Recently, I visited a friend in the hospital. As her condition improved, the nursing staff suggested it was time to discuss discharge planning and called the social worker to make the necessary arrangements . The social worker entered the room, remaining close to the doorway, and announced that she had very little time since she had many other things to do. We certainly didn’t feel confident that the plans would go well.
As we rush through our days, we frequently feel just like this overworked social worker – too much to do in too little time. Our patients, on the other hand, are frequently worried and need not just our expertise but our time and reassurance.
Fortunately, there are concrete things we can do to help us balance these opposing demands.
Research shows that when we sit down at the bedside, our patients perceive that we are spending more time with them than if we stand. So even if we are pressed for time, it is important that we sit down, even for a minute or two, and talk eye-to-eye with our patients and their family.
Another effective communication strategy is to share our own frustration with our limited time. Patients are generally quite sensitive to the fact that we work very hard and have a lot to do. When we share our wish that we had more time to spend, we let them know that we care about them, even if our time is short.
Lastly, we can focus the conversation on what is most important. When I first began my practice as a general internist, I saw 20-25 patients each day and frequently ran behind schedule. Due to the clinic’s policy that new patients arrive an hour before their appointment, one patient waited two hours to see me and was understandably furious. As I entered the room and apologized for keeping her waiting, she launched into a tirade that included sentiments such as, “my time is just as important as yours,” and many others. After listening for a minute, I interrupted, apologized again, and then suggested that she could continue berating me for my tardiness, or we could spend our time together solving the problem that she had come in for. The tension in the room was immediately defused and we spent the next 30 minutes taking care of her concerns in a productive and cooperative way. Similarly, by stating that we wish that we had more time to spend with our patient today but want to be sure to take care of their concerns – either today or at a future date – we focus the conversation on what is most pressing and let our patient know that we understand the importance of their concerns and are committed to addressing them.
The doctor-patient relationship is a partnership. For it to be most effective, we need to build a foundation of honesty and trust. As we become increasingly squeezed for time, it is essential that our patients understand both our situation and our continued commitment to doing what we can to insure their health. It doesn’t serve us, our patients, or our partnership to pretend that we can promise unlimited time. There are, however, ways of saying this while also expressing care and concern, so that our partnership remains strong, even as our patient visits grow shorter.