Thursday, April 12, 2012

It's A Matter of Time

One of the most jarring memories of my life took place during my surgical residency. It's been almost 30 years ago and it still haunts me.

A young woman was admitted to the hospital because she had a brain tumor. The good news was that the brain tumor was benign. The bad news was it was growing so fast that if it was not operated on shortly, it was going to compress the woman's brain and cause her demise. The problem was that the woman was refusing surgery.  Under the circumstances, I was sure that time would be invested in overcoming any of her objections and persuading her to move ahead with the life-saving operation. Her life was at stake and surgery could easily save it. As an intern, I had no say or control over the situation, but was I sure the senior residents and attending physician would address the issue.

I was wrong. No one seemed to have the time that appeared necessary to speak to this lady and convince her of the imperative nature of surgery and of the immediate threat to her life. She died. I have never been able to reconcile in my mind how that was allowed to happen. Yes, maybe despite best efforts, she would have ultimately refused anyway. But such efforts were never truly expended. I have always thought what happened was a crime and tragedy.

Yesterday, a dangerously overweight patient came to my office with her daughter. She had been referred by a home care agency and her first words to me were, "I am here under duress." She explained that her daughter, who lives out of town and was visiting, insisted she come in for a wellness visit. Suffice it to say that the lady resisted my charms and persuasive skills. She would have nothing of what I was offering. Nevertheless, I am a persistent fellow and I simply kept trying. I outlined the benefits of her losing weight and the dangers of staying so overweight. I even played the "do you want to see your granddaughter get married and meet your great-grandchild" card. Every attempt was met with a "no...not necessary...not interested...not needed."

Then something amazing happened. At about the half-hour mark, she suddenly said yes, "I will come in for one session of weight loss counseling." The nurse practitioner with me quickly chimed in that it would take at least three sessions to get a feel for the program. The patient again responded in the affirmative that she would try the three sessions. I exuberantly shouted out. "Wow." I was so happy that the time I had spent trying to convince her had appeared to pay dividends. I am still excited. From my residency days, I have believed that given the time, patients can be convinced to do the right thing for themselves. It just a matter of time.

Time is a commodity in short supply in the medical profession today. The days of doctors playing golf in the afternoon are long gone. This past week I tried to have a conversation with my brother, a cardiologist, at 9 PM who could not speak to me because he was still seeing patients and then reached a close friend, a pediatric ear, nose, and throat doctor, who was still in his car on the way home from the office. Doctors are working harder than they ever worked before just trying to keep up.

This is a shame because the more time a doctor can spend with a patient, I believe the better the care. Doctors cannot work all day and all night and provide good care. I know that the appeal of concierge medicine is improved access and increased time with a doctor, but it is unfortunate that people have to pay thousands of dollars more out of pocket to get that type of attention.

Recently, I was asked to respond to a national home health magazine request on how patients should make sure that they have enough time with their doctors to get all their questions answered. Here was the query:

Looking for therapist, nurses and doctors to share tips on how patients can have useful conversations with their doctor to discuss their pain, symptoms, medication etc. for a health magazine targeting senior citizens and home bound patients.

Here's what I wrote:

"The ideal way to ensure that a meaningful conversation can take place is to schedule the time for it. When scheduling an appointment, the patient should ask the scheduler to ensure at least 45 minutes are made available for the appointment to address all concerns. That may require scheduling an appointment further out, but it sets expectations for both patient and doctor that this will not be a rushed appointment. At the start of the appointment, the patient should hand the nurse a list of issues that need to be discussed and keep a similar list. As the issues are addressed, I recommend checking them off. If a doctor is unwilling to give you such extra time, I recommend finding another doctor who will."

Amazing things happen when appropriate time is spent with patients. Insist that your doctors give you the time you need. To be fair, try to schedule for it so expectations on both sides are met.

1 comment:

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