Am I My Genes?

Confronting fate and family secrets in the age of genetic testing.

The Doctor Will See Me...When? Patients, Patience and Care

How doctors and their patients experience time very differently.

"A person waiting is a person suffering," a doctor told me recently. "I never realized that -- until I became a patient myself. The difference between being a doctor and not being a doctor is the timing."

The word "patient" has two meanings - referring to a person with illness, or to waiting. Both meanings derive from the same Latin word - patientia - meaning, "to suffer."

But unfortunately, healthcare institutions, policies and providers often ignore this fact.

Patients pay the price every day.

"I went to see my doctor," a physician recently told me. "And he kept me waiting outside in the waiting room for 45 minutes! It drove me up the wall!"

"Have you ever kept patients waiting," I asked him.

"I don't know. I guess so. I never thought about it"

The fact that he didn't know surprised me, but is hardly unique. Doctors experience time very differently than patients, but usually don't realize that this discrepancy exists.

Recently, I interviewed a group of doctors who had become patients, and who repeatedly described their astonishment to suddenly experience time very differently.

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In the past, I, too, have kept patients and others waiting. I try not to do so anymore, though I don't always succeed. Other pressures exist.

With increasing deluges of emails, and electronic medical records producing around the clock information, balancing time gets ever harder for everyone, including doctors.

Still, especially when anticipating test results that can determine one's future -- even one's survival -- minutes can seem hours, and hours can seem days.

But physicians, on the other side of the stethoscope, tend to dismiss these variations in experiences of time.

Psychologically, the experience of time -- the sense of its duration -- is very subjective, varying widely between people. Time is relative and, as the adage says, "flies if you're having fun."

Conversely, as a child, I remember boring, seemingly endless car trips, asking my parents, "how long until we get there?...How many Batman shows?" I tried to find a period I understood, to which to compare the stretch of seemingly endless time now before me. I didn't yet fully know what "an hour" felt like.

Suffering afflicts one's inner one's life - one's soul -- not just one's body. To acknowledge, feel, and respond to another's suffering is hard. As our choices of distractions through ipads, cellphones, and twitter infinitely expands, this awareness becomes harder. Bored by someone else's pain? Simply click to another screen.

Only when become patients themselves do many doctors now realize that patients wait much more than necessary - even to receive the results of medical tests. One physician with cancer called her doctor's office on a Friday afternoon to get a test result, and was told she'd to wait until Monday. "The result is sitting on somebody's desk," she thought. "Why do I have to wait three days? " She now works hard to give patients their lab results as soon as possible, so they don't have to spend the whole weekend worrying. She had never before contemplated the costs of waiting.

Some waiting may be inevitable. Emergencies are, by definition, unplanned. Illness and treatment take unpredictable amounts of time.

But too often, health care institutions and providers structure their timetables around their needs and priorities, rather than those of patients.

Once they become patients themselves, many doctors also now realize, in retrospect, how they didn't discuss time well with those they treated. "My doctor told me, 'your cancer shouldn't come back too soon,'" a physician told me. "I wondered: what's "soon"? Weeks? Months? Years?"

Frequently, doctors talk very casually about time, especially in predicting how long patients have to survive. It is easier to hide behind vague words, hedging our bets. After all, doctors' prognoses are often wrong, since many unpredictable factors are involved. "They told my grandmother she had four months to live," I often hear. "But four years later, she is still alive."

Still, using vague terms is not in the best interests of patients or their families.

We can do better. Most doctors don't think about these phenomena, but should. Increased awareness of these issues, by physicians, patients and others, can help.

"I now say to every patient who walks into my office, "I'm sorry to have kept you waiting," another doctor told me. " It melts the tension in the room."

If a doctor gives only vague descriptions of time, patients should ask for more specificity and precision.

When doctors give you results sooner, maybe say, "thank you. It is hard waiting...I am sure you know." If you know any health care providers, encourage them to realize that time flies...but not always for patients.

Even if we are not providers, many of us can benefit from this awareness, too, as we keep others waiting.

Hopefully, physicians and the rest of us can change without having to become sick, and wait long periods, ourselves.

Robert Klitzman, M.D., is a professor of clinical psychiatry at the College of Physicians and Surgeons and the Joseph Mailman School of Public Health. more...

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