During a recent visit to Dublin I was saw a neon sign in a pharmacy which read:
I was, first, amused by the wording. Dublin, home of George Bernard Shaw and Yeats and Joyce (and storytellers and bards in every pub) is a city with a deep and natural love of language--where even pharmacy signs are poetry.
But, next, I got to thinking. Am I "present" in my practice, even when I am in?
Though we all like to think of ourselves as exceptions when it comes to unflattering statistics, the likelihood is that I am not as present as I think I am or would want to be. If we define "presence" for a doctor as maintaining eye contact, paying close attention to what a patient is saying and not interrupting the statistics aren't pretty.
An often-quoted 1984 study demonstrated that doctors interrupt patients within 18 seconds, on average. Despite more emphasis in medical schools on communication skills, that appalling figure hasn't improved much.
Shorter office visits and computer screens in exam rooms haven't exactly inspired doctors to be more contemplative.
Author and physician Abraham Verghese has urged physicians to slow down, and focus on looking at, listening to, and examining the patients in front of them. His wonderful TED talk about this is here.
My first day back after my vacation I had 20 patients on my schedule, and several phone messages to return from patients and their family members. One was a woman with traumatic brain injury, who speaks very haltingly. One was a patient who had many questions about a new diagnosis. One came in for a "quick" visit to check out a cough but started talking about her fears of dying of the same disease other members of her family had.
With that neon pharmacy sign flashing in my brain, I resisted my desire to speed up, to interrupt, to get through the day as quickly as possible. I found myself more relaxed than usual, and less exhausted by the enormous effort it requires to resist being present.
And guess what? I left the office the same time I always do.
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