Spending Extra Time With A Patient

Unpredictable things always happen on a clinic day for physicians. When you are scheduled to see an established patient in fifteen minutes, it is almost inevitable to run over time when you have a patient who has more issues than expected to take care of, or a problem that is more serious than anticipated to address.

A patient in her early 80s was scheduled to see me in the afternoon the other day. Let us call her Mrs. R. Her appointment time was fifteen minutes. Her appointment was made weeks ago, and it was meant to be a routine follow up. She has a history of localized breast cancer about twenty years ago. She had a lumpectomy and received chemotherapy at that time. About a year ago, she had recurrent breast cancer that was high grade and had spread to the axillary lymph nodes on the same side. She underwent a more extensive lumpectomy and axillary lymph node dissection, followed by chemotherapy, radiation and was started on endocrine therapy.

She was found to have some abnormality on the same breast from a surveillance breast imaging study. She was recommended by the radiologist to undergo a biopsy. The abnormality was small, yet enough for the radiologist to be concerned. Her breast biopsy was scheduled to be several days after her appointment with me.

Having known Mrs. R for more than ten years, I predicted that she would be anxious. She was anxious when she was found to have recurrent breast cancer last year. By the time I was notified of her breast imaging abnormality, I was not able to reschedule other patients to allow more time for her appointment.

I knew that I would spend at least thirty minutes with Mrs. R, if not more. Her daughter who comes with Mrs. R regularly, is very understanding. Remembering my goal in patient care is to take great care of the patient and leave work on time, Mrs. R’s appointment was likely going to delay my work day. Notice my goal is two-fold – take great care of the patient as the first part, and the second part is to go home on time. It is listed that way because patient care comes first. Sure, it Is important to go home on time too – what happens if you leave work on time and the patient is not taken care of appropriately? You will end up spending more time to “make up” for what you left off.

When you realize that the patient will need more time than the scheduled visit, and if you are not excited about it, if you are not happy about it, or if you are frustrated about it, allow yourself to feel those emotions. Why are you experiencing those unpleasant emotions (or other negative feelings)? It is not because the patient is requiring more of your time. It is because of what you think about the situation. One common thought is that the extra time spent will delay your time to leave work. Another common thought is that you do not desire to address the patient’s emotional state.

It is important to notice what opinions your mind is offering you, and ask yourself if those are helpful thoughts or not. If they are not helpful thoughts, what is another perspective that is more helpful? For me, focusing on patient care includes addressing the patient’s emotional state related to their medical problems. When a patient is anxious about a certain abnormal finding, I do my best to address it so that the patient will leave the clinic feeling better.

For Mrs. R, the biggest concern was that the breast cancer came back. While it could be a possibility, I emphasized that it was not for sure that it would be cancer. We could choose not to focus on the worse case scenario. What if the biopsy was not cancer? We also discussed that, by worrying about the outcome, by thinking of the worse case scenario, it would not change the result. Whatever the result would be, we would face it head on, together. I emphasized that there was always something we could do about it, whatever the outcome would be.

We chatted for about thirty minutes, if not a little longer. At the end of the visit, Mrs. R was more calm and hopeful. She even smiled. I could sense the change in her attitude. The daughter also felt encouraged after the visit. Yes, I spent extra time with her. I chose to do so, because to me, that was exactly I was there for. I am glad that I could offer her some peace and calm in this challenging situation. I am grateful that I could put patient care first and go home on time second. It turned out that I still ended my clinic day by 5 pm because I was able to be more efficient with a few other patients.

As physicians, it is important to remember the reason for patient care and live by it. For me, taking great care of the patient and going home on time has been my goal. What is your why? Allow yourself to focus on what is important for you while offering the patient your medical expertise and compassion. Allow yourself to be more flexible as medicine is unpredictable. Human beings are unpredictable. Have the awareness of how you feel in a certain situation and bring yourself back to what is the most important thing in medicine for you. Let us live in alignment with our values.