The Three E’s Of Interrupting Patients

The skeptical cardiologist was trained to listen carefully to patients who are relating their “history” as we term it and to minimize interruptions. However, there are only a limited number of minutes in the day and some patients are capable of monologues that rival a Shakespeare soliloquy.

If a physician doesn’t learn methods for getting the patient back on point he will spend his days stressed and running behind schedule.

A recent JAMA editorial describes the three E’s that physicians should employ when interrupting a patient.

The first “E” element is to excuse yourself. The second is to empathize with the topic being interrupted and the third is to explain the reason for the interruption.

For the patient who is repetitive, disorganized or circumcloquacious:

(circumloquacious (adjective): Using excessive language to evade a question, obscure truth or change the subject [comb. of ‘circumlocution’ and ‘loquacious’]

Always circumloquacious, she evaded defining the word and instead started a discourse on etymology and metalinguistics.

the writer suggests this typical “topic tracking” interruption:

Forgive me. You are sharing a lot and I can see you are really bothered about… your headache, fatigue, allergy, stomach pain… and this is frustrating and scary for you. I would like to switch gears and ask several specific questions, then do an exam to make sure we develop a plan that works best for you.

Excessively circumloquacious patients can be their own worse enemies as the office visit is spent on issues peripheral to their major problems.

Hopefully your doctor has learned some variation on the three E’s to deal with circumloquacity (I just invented that word!), otherwise he/she will continually be late and stressed.

Empathetically Yours,

-ACP

 

4 thoughts on “The Three E’s Of Interrupting Patients”

  1. love the word circumloquacity and am seriously considering stealing it from you. I’d be happy if my doctor would actually just LOOK at me. the man never lifts his head from my chart…lol I have convinced myself it is because of my great beauty…..it is so much better than he’s just “a twit”…lol

  2. I know this is a rather old post to comment on. But to me it is brand new—I ran across it only yesterday while searching your blog for something else. And it really struck a chord or two with me.

    First, appreciation.

    I appreciated your post because of the insight it gave me into doctor’s comments (haha!).

    I also appreciate the opportunity it has given me personally to reassess doctor’s comments that I have struggled to make sense of.

    As a patient who can tend towards circumloquacity and can sometimes even tell that she has fallen inextricably into a ramble, I can attest and aver that such situations are indeed problematic for the patient as well as for the doctor.

    Basically, we do sometimes need to be saved from ourselves.

    But the second E is a terribly misguided and ineffective way to do it.

    I am a patient who comes with a tendency (wordiness) and three or four handicaps in this area (a debilitating condition that makes clear cognition/recall difficult, a plethora of symptoms that affect every major body system, and 10 years of symptom patterns–plus the fact that I very likely have a condition still in research and riddled with misconceptions).

    I have long suspected that doctors say this with the best intentions, but on more occasions than not its effects have been weighed in the balance and found wanting.

    In regards to the effects of this model of interruption, I offer you 3 D’s to ponder:
    1) it’s Distracting
    2) it’s Demeaning
    3) it’s Dishonest

    In the interest of brevity, rather than explaining each of the D’s, let me demonstrate. Here’s what it might sound like if the same words were said from patient to doctor:

    Forgive me. You are interrupting me, and I can tell that you are really bothered about how much detail I am putting into my symptoms and how they seem to be presenting, especially in light of your time constraints and lack of definitive answers. I can see how overwhelming and scary this all is for you. Why don’t we switch gears and let you give me a summary of what you are hearing and ask any questions you have at this point. Then I can tell you what you’ve missed.

    (If you would like a more serious discussion of the 3 D effects I mentioned, I’d be more than happy to elaborate, but for now I remain your loquacious reader, grateful for this post.)

  3. I have had doctors who have interrupted well and have avoided the 3 D’s of interrupting, and I have appreciated them immensely. I have also managed to leave their office feeling like a person and not an idiot. It can be done well!

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