I’m sure I am not alone in saying that I am almost obsessively conscious of time. Namely, that there never seems to be enough of it. As busy oncologists, we all have constant demands on our time, from our leadership, colleagues, drug company reps, insurers, and our families, not to mention the time we try to carve out for ourselves. But for most of us, the biggest amount of our time is spent interacting with our patients.
I was recently seeing a new patient, someone who had traveled from another state for a second opinion about his lung cancer diagnosis. I am very fortunate to have an hour set aside for these meetings, and that is often but not always sufficient. After reviewing his extensive records and scans, examining him, and laying out both standard and experimental treatment options, our hour had flown by. The gentleman was accompanied by his wife who did most of the talking, and the two of them had done thorough research ahead of time and had a long list of questions. At the end of the hour, we were still only part way through their list.
At this point, I could see the patient start to squirm in his seat, often glancing at his watch and making throat-clearing noises as his wife moved from one question to the next. At about 10 minutes past the hour, he finally spoke up, “Now, honey, the doctor doesn’t have time for all this. I’m sure he is very busy and has to get on with his day.”
Patients say something like this surprisingly often. Yes, some patients call or email daily with complex demands and never seem to notice or care that they take three times as much time as the typical patient. But for every example like that there are many more who seem to think I’m going out of my way to return their calls, who look surprised when I come to see them in the hospital, or who hesitate to ask a question or to tell me something is wrong because they think they are taking too much of my time.
Now, in fact, I am busy, and spending extra time with one patient means I make someone else wait. I remember my residency training in primary care, where we were taught to address one major issue per patient visit and reschedule the patient if there was more going on. However, oncology doesn’t work that way. Fifteen or 20 extra minutes of my time is nothing compared to the investment the patients make, in this case driving eight hours and staying at a hotel in a strange city, confused and afraid of what was going to happen. Future visits during treatment are likely to be much shorter and revolve around urgent issues and side effects. It is the initial consult that allows time to reflect and educate—the relative calm before the storm of chemo and/or radiation begins to address questions about diet and supplements and scary questions about prognosis.
And this isn’t unique to new patient consults, the same need for extra time comes up in any visit that marks a major transition, such as scan visits showing disease progression, or clinical changes necessitating discussions about goals of care or the end of life. As a doc treating lung cancer patients, these extra demands on my time can and often do come up multiple times in a single day.
Spending that time, not the time allotted on the schedule but the time each patient needs, is my job. That is what I trained for and what I get paid for. As a disease specialist in an academic practice, I recognize that I have more time to spend than most oncologists in this regard, and that oncologists everywhere are feeling the pressure to be more productive in the face of a constantly growing list of demands on our time that threaten to steal away from patient care. But one way or another, we all have to find a way to make it work, because that is our job.
Yes, sir, I am busy. And yes, I have the time.