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In the 1999 movie The Matrix, the story’s hero Neo, played by Keanu Reeves, learns how to slow down time. With special training, our hero’s perception and reflexes become so highly attuned to his environment that he is able to anticipate and dodge bullets, blows and kicks — while remaining unflinchingly calm.
There are days in medicine where we all wish we could be like Neo.
Despite the fact that consultation times have increased over the past few decades, our patients are frequently dissatisfied with the amount of time we spend with them. Increasingly complex and sophisticated medical options and rising patient expectation both dictate that we need more time. But decreased funding and increased pressure to see more patients mean that it’s not always available. The race to keep up has resulted in doctors running faster and faster just to stand still — resulting in what Dr Richard Smith, writing in the BMJ, calls ‘Hamster Healthcare’. It is a style of practice that leads to a reduction in professional (and patient) satisfaction and to burnout.
The race to keep up has resulted in doctors running faster and faster just to stand still. It is a style of practice that leads to a reduction I professional (and patient) satisfaction and to burnout
Whereas one possible solution is to allow enough time for every patient by allocating the necessary resources to do so, this will not be seen as an attractive solution to those paying the bills. An alternative solution to ‘Hamster Healthcare’ will come, according to Smith, from “getting off the wheel, not running faster”. He suggests a fundamental redesign of the practice of medicine to meet the patient needs within the economic constraints that exist. This approach will be music to the ears of those in the Department of Health and health insurers, no doubt.
Technology will help
The creative use of technology in medicine is likely to play a significant role in improving the continuity of care, eg, the use of secure email, text messaging, telemedicine and the use of online communities to share relevant healthcare information and support between visits. By using technology to deal with routine tasks and information-related exchanges, it is hoped that more time can be allocated to more meaningful face-to-face visits, when necessary.
Rethinking the consultation
It has also been suggested that rather than focus on the amount of time spent with patients, we should put some thought into changing how that time is spent. A study of patient satisfaction published in 2002 suggested that a patient preference for “more time” in the consultation correlated with patient dissatisfaction about the “emotional aspects of the consultation”. The study concluded that “a doctor who listens and tries to understand their patient may make the patient feel more satisfied with consultation length and subsequently more motivated to follow any recommendations for change”. This can be a hard task to pull off in 12 minutes, the average duration of a GP visit.
Dr Robin Youngson, founder of the Hearts in Healthcare movement and author of Time to Care, suggests that to understand the consultation properly, we need to look at time differently.
“In our clockwork analogy of the universe, we have an idea of time as something rigid, punctuated and inflexible. This sense of time is reinforced when our care becomes nothing more than a series of tasks.
“But the human experience of time is quite different,” he writes. “In moments of connection, time stands still.”
He also suggests a number of practices which will help us to use our time with patients more effectively.
He emphasises the importance of building a good rapport early in the consultation and of the importance of a good introduction. He advocates the use of mindfulness; the ability to pull our fragmented, distracted selves together to help us pay careful, non-judgemental attention to our patient, and to our reactions to them.
He emphasises the importance of compassion, for ourselves and for our patients, the use of humour and the usefulness of allowing our patients to set their own agenda.
Whereas it is important that we take advantage of whatever technological and metaphysical tricks we can use to maximise the efficiency of our time with our patients, no-one, even Neo, can slow down time.