My high school graduation ceremony was your typical Californian high school graduation — the sun hovering lazily over us, a cool, ocean breeze bringing wafts from the sea. As I listened to my principal deliver his address, my attention waned in and out. The sun was too warm and the wind was too soft. When the student speaker came up to speak, I reclaimed my attention to listen to him since he was a friend.
Incidentally, the only words I specifically remember from the entire ceremony were his first few: “Time is our most finite resource.” This phrase resonated with me, and I turned that phrase over and over in my mind.
By my college graduation, the trials endured and lessons learned at my alma mater had transmuted the phrase: attention, not time, was my most finite resource. In my classes, there were too many assigned readings and too many problem sets to complete satisfactorily within seventeen hours (my seven hours of sleep were non-negotiable). And somewhere in there I had to relax and socialize. One of my favorite professors joked that “all professors are narcissists,” assigning mass amounts of work under the presumption that their respective classes are the most important. It quickly became apparent that more time would not make a difference. Attention became essential, as I had to prioritize certain readings over others and hone in on certain concepts.
Attention factors into every field, especially medicine. Recent research shows that on average, physicians spend about 13 to 16 minutes on each patient during the visit. That’s 13 to 16 minutes to obtain a thorough history, perform a relevant physical examination, formulate a leading diagnosis, and counsel the patient regarding the disease and treatment. For some context, in our clinical training in our first year, we are given 15 minutes to obtain the history and perform a physical; even with just these two portions, there’s a sense of feeling rushed.
Our training is even designed to minimize extraneous conversations and actions, as our standardized patients are actors who don’t actually have a problem and are coached about what to say and how to say it. In a New York Times blog post, Dr. Pauline Chen writes about how the new generation of doctors are actually spending even less face time with the patients, citing estimates that interns spend about eight minutes each day with their patients.
With the new health care law and mandate, more people will have access to insurance and basic health care. As more people get insurance, more people will visit their doctors. As the number of people visiting doctors increases and the number of physicians remains relatively constant, there is an increasing amount of pressure and burden on physicians to see more patients in the same amount of time; the only logical result is that the physicians must spend less time with each patient.
The medical field is left at a crossroads. If we ask physicians to work longer hours in order to spend more time with each patient, we will undoubtedly overwork them, resulting in fewer satisfied physicians and fewer students pursuing medicine. This would then increase the burden on the remaining physicians, sparking a vicious cycle.
If, however, we ask doctors to spend more time with each patient at the cost of seeing fewer patients, then wait times to see a doctor will increase and fewer people will be able to receive quality health care. This path may trigger more health care disparities, as those who are the sickest cannot receive the needed health care while those who can afford it may be able to spend more to see a physician earlier. Either path will only hurt the field and more importantly, hurt people.
There are numerous articles about this very problem. Established professionals have discussed this issue at length with eloquent turns of phrases. To this wealth of discourse, I can only supply my small suggestion: Emphasize the attention a doctor pays to the patient. Attention encapsulates specific observations, such as a patient’s preference to stand because of low back pain. Attention can identify a commonality between patient and physician, such as a shared experience of the emotional upheaval of sending a child off to college; thus, attention can engender a deeper empathy and compassion. Levine’s sign, the classic clenched fist of the right arm over the chest used to describe angina, was first noted by Dr. Sam Levine; his keen attention to how his patients described the pain illuminated a very specific sign for ischemic chest pain.
Attention alone will not solve this issue of dwindling patient face time. That problem is multi-focal and requires a systematic change on many different levels. But attention may expedite the process of a physical examination as well as facilitate the development of compassion, both improving the quality of health care and the satisfaction of the patient. The word “attention” itself is inextricably tied with economic terms; we talk about “paying attention” and “lending an ear.” Attention may not reduce overall health care dollar costs, but it doesn’t cost much on our part to pay careful, specific attention.
Andrew Choi is a medical student.
