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The calm before the storm

I am taking up a lot of your time, doctor,” the young woman said, as she positioned herself on the edge of the chair, already fully dressed in coat, scarf, boots and cap, following her physical examination. I looked up from the computer, where I was typing a referral letter. “Just a few more minutes,” I said. “I’ll finish this and you can be off.”

When she first came in she had sat in that same way, on the edge of the chair, as if to convey that she didn’t want to take up too much of my time and in an apologetic tone, informed me that she had two problems that she would like help with, if that was okay.

The most pressing one was recurrent abdominal pain that had resulted in a recent visit to an emergency department. The second was a recurrent headache that she thought might be migraine. I reassured her that these were legitimate reasons to come to see me and that I would address both today. I suggested she give me her coat, scarf and cap so that I could hang them up and she could sit back in the chair, relax a little before we began. She did as I suggested and the consultation proceeded smoothly with a focused history and examination followed by a negotiated management plan for both problems. 

It was at this point that she voiced her concern about the amount of time she was consuming, causing me to disengage from my typing and become aware of my external circumstances. I looked at the clock and saw that she had been in for almost 25 minutes. I could have sworn it was five. But, for once, this didn’t matter. This was the morning of Storm Emma and ‘Mary’ was the last of only four people who had attended me that morning. A further 12 had been afraid to brave the elements and were present only as red cancellations on the computer screen. All four who had attended had received more than 20 minutes each and like this consultation, every minute had been focused and necessary. 

Freed from the usual time constraints, I had the opportunity to fully engage with each patient, deal with their agendas as well as a few of my own, conduct necessary examinations and decide management plans in an unhurried but effective manner. I had worked hard, but did not feel drained or overwhelmed and did not have a mountain of paperwork to attend to before my afternoon surgery, as is usually the case. It was a good feeling. I realised that what I had been experiencing throughout the morning was a state that psychologists call ‘flow’: A state where body, mind or both are fully engaged in an activity to accomplish something worthwhile. A state more associated with artists and creative work than run-of-the-mill workers like myself. A state that not only makes work seem effortless, but has proven beneficial effects on wellbeing.  

According to psychologist Mihaly Csikszentmihalyi (pronounced Cheeks-Sent-Me-High), there is no reason why any activity cannot induce this state of flow, provided the conditions are right. These conditions include: Clear goals, no interruptions, being able to complete the task, immediate feedback, a sense of control, and absence of intrusive worries about everyday events. These conditions lead to an altered sense of time when minutes can seem like hours or hours like minutes and the experience is one of a deep sense of enjoyment. It is a state not often experienced in general practice with over-booked surgeries, constant interruptions and often, an inability to complete one task before having to consider the next one. 

“You picked the right day to come in,” I said. “I wish it was like this all the time. I hate when I have to rush people or when I keep people waiting.” The woman raised her eyebrows and gave me a look of surprise.

“Well, the worst day ever it was here, wasn’t a patch on the NHS,” she said. “There, I don’t think I ever even took off my coat. I could wait up to three weeks for a GP appointment, go in, start to say something and find I was back out in the waiting room before I had finished my sentence. I saw a different doctor every time and to be honest the place was so busy that they barely looked at you.  I gave up going in the end as I found it such an unpleasant and pointless experience. I hope it never gets that bad here,” she added, as she made her way to the door. “I hope not, either,” I replied, feeling a little selfish that I was grateful for the storm and the enjoyable morning’s work, but also wondering how long it would be until we are just as good as the NHS. 

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