november 2008 | Welcome to Finding Balance eNews.

Chattiness
Here’s the scenario; you are in the exam room, one on one, and they won’t stop talking. They are telling you about themselves in ways which can’t be useful to you at all. You are trying to be polite and respectful, but inside, you’re frustrated and irritable. Why can’t they just focus on the reason for this visit? Finally, after what feels like an eternity, they stop talking about themselves and you can get to the point of the visit. Some doctors can really talk. Yes, I said doctors!

We have all had patients who will talk our ears off. They consume our time when we are busy and they talk about issues and concerns unrelated to the visit. On average, I would guess that about 2-3% of our patients are just there to talk. We sit with them, forcing a smile and trying to nod appreciatively knowing that we need to get moving, but doctors may be as guilty of this as their patients.

A study, published in the The Archives of Internal Medicine, looked at physician ‘chattiness’. One hundred primary-care doctors in the Rochester, NY area participated in this study in which they agreed to allow two people trained to act as patients come to their offices sometime over the course of a year. The test patients would surreptitiously make an audio recording of the encounter. The investigators analyzed recordings of 113 of those office visits, excluding situations when the doctors figured out that the patient was fake. The outcomes were disturbing.

In one third of the visits, the doctor talked about themselves and their own interests, health behaviors and even vacations, without tying it back to the patients concerns. A sample conversation was as follows (taken from Gina Kolata, NY times, June 2007):

A new patient comes into a doctor’s office weighing 204 pounds. He’s six feet tall. The following conversation ensues:
Doctor: Is that up a little bit for you, weight-wise?
Patient: It might be up a few pounds. I used to jog and I just haven’t ...
Doctor: See, ’cause I’m weighing more like 172, 173 and I’m six foot. And I’m still running. I’m doing the 5 and 10 and 15 K’s. The half marathons and ...
Patient: So, I’m 30 pounds heavier than you?
Doctor: Right now, yeah.

Why would we do this in one third of all office visits? Susan H. McDaniel, lead author of the study, stated; “We were quite shocked. We realized that maybe not 100 percent of the time, but most of the time self-disclosure had more to do with us than with the patients.”

It is often important for us to comfort or relate to the patient with our own experience and we often use it as a way of connecting with the patient and possibly to teach the patient ways of managing their health issues. This can be healthy and humane, but in this study, it appeared that the physicians were ‘just talking to be talking’.

What would be a more appropriate way to connect? If you have had a similar health issue and feel that disclosing a personal story would be of comfort to the patient, then do so. However, do so in a concise way without loads of unnecessary personal disclosure. It may even be useful to ask the patient permission to do so. In the end always tie your story back to their health concern.

A good rule is to ask yourself, when you are about to tell your story, ‘is this for me or for the patient?’ If it’s for you, you probably shouldn’t bother. After all, most of us dread the 2-3% of our patients who just want to talk. And, after all, they are the ones paying for the visit!

Physician Self-disclosure in Primary Care Visits: Enough About You, What About Me? Susan H. McDaniel; Howard B. Beckman; Diane S. Morse; Jordan Silberman; David B. Seaburn; Ronald M. Epstein, Arch Intern Med. 2007;167:1321-1326.

Just for fun
Levon Helm, famed drummer and often lead singer of The Band, has released his first solo album in 25 years. This album, Dirt Farmer, marks his return to performing after a bout with throat cancer. The album is gritty American music at it’s best, from rock to bluegrass and country in between. If you are fan of The Band, you’ll love this CD.