In medical training, there is an increasing didactic focus on empathy and professionalism. In many of these sessions, I have learned certain skills: Sit down at the patient’s level. Ask them open-ended questions. Don’t interrupt. Use an in-person, video or phone interpreter. These skills are helpful. But often, they run up against the great limiting factor in many of our clinical encounters: time.
In medical school, I chose not to take patient histories on a computer. I didn’t like the clack-clack of typing while the patient or family member was talking, and I felt distant with my only intermittent eye contact. I preferred sitting closer, maybe taking some handwritten notes, but having my attention freed up to make a human connection, to notice subtle body language. I often received feedback that I took too long with patients. In intern year, in an effort to be efficient like everyone else, the computer on wheels became an appendage. I rolled it room to room during “bedside” rounds, standing just outside the room and putting in orders while my co-interns presented. I brought it in while seeing a new patient, only leaving it to do a physical exam. In the afternoons, when I vowed to go back and check in on patients, I’d find myself instead tethered to the computers in the workroom, putting in orders and consults and responding to phone calls to do more orders and consults. At clinic, I was perpetually running behind, and practicing what I thought I would never do: hand-on-the-door medicine. This is when a patient asks you a question as you are hurrying out the door, and you answer their question with your hand still on the door, rather than sitting down and addressing it fully.
But it wasn’t my fault. It was time. Clinic visits are allotted 15 minutes. We have 16 patients to see during morning rounds. Pre-rounding happens at 7am. The afternoon is busy.
Shortage of time creates habits that are hard to break. It creates a culture.
I was reminded of this when reading “Scorpions,” a piece of short fiction by Jingyi Zhang in the Fall 2021 issue of Intima. In “Scorpions,” a husband (Feng) and his wife (Ying) recount encounters with Western medicine and traditional Chinese medicine practitioners. The Western medical doctor is busy and sees them while eating lunch. He barely glances at the CT scan or their faces, delivers a terse opinion, then sends them on their way. By contrast, Dr. Bian (the traditional Chinese medicine practitioner) seems to care. “Ying remembered Feng’s hesitance when they first arrived, but also how relieved Feng was after Dr. Bian spent thirty minutes talking to them,” Zhang writes. In the piece, Ying tells her son-in-law: “Dr. Bian was the only doctor that’s kind to us. Young doctors don’t even raise their eyes to look at you.” She says this to justify their visit, amidst the doubts she is having about whether the costly herbs they end up buying actually worked.
In “Misunderstood,” I describe a clinical interaction where two teenage granddaughters are expected to translate between Cantonese and English during their grandfather’s assessments for cognitive impairment and depression at the neurologist’s office. In that encounter, I was a medical student shadowing the neurologist, and I felt uncomfortable at the fact that no interpreter was present. I’ve come to realize that sometimes, access to an interpreter is not the issue. Even when that access exists immediately, through phone or video chat, those extra moments of translation cause stress for the provider. Perhaps professionalism and empathy are built through patience, and patience is built through systemic change, which includes more time per patient.
Vidya Viswanathan is a third-year resident in pediatrics at the Children's Hospital of Philadelphia, and is the founder and president of Doctors Who Create, a website focused on encouraging creativity in medicine.