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Perspective | Magazine

Doctors, your patients’ time matters too

The Japanese have a phrase that describes the visit to a doctor: “three-hour wait, three-minute visit.” Feel familiar?

Associated Press

In the interest of time, my neurologist began our first appointment with a brisk, Aaron Sorkin-style walk-and-talk from the waiting room to his office. Before we entered, he informed me that a medical student would be observing. I’d long been a patient at the teaching hospital, where my dad was chief of medicine for 25 years, and this wasn’t unusual, though I was typically asked, not told. Still, I was there to be treated for migraines, not for a physical — how intimate could that be?

It turned out the intake questions were pretty personal. When the doctor excused himself in the middle to take a call on his cellphone, the student and I exchanged a smile, as if we both were wondering if this were actually happening. After a few moments of awkward silence, the doctor returned. “So,” he said, “where were we?”

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I eventually moved on to my second hospital and another neurologist. But judging by the number of times he checked his watch, it appeared I bored him in our first brief meeting. A few days later, I sent him a seven-line e-mail that began, “After I visited your office on Friday, I had the most prolonged migraine I can recall.” I wasn’t suggesting some kind of cause and effect, just asking for clarification of his treatment plan. He returned with a far more concise reply that concluded: “For future reference, try to limit e-mails to 3 lines please. (Got a ton of e-mails to reply to).”

Determined the third time would be the charm, I chose a practice with a large electronic board displaying each doctor’s name and constantly updated schedule. The feeling of getting medical treatment at Logan was outweighed by the logic that any practice so conscious of the doctor’s time might reinvest it in the patient. My doctor, it turned out, was never delayed less than 45 minutes and always appeared as if he had a plane to catch.

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I had recently begun a regimen of Botox injections for migraines that was initially promising, but I had concerns about the long-term side effects. Mindful of his schedule, I had written down three questions on a slip of paper so I could ask them efficiently. But as I read the first aloud, he put on gloves and prepared the syringes without looking up. I could hear the anxiety in my voice, but before I could get to my second question, he had efficiently delivered 31 shots, handed me an ice pack, and sent me to the scheduler for my next appointment. I felt a migraine coming on.

In retrospect, I realized, I was spoiled. Growing up, time had never been a factor in my medical care. It was years before I understood that I had been lavished with the kind of attention only available to the spouse or child of a doctor. With that benefit gone, I was cast into the real world of stopwatch medicine and “Patient, heal thyself.” According to a 2015 study, the average visit to a medical clinic is 84 minutes, but only about 20 minutes of it is actually spent with the doctor.

This lack of time was a reality my own father experienced when he developed lymphoma. Training hundreds of medical students, residents, and fellows was a highlight of his 40-year career, but he ruefully noted that technical brilliance was not always accompanied by empathy and communication skills, those attributes commonly known as bedside manner. When searching for an oncologist, he met with an eminent practitioner, whose first words were that my dad would be treated just like any other patient. That might have been a statement of egalitarian principle or a harbinger of things to come.

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Ignoring his own instincts, my dad chose the physician based on his resume, without regard to the human component. It proved a fateful decision. When he was hospitalized with a serious virus for a week, his oncologist did not find the time to visit once. Throughout much of his illness, my dad was largely left to manage decisions that no patient, even a doctor, should be forced to make for himself.

There’s no question that our so-called Best Health Care System in the World is built on a business model better suited to Supercuts than medicine. Dr. Ateev Mehrotra, a professor at Harvard Medical School and lead author on the 2015 study on wait times, believes no single reason explains why doctors spend so little time with patients. But, he says, “the fee-for-service system encourages physicians to squeeze in as many visits as they can per day.” And, if it makes us feel any better, we’re not alone. He notes that in Japan there is a phrase about visiting the doctor that means “three-hour wait, three-minute visit.”

Even if the fee-for-service system conspires against physicians who truly want to be there for their patients, no system can actually instill that motivation and commitment. Bedside manner could not have cured my dad’s lymphoma, but it could have extended his life and improved its quality for him and his family.

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Shortly after losing her husband, my mother sent a letter to his oncologist. I can’t recall the exact words, but it spared no detail in describing how the doctor had failed to be there for his patient and what the consequences were for us all. Though defensive in spots, his reply mostly seemed candid, thoughtful, and sincere. When I read it, I couldn’t help thinking that he, too, wished he had made the time.


Andy Levinsky is a writer in Boston. Send comments to magazine@globe.com.