How I cope with patients who talk too much

Have you ever heard of the term “ear beating”?

In my introverted mind the emotional violence some patients inflict on me every day can be described in no other way.

Its the point at which you completely dissociate from the situation and contemplate whether they will ever stop.

Usually by this point you think you’ve given enough social cues but the steady flow of inane shit continues to pour out of their mouths.

You feel yourself becoming more and more frustrated as the wasted minutes pass by.

You’re screaming internally “SHUT UP!”, “PLEASE STOP TALKING!”, “GET TO THE POINT!”

Thankfully you can self regulate.

Your visible distress may be obvious to some people, but not them.

You realise you’ll be trapped for eternity if you don’t take decisive action now.

Your body tenses in anticipation.

Its like having to open the passenger car door to jump out whilst they continue driving down the motorway.

But whenever you jump out you have to get back in again because its your job.

This week I’ve been unwell with flu and fatigue. Unfortunately I had to work Monday and Tuesday covering Easter Holiday GP shifts.

So I’ve been more acutely sensitive to managing my energy levels.

The physical aspect of just sitting and consulting people wasn’t an issue for me but the mental energy drain over the day was A LOT.

When I was forced to function at 1% energy I realised how much unnecessary talking people do.

Usually when I have the energy to spare I don’t notice it.

But these 2 days I was determined to maintain a protective shield of peace and serenity from which I could observe people from behind.

I wasn’t going to be KO’d by any ear beating.

Introversion and Stimulation

People feel the best when they are being stimulated at just the right level.

Stimulation is any input from the outside world, for example noise, light, social interaction.

The perfect base level of stimulation varies between individuals.

Ongoing research since the 1960s has established introverts are more sensitive to stimulation than extroverts.

Imagine 2 buckets being filled by equal stimulation taps.

The first bucket is covered by a lid which has a small hole in the top.

It fills slowly, so needs to be under stimulation longer to fill to the perfect level.

This is the Extroverted Bucket- A lot of stimulation is needed in order to get them to the perfect level or push them past it.

The second bucket has no lid, its just open, every last drop of stimulation goes in.

It fills quickly, so the perfect level is reached after a much shorter time.

This is the Introverted Bucket- Less stimulation is needed to reach the perfect level.

Once the perfect level is passed you feel like you need to chill or retreat to a quiet place to let the bucket drain back down to the perfect level.

If you can’t do that then the bucket starts overflowing and that’s when you stop being able to think clearly.

You are overstimulated.

This bucket metaphor explains the increased sensitivity introverts have to stimulation compared to extroverts.

Over Stimulation

When I was a GP trainee I often felt overwhelmed by talkative patients.

I needed to think carefully about how to best solve the patients problems.

But their incessant talking prevented me from thinking.

I could tell that some of my seniors couldn’t really understand why I appeared so easily stressed.

I couldn’t help it, I was receiving so much stimulation at once that I overflowed.

It wasn’t just talkative patients that got me, screaming children had the same effect.

The family combination of talkative parent and screaming children pushed me over the edge easily.

With experience I’ve seen enough of the same problems that I don’t have to think as much because I automatically know the answer.

I can just allow them to continue rabbiting on whilst I do other tasks.

However I observed this week that complex chronic presentations compose a substantial portion of my workload as a GP.

These presentations require a lot thought and mental effort which is where my strength lies as an introvert.

But I need silence to think and come up with a solution to the problem that they have presented.

This is why I end up feeling so annoyed because they are preventing me from helping them.

Over Stimulation triggering Emotional Reactions

When problem solving you need the full capacity of your logical brain.

If your emotional brain (amygdala) is being triggered too much by annoyance it clouds your judgement and makes for a very difficult consultation.

You may just feel like:

“I don’t know what to do”

“How do I escape this?”

“I need help”

Getting help is sometimes the only way out because you need another brain that is not over stimulated.

How often do you go and speak to your colleague about the problem and they just give you the solution really quickly and simply and you feel like—

“Oh its actually not that difficult at all”

Or you may find yourself later in the day when your own brain is not overstimulated thinking about the problem again.

Then the magic insight comes and you wonder how you didn’t think of it before.

