Many believe that a long visit with the doctor is a good medical visit. This is the long visit fallacy.
Years ago I had a partner who related poorly to parents. So after some discussion and counseling he thought he’d fix the problem by spending more time with families. Time, of course, is correlated with compassion. And caring doctors take lots of time, we believe. So if he took lots of time, he thought, he’d be caring and well-liked. But what happened was that instead of parents being with an unrelatable doctor for 15 minutes, they had to endure him for an hour. Parents were four times as frustrated.
More is not the answer when you don’t understand or have the ability to address a patient’s needs.
When rounding with residents on the GI service at Texas Children’s Hospital, my approach has always been to give every parent exactly what they need. A stable, healthy child with short gut riding out day 7 of 10 antibiotics for their central line infection may not need more than 8-10 minutes on daily rounds. Typically they expect and need nothing more. Other parents at critical transition points in their child’s evaluation or care might need 45 minutes of our time. Occasionally, more than that.
It’s about the right attention for the right patient.
Some clinical encounters are transactional and have well-defined end points. Taking out stitches, for example. Other encounters involve critical conversations that call for deeper introspection. An example might be the initiation of an experimental therapy or the transition to hospice care.
All of this starts with understanding the patient’s needs and expectations. We should probably be more expectation-dependent rather than time-dependent.
And meeting a patient’s expectations and needs may take a long time.
If you enjoyed the long visit fallacy you might like the Doctoring 101 Archive. This is everything written on 33 charts about the art of clinical medicine.
Image via the U.S. National Library of Medicine.