Talkativeness in the patient is to be discouraged.

There, now you will think I am some curmudgeonly, controlling, obnoxious doctor - and, yes there are some times when . . . . .

But the loquacious patient can drive you crazy. Diagnosing what is wrong with your patient is a computation process - and to do that, you have to obtain the data. When your patient is terminally circumlocutory, this can be frustrating  - and can prompt the doctor to do what we are all chastised for. To jump in with questions within nano-seconds of the start of the consultation (time is money!).

Some still don’t get it and insist on telling you everything that happened in the three days preceding the start of their symptoms and what their mother had to say about it.

I was coaching my nurse the other day. “When you can’t get a word in edgeways, think mania”.

There is also a tendency for the patient to think any time you are not talking, they can/should be - and when you’re trying to listen to their heart or lungs, or worse still, the carotid arteries, this doesn’t help.                                                                                                                                             

                                                                                                                                                                                         Talk to my stethascope!

In fact the patient seems to think the stethoscope is some kind of a speaking tube, and this is the time to let it go with their verbal diarrhea.

Mind the stethoscope can be your savoir. You can plug in and turn off. There’s a kind of conditioned reflex, where you go into a state of sensory deprivation. I have heard stories of exhausted residents actually falling asleep on the end of their stethoscope. I find there is some kind of reflex that starts me yawning whenever I plug in - though it’s discreet to do it when listening to the back, where the patient can’t see you.

So the perfect patient answers questions accurately and succinctly and then has the grace to shut the fuck up.

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