If possible you send the patient a text message rather than risk getting stuck on the phone with them.

Why Do Patients Talk So Much?

In my experience there’s 3 different reasons why patients over talk.

I’ll discuss the reasons and my best ways of coping with each.

1)They think they are helping

These patients mean no harm they’re just misguided.

They may not visit Doctors very often and when they do its usually something that’s been going on for a while.

They talk like they are writing a message in a bottle… Like they have to say absolutely everything as they will have no other opportunity.

They tend to enjoy telling stories and having a captive audience.

They think the higher the volume of information they give the more likely some of it will be relevant.

But they don’t realise that they are making it harder for us by overloading us with information.

They also don’t realise that its easier for us to help them if they just directly answer the questions we ask.

Usually after explaining this to them the consultation can progress.

2)They are Anxious and Fearful

These are the patients that will talk themselves into a trip to A+E.

They answer every question with uncertainty which takes a lot longer than giving a definitive answer and makes it impossible to rule out red flags.

Again they want to give as much information as possible but because they are so anxious and stressed they present chaotically.

The primary focus is on expressing their emotions as opposed to the factual details.

You certainly know how they feel about the problem but you don’t actually get any specific details from them about the problem.

Every time they try and remember the emotion is so overwhelming that it shuts of the logical part of their brain which is aware that you need to know details in order to help.

Being calm and not rushing them is the best approach.

Acknowledge their anxieties and the thing they fear happening is important to gaining their trust and reassuring them that you know so they don’t have to continue repeating themselves.

Sometimes you will need to be very frim and assertive with them as they are reassured by confidence and certainty, even if its not something that you can be certain about try your best to appear confident and certain and they will calm down and let you think.

3)They are socially inept and lack interpersonal skill

These people may appear very social because they talk a lot but they are actually very bad at sensing what other people are thinking and letting others speak.

They have poor social skills, low sensitivity and can’t stand silence.

Some may be neurodivergent which is fine, they can’t help it anymore than I can help being sensitive.

But I think the vulnerability and anxiety of being unwell can cloud even neurotypical peoples judgement.

Especially as many people believe Doctors aren’t actual human beings with the same weaknesses and flaws as everyone else.

So I understand why they may not be aware we actually need time to think and process complex information.

Nevertheless they cause a lot of  trouble by not picking up on hints and seemingly ignore direct requests to stop.

These patients either need to be shut down or shut out.

This may sound callous but you have to protect your energy and recognise when a patient is compromising their own care.

You need to control the situation externally by communicating with them to stop.

Or internally by controlling your attention and awareness to create space to solve the problem.

This is the highest level of function for a sensitive introvert and if you can do this you should congratulate yourself as it requires exquisite mental control.

You have to tune them out and focus on your own thinking.

This is where mindfulness practice comes in handy.

You need to intentionally direct your attention and control your sensitivity so you can think clearly whilst they are still speaking.

Think of this as putting a lid on top of your bucket with a small hole that you can open and close.

A) Close the hole and do your problem solving based on the pertinent pieces of information you have so far.

You are essentially taking a calculated risk that they don’t say anything important that you miss whilst the bucket is closed.

B) Figure out the missing pieces you need to solve it. Write them all down on a piece of paper.

C) Now open the hole to ask them the questions to obtain the missing pieces.

D) Repeat ABC until you have the solution.

With experience your awareness will pick up on pertinent things they say which will prompt you to switch back to listening to them at the crucial moments.

Summary

Patients who talk too much in consultations present a unique challenge for introverts because they can cause overstimulation which:

• Interfers with clear thinking

• Compromises problem solving

• Makes it harder to care for them

Patients with low sensitivity and social skill are most difficult to handle. They either need to be shut down or shut out.

The benefits of focused thinking outweigh the risks of temporarily ignoring them and missing things.

With practice and experience it becomes easier to tune in and out automatically to prevent yourself becoming overstimulated and overwhelmed.

Thats all for now.

Lewis

P.S

My free positivity guide is almost done, progress stalled this week due to illness but hoping to have it complete by next weekend.

I help Introverted Doctors Escape Career Stagnation by being True to Themselves.

If you or anyone you know needs help, book a free call and we can talk it over.

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