I spend a lot of time these days listening to children's music in the car. Despite the wide variety of music in our queue, my 3-year-old son's favorite musician is Laurie Berkner. He requests her CDs by name and bops along to the beat even while restrained by a five-point harness. At this point I know all of the lyrics and often sing them mindlessly as I drive, sometimes even without Grady in the car. Every once in a while, though, I actually pay attention to what I am singing. Yesterday, we were listening to “Fast and Slow (The Rabbit and the Turtle),” a conversation between a speedy rabbit and a turtle who takes a more relaxed pace. I was surprised by how applicable it was to my life.
I don't want to go slow I go fast
I'm a rabbit I hop and I jump and I dash
And I'll go whizzing by
In the blink of an eye
Like a jet engine airplane that speeds through the sky
I don't want to go slow I go fast
You don't want to go slow you go fast
And you may find you're missing the world you go past
Crickets making their sound
Golden leaves turning brown
You might find something new that you wouldn't have found
If you never went slow only fast
At home and at work, I often feel like I live the life of the rabbit. I know I am not alone. These days many PAs are forced to “go fast” to meet productivity standards and maximize RVUs. Unfortunately, I have found that racing through my day in the clinic can sometimes get me into trouble. When I move too quickly or when I am worried about the patients in the packed waiting room, I may forget to ask an important question in the HPI. I may brush off a comment made quietly by the patient that holds the key to their illness. I may fail to make critical connections between pertinent past history and current health status.
When, like the turtle, I take my time and give my full attention to the individual sitting in front of me, I find the experience much more rewarding for both of us. I was taught in school that the average physician interrupts the patient within 18 seconds. I was also taught that, given the opportunity, patients will tell you what is wrong with them; history being as important as physical exam. While it can be challenging at times, letting patients talk often allows them to reveal as many pertinent negatives and positives as the pointed questions I would use to break into the conversation. This is especially true if they have already Googled their symptoms. Sitting down and looking at the person in front of me, rather than shuffling (or clicking) through the chart, allows me to make use of multiple senses as I put together the pieces of their illness. Interestingly enough, slowing down doesn't always mean I run an hour behind schedule. Quite often, it actually saves me time.
If, through careful questioning, I learn my patient is more concerned about his erectile dysfunction than his blood sugar of 452, I can quickly make the connections between the two conditions and treat them both rather than getting stopped on my way out the door to write a Viagra/Cialis/Levitra prescription. When I catch a drug interaction in the exam room, it saves me from being interrupted later in the day by the pharmacy. If I improve compliance by ensuring the patient can afford, and is willing to purchase, the medication I plan to prescribe, it saves me a lot of time and return visits wondering why their condition is not improving.
I think there is something to be said for being the turtle. I might find something new that I wouldn't have found. I might be more satisfied with my work and my patients might be more satisfied with the care they receive. And, doesn't the turtle win the race anyway? JAAPA
Amy Klingler practices primary care at the Salmon River Clinic in Stanley, Idaho.