I was making a mental packing list for a fall weekend at the beach: sweatshirt, jeans, sunglasses, those sandal things--you know, for walking on rocky shoreline? Kind of ugly, but useful? I could picture them clearly--the rubber soles and webbed uppers--but their name escaped me entirely. A person's name, maybe? I started to go through the alphabet letter by letter, hoping for a clue. But it was gone. Not "wait, wait, don't tell me!" Not "on the tip of my tongue." Just gone.
This kind of lapse has always happened to me now and then, especially when I'm very busy, and happens more frequently as I get older. It happens to my patients, too, and they come in concerned that it may be the first sign of Alzheimer's disease or some other form of dementia. It rarely is.FULL ENTRY
Medicine, like politics, sports, and everything else, has gotten sucked into a 24/7 sound bite culture in which the most complex issues are spun into a few provocative words on news sites, TV, and radio shows. Enraged readers and listeners then weigh in. As the old expression goes, much heat, but little light ensues.
But three recent stories involving medicine are worth a closer look, and cooler heads.FULL ENTRY
I received many interesting responses to my recent column about whether longer visits might actually be more beneficial and cost-effective--not to mention more satisfying for both doctor and patient.
A dermatologist wrote to say that he insisted on spending a half-hour with each patient--very unusual in his specialty--accepting the loss of income that this practice incurred. He wondered if physicians were being creative enough in finding ways to spend more time with patients, even if that involves earning a lower salary. Unfortunately, in many practices, that's not an option--a physician needs to see so many patients per year to keep his or her position.
A teacher, a therapist, and a businessman each commented that slowing down and being more present, whether dealing with a student, client, or colleague, builds stronger relationships and nets better results--no matter what the goal.
Several people asked whether shorter and longer medical visits and have been compared head to head in a clinical trial. They haven't, to my knowledge.
One reader pointed out something that I've noticed in my own practice: extra time spent getting to know a patient saves time (and, probably money) later when an urgent issue arises. If the clinician understands a particular patient's preferences, fears, support system (or lack thereof), etc. and a patient feels comfortable with the clinician, it's amazing how much faster they can get to the bottom of that mysterious fatigue, nausea, or headache.
Finally, one hospital administrator noted that we seem to be trending away rather than towards the "slow medicine" I described. She worried that as we move into ever larger medical "systems," such as Atul Gawande discussed in a provocative New Yorker essay comparing medical practice with the Cheesecake Factory, visits will become even shorter.
I'm worried, too.