By RICHARD GUNDERMAN, MD
NOVEMBER 16, 2014 – Americans tend to like fast things: instant coffee, sports cars, and speed dating. Many share a fascination with record holders, such as the world’s fastest runner or texter. And increasingly, the same goes for medicine. The number of minute clinics is exploding. Some emergency rooms now post their current wait times on roadside billboards. And increasingly, physicians and other health professionals are under pressure to increase the speed at which they see patients.
A friend of mine, a family physician, was recently advised by the new manager of his practice that he will be penalized if he doesn’t increase the number of patients he sees each day in clinic. A thorough and compassionate physician who is known for the quality of the relationships he builds, he asked the man, “How am I supposed to work faster and still provide good care?” The practice manager thought for a moment and responded, “Why don’t you stop asking open-ended questions?”
To be fair, there is something remarkable about fast medicine. Consider Robert Liston, a 19th-century British surgeon who is said to have called out to his students, “Time me, gentlemen, time me!” It was widely known that Liston could amputate a leg in under three minutes, a hastiness attributable in part to the fact that inhalation anesthesia had not yet been invented. Yet such speed has drawbacks. In one of Liston’s most celebrated cases he removed his patient’s testicles, and in another he also amputated his assistant’s fingers.
In medicine, the pressure to shorten visits is being exacerbated by demands to devote more time to non-patient care activities. For example, a study of emergency room practice published last year showed that, on average, physicians are now spending twice as much time entering data into the hospital information system as they spend on direct patient care, recording no fewer than 4,000 mouse clicks per shift.
Some things simply cannot be rushed, at least not if high quality is the objective. Part of the problem is the fact that haste leads to errors. But moving too fast can also rob life of meaning. Consider conversation, friendship, and intimacy. When it comes to such relationship-based activities, going too fast can prevent them from really happening at all.
What happens to a medical encounter when the patient senses that the physician is rushing? In many cases, patients end up feeling as though they have been taking a multiple-choice examination. It may not take long for a physician to compose a list of a patient’s prior surgeries, but to delve into marital problems, depression, or the prospect of dying is a different matter, requiring a different tempo.
Good medicine is grounded in relationships. And because good relationships take time, good medicine often equals patient medicine. To focus on the patient means listening, interacting, and practicing patiently. It means taking the time to let deep concerns express themselves, and investing the time needed to build real relationships.
We physicians sometimes forget how truly impatient we are. Consider, for example, Dr. Jack MacKee, the rock-star cardiovascular surgeon in Randa Haines’ 1991 film, “The Doctor.” MacKee is a technical virtuoso, but he has allowed his interactions with patients to become superficial and brusque. Only when he is diagnosed with throat cancer and gets a like-minded physician does he begin to appreciate the insipid taste of his own medicine.
Carlo Petrini launched the slow food movement in 1986 in protest over McDonald’s plans to open a restaurant on the Spanish Steps in Rome. He argued that globalization and industrial production represented a threat to something important – namely, the cultivation of local culinary traditions and foods. As he saw it, speed and value were supplanting something important – community, taste, and conviviality, the capacity to truly enjoy the experience of dining together.
A former student of mine recently expressed his bitterness at being asked by his employer to see a different patient every 11 minutes. At this rate he feels he will no longer have time to get to know any of them. Such pressures to increase productivity, which is always measured in relation to time, are transforming medicine into an anxious profession, in which many practitioners sense they no longer have time to take proper care of their patients.
Medicine at its best is not just a collection of clinical processes, such as delivering the right immunizations or prescribing the right antibiotics. It isn’t merely a matter of optimizing throughput, cutting costs, or enhancing efficiencies. Truly great medicine is built on relationships. It is about people. And taking good care of people means taking the time to know and care for them as persons. Regardless the effect on the bottom line, sometimes we simply need to slow down.