want to tell me what's wrong-- from simple compassion to dead silence. We are taught that the first 2 minutes belong to the patient, how to ask only open-ended questions ("describe your pain" vs. "is your pain sharp or dull?"), and how to normalize any potentially embarassing disclosure-- no matter how bizzare it may be. Yes, many of my other patients have diarrhea after eating boiled peas; please do tell me if yours is bloody.

How to make someone with verbal diarrhea focus on what I'm trying to deal with in my patient encounter, however, is a proficiency I am apparently sorely lacking. I tried asking only closed-ended, yes-or-no questions, only to be foiled into derailment from "do you have palpitations?" to "I feel like I'm going to fall, especially on concrete." "Does your pain radiate down the arm? Please answer yes or no," turned into "You know, this one time, 5 years ago, I had shooting pains in my foot and it went away after a week." Patient after talkative patient, I was helpless in the face of torrential verbiage rushing my way. 15 minute patient encounters became 20, even 25 minutes. Problem lists grew from 2 to 3 to 5 long. The waiting room got crowded. My hungry stomach begged for mercy.

My preceptor and I saw Talker number 3 together, and it was then that I was relieved to realize that focusing an interview with a gregarious patient is not only difficult for me. But I am happy to say that I've learned a few tips along the way-- and Talker 3 leaned in conspiratorially near the end of his interview to say, "I know I like to talk a lot." At least he's not in denial.