Rushed Is a Feeling, Not a Schedule: Why Calm Physicians Are the Most Efficient

Another day of full schedule. The patient I was about to see was a new patient, who was referred by her primary care physician for “abnormal labs”. I was about 15 minutes behind schedule. As I was walking into the exam room, Mrs. S was looking at me. I could almost feel her trembling hands. Her eyes were glazed with anxiety, as if I was going to do something to harm her. I smiled, sat down, and asked if she knew why she was there to see me. I always ask the new patients this question, especially for the hematology patients, to get an idea of what their understanding is so far.

Mrs. S told me that it was because her blood work showed high protein. That was correct. I started to explain to her how her high protein was connected to hematology, including the benign spectrum of monoclonal gammopathy of undetermined significance to the other end of the spectrum with multiple myeloma. She admitted to me that she already had the opinion from Dr. Google before her visit that day. She felt anxious because she was convinced that she had cancer.

I spent the time I needed to spend with her. Not in a rush, although I was mindful of what time it was. I did my best to explain and answer all her questions. Even though I told her there was a possibility that she might have multiple myeloma, she felt much less anxious by the time she left the exam room. She smiled and thanked me. She was grateful that I spent the time to talk to her and discuss with her in a way that she understood.

As physicians, we often encounter patients who are anxious. You may feel rushed because you are more than half an hour behind schedule. Patients who feel anxious tend to ask more questions. They are often looking for some form of an answer which will help them ease their anxiety. While the patient is asking away, the physician, on the other hand, often tries to answer the questions quickly to move on. When the physician is rushed, the patient can feel it. That patient may not feel confident in your care and ask more questions. You likely will end up spending more time with the patient. While hoping the patient will stop asking more questions, you also answer in a way that reflects your impatience. In the end, the patient may seek care elsewhere, or, if they stay, it is not the deeper connection you hoped to have made.

You want to be efficient. You want to take care of your patients. You want to create meaningful connections with the patients. It is possible to achieve all of the above. First, prepare your mind. Remind yourself that you have the time you need to take care of the patients. Expect that you will spend more time with certain patients while other patients may only need a few minutes.

The important concept is that being efficient does not mean you have to feel rushed. In fact, you are more efficient when you do not feel rushed, while being mindful of the time. When you believe that you have enough time to take care of each patient, you get to focus your mind and energy to do just that, as opposed to thinking about when you will get out of that exam room. After all, we want to take care of our patients not just by managing their diagnoses but also to address their psychosocial needs.

Second, be a detective. Be curious. When a patient is anxious, ask why. What is the reason behind it? What are they thinking that makes them feel anxious? Once you discover what the patient is worried about or what the fear is, you can shift your focus to address that. For Mrs. S, it was the fear of having cancer. That was the topic I spent time discussing what her lab results meant, the reason I ordered certain labs, and what possible outcomes there were. I further discussed that there were things we could control and things we could not control. For the things we could not control, we could decide how to approach them.

Third, connect with your patient. This depends on the previous two steps. When your mind is prepared, when you are open to possibilities, when you can address what the patient’s biggest concern is, the patient feels heard and cared for. This is where the deeper connection begins. When you establish that connection, the patient is building trust in you. This means that the patient is not going to ask you questions because they do not trust you.

Preparing your mind is just as important as having your medical knowledge to care for the patients. Always keep an open mind and ask questions without judgment. Being curious is always helpful. When you can pinpoint what the patient is most concerned about, when you can identify their fear, you can address it head on, ease their mind, establish trust and a deeper connection. You and your patient will have a more pleasant time during the encounter while you are not spending the whole day trying to explain or justify your management plan.