“I have a list of things I want to cover, but before I start, do you have any concerns you wanted to discuss today?”
I usually start out my well visits with a line similar to this. I didn’t always begin this way, eager to tick off things on my personal to-do list: mammogram, check, diabetes meds, check, pneumonia shot, check, check, check. After half a decade in practice however, I have wisened up, changing my flow to start with an open ended question, allowing me to avoid any last minute hand on the door handle “oh by the ways.”
This week after starting with my typical opening, I was surprised by one patient’s reply. The patient was healthy but struggling with the stuff that plagues those in middle age, parachuting from years of packed motherhood craziness into a house that is suddenly empty. I knew her well, took care of her husband and children as well. I had seen her son after his honeymoon not too long ago.
Her response surprised me: “I wanted to say something. Thank you. I know you have other patients and I try not to take up any extra of your time but thank you for not making me feel rushed if I have a problem.” She was at the age when caregiving seems to pile up, also caring for her 80 year old father. At a recent visit with his physician, as the doctor was walking out the door, her father asked to speak to him privately about a health concern. The doctor’s response: “We are out of time. You only have 15 minutes.” My patient was upset, and let the doctor know it. She told him that there are doctors out there who do not rush you if you have an important question or problem. The doctor then took the time to listen.
What I did not say to my patient is that I certainly have fifteen minute visits too. But not everyone. I schedule 30 minute visits and 45 minutes and (gasp) even sometimes I schedule an hour. It depends how much time I think we will need. And sometimes you need more time than you think. And we adapt.
Primary care is a time crunch. There are endless tasks to do between visits. But an often overlooked art is skillful time management during the patient encounter. This involves doling out a few extra minutes here and subtracting a few extra minutes there. Sometimes a 15 minute visit is an easy plugged ear or strep and you get ten minutes of free time. But, your 15 minute visit can be a heart attack. Or a patient’s spouse suddenly died and you need time to provide a listening ear. You add the extra ten minutes there. Sit down, look your patients in the eye and listen. It matters. Sometimes I end up a little behind and my patients wait for 20 minutes. I knock, enter the door with a smile and say “I am so sorry to make you wait. I know your time is valuable. I had a patient who just needed a little extra time today. Do you have any new concerns today to discuss?” And then I start right over again…every fifteen to thirty minutes.