I am one of those fast doctors—and I don’t apologize – Musings of an NYC Dermatologist

  • Posted on: Sep 22 2016
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When we think about the technology revolution we often get excited at the thought of getting what we want instantly. We wait in line for new smartphones. We instant message. We love fast. Getting something done faster, with as good a result, is usually seen as a virtue—unless one is a doctor.

In these times of fast information, we find ourselves bombarded with surveys—because it is cheap, fast, and easy to send them. Part of the downside of this is that Instead paying attention to our own goals and experiences, which may be enjoying a delicious cup of coffee on our way to work, we are supposed to notice and report specifics—such as to whether the barista said our names when the coffee was handed to us–because a third party wants to know. In medicine we encounter “patient satisfaction” surveys and the question “Did your doctor spend enough time with you?”

Sometimes when we ask a question, rather than an answer, another question is generated. When I hear people comment that their doctor didn’t spend enough time with them, whether they are talking about me, or someone else, I often ask “what is enough time?”

What I find interesting is that the people who complain that they didn’t get enough time often don’t know how long “enough time” is. When I’ve looked into feedback of people who said they didn’t get enough of my time, I’ve found that I’ve often spent much more time with them than with most of my happy patients–who appreciated my efficiency. How does one address this?

As a habit, I ask patients at the end of our visit if there is “anything else?” If there are other issues I address them. If they respond “no,” I confirm our follow up plans and say goodbye. I find the people who feel they “didn’t get enough time” sometimes say that “she didn’t answer all my questions.” Usually these were questions that were never asked. In fact, I’ve even had patients interrupt me as I am explaining their condition, side effects and treatment plan, to complain that I had not spent “enough time” when I wasn’t even finished. It those situations it seems that it’s the patient who is rushing—yet projecting impatience on to the doctor.   It sometimes comes across that the patient had been trained to think that they must try to put the doctor on the defense with this comment—in order to be “empowered.”

What are people really complaining about when they report they didn’t get “enough time?” I think sometimes it is an impatience with themselves.

If one were flying from New York to Los Angeles, and one were told to expect the journey to take 6 hours, would the pilot not have spent “enough time” if she were to land the plane safely at LAX in 5 hours? Instead of landing, should she instead circle the Pacific coastline and show us Malibu, Santa Monica and Manhattan Beach–to give us the 6-hour flight time we were promised?

It would be one thing if the pilot had rushed—and crashed the plane. It would be one thing if the doctor rushed out of the room without suturing a wound, a wound that was supposed to be sutured, leaving it unclosed. If an experienced doctor can make a diagnosis quickly, and we as patients cannot, should be feel dissatisfied? Isn’t that what we hired them for? Isn’t often this complaint an issue of perception rather than reality.

Interestingly, most people pay lawyers by the hour and it follows that most would describe a good lawyer as on who gets the desired results quickly. In fact, we accuse lawyers of “churning the case” when they take more time. Doctors, however, are not paid for time. Could this be why some feel they want more of the doctor’s time? Would we want more of a fast doctor’s time if the doctor were in fact a robot—or would we be impressed with its speed?

In the course of running my own medical practice I have participated in a number of entrepreneur training programs. One such program introduced me to the Kolbe self-assessment. A Kolbe measures as person’s “instinctive method of operation” which helps identify how they can be most productive. There are 4 Kolbe types: Fact finders (they require a lot of information), Follow throughs (they are good at completing things), Quick starts (they can make decisions quickly), and Implementors (they enjoy the process—i.e. the person who wants you to invite him or her over to put your Ikea bookcase together).  We all have all of these action modes, but some are our dominant ones. One interesting thing is that one’s Kolbe cannot be changed.

My Kolbe results were a bit unusual—but not surprising. I was a Quick start, but with a strong Fact finder. On the one hand, these are opposite action modes. On the other, these are two qualities one needs to be a doctor. Medical education and training are the fact finding. Quick start qualities allow me to actually take action on the facts. I am a Quick start with strong Fact finder qualities—it won’t change. I also understand that the Kolbes of the people I interact with in the would also won’t change. How do we get satisfaction in a world with such diversity? I think the answer is focusing on self-knowