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Only Time Will Tell

Only Time Will Tell

Most days at the office, I am running behind. I realize that everyone has a schedule, or at least we were taught to follow a schedule since we were in elementary school. More important, we were taught that it is obligatory to be punctual and on time. I remember for being scolded in medical school classes if I was the slightest bit tardy to a lecture.

There are times when it's okay to be late, sometimes even fashionable. When anyone arrives at a party or night club, no one really wants to be the first one there. Arriving at a concert or football game varies depending on whether the attendee has an assigned seat or if it is a first come first seated arrangement. Stores that open on Thanksgiving often have a limited supply of severely discounted merchandise to be sold. Being the first person in line makes a big difference if you are interested in that particular item at that particular price.

Speed of service is a very important factor in staying on time. I have tried all kinds of mind tricks to speed up what I do in the office. My last great idea was the hour glass timer. In theory, it should work and everyone should get what they need by the time the last grain of sand leaves the upper chamber of the hour glass. However, patients quickly figured out that flipping the hour glass over a second time was a way to get a little more Doc Time. Clever I might add and totally unforeseen on my part. But I still have the hour glasses in the rooms to remind me of being on time as best I can.

During the week, patients are encouraged to walk into the office for evaluations of their acute onset illnesses. There is never a bad time to practice acute care medicine. And I prefer that patients who are under my care see me when they are acutely ill because I understand their chronic ailments better than a physician or nurse practitioner who only sees them episodically. As my patient numbers have grown, the office practice has transformed with it. We see a few walk-in patients every day and that changes the idea of on-time-ness.

The front office area is manned by three very capable women who have a combined twenty-plus years of experience with The Stone Institute. They carry the load as much as our clinic staff. And even when its clicking on all cylinders, the idea of being "on time" seems to be an imaginary goal that we neither enjoy nor achieve. The summers are easier on us because we see daylight when we leave at 6:00 or 7:00 PM.

I remember being in the office several years ago looking out the window and wondering why can I not be on time? I was between patients and the next patient was late. I was for the first time in my life, not upset that the timing was off. I heard the words "what's your hurry?" I had no place to be, I had no responsibilities after work other than to feed my dog then myself. A calm came over me as if the Gods of Time released me from the demands of the time police. I was not going to jail if I did not stay on time. I needed to communicate to my patients about my delays and that is something we still struggle with in the office.

So how could I get so far behind? Well picture a patient coming into the office with an unknown burden on their shoulders. Not unknown to them, unknown to me. As we end our conversation about the patient's specific ailment, perhaps they may share something secret, like their mother is dying of cancer and they were wondering if Vitamin C infusions would help her to reduce her suffering. Or maybe this girl friend has been told she is going to die and there is no real diagnosis given to her to explain her future death. In that moment, there is usually a silence that I cannot describe. But one thing is certain, it is not the time to invoke the punctuality rule and refuse to answer the question due to the lack of time. It is ironic that our office is most concerned about time, instead of wondering what to charge for time.

One of the most challenging features to reconcile in my practice is the fact that sometimes patients have to leave or miss their appointment if I am behind. They cannot stay after hours for one reason or another. Many times, they are the most ill or have the hardest disease to treat. And usually they are most restricted when it comes to time. Time erodes as a result of keeping the practice open to new patients and more and more difficult cases. Time is the most important dimension of human life and yet it is really nothing more than a measure of the revolutions of the earth. Before timepieces were invented, I wonder what Shamans did to stay on time. Did they wonder the countryside looking for the infirm? Did they have office hours and charged by the movement of the sun in the sky? Was there an unconscious understanding or timer that sounded when enough time had been spent with an ill person? Every therapeutic adventure has a beginning, middle and end regardless of what era in time it occurred.

I don't know what the answers are. All I know is that time seems to be passing faster as my staff and our new and old patients return to the Stone Institute to unravel and repair illnesses of all types and severities. Or the illusion of time has become more important as I get older, and I have become more aware of everything that has value in my life.

No matter what I believe, I think only time will tell.

Doc
Posted by Amanda Sanders at 9:45 AM
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