Time is slippery

Time is a great two faced monster. In between patients, when I am charting and composing letters, time sits on my shoulder and breathes in my ear…hurry, hurry, hurry. During phone calls, he is less insistent. As soon as I walk into an exam room where a patient is waiting, time leaps from my shoulder and waits to pounce as soon as I come out. 

Asking questions and getting to the bottom of the problem are my favorite things. When did it start? How long does it last? What does it feel like? Have you ever had it before? What do you think it is? I am allowed to be nosy. In school we learn that the diagnosis is 90% history. That means you tell me what is wrong before I ever lay hands on you. If you ever notice a frustrated health care provider and you happen to answer in one syllable, this is why. 

While sleuthing for answers is usually fun, there is one phrase that will kill it. "You're the doctor, you tell me." The human body is not a stereo. You cannot open it up and look into the back, solder something back together and be done. There is no jiggling it to see what is broken. When I started school I thought it would be easy. I thought that a patient would come in and tell you the symptoms they were having, you would reach back into your memory and say ahh, those symptoms equal this problem. Here's your prescription. Yeah. Not. I need you to tell me all of the pertinent details to figure out whether you have a horse or a zebra (I will explain the zebra thing later).

For lots of reasons, patients are sometimes trained not to give all the pertinent details. When you have a provider that has been seeing patients for 20 years, they often figure out what is happening in the first few minutes. And they are usually right. I have found that being a relative newbie is helpful because I have to ask more questions. Sometimes, one answer changes everything. You may get cough syrup…or you may go to the Emergency Room. I will spend more time getting there than my learned and experienced counterpart.

So, time stops in the room with a person who is hurting. It starts again when I step out into the hall. Unfortunately, I have sometimes spent too much time with one patient at someone else's expense. I feel bad for that. But I feel very good when I can look back at the end of the day and know that I did all I could for each patient. I hope that the people who come to see me feel supported and are willing to wait around just a little bit so that everyone gets what they need. It isn't the most efficient way, but it's the most caring way I know to do the job. One day, I will kill the two faced monster. Probably right before I die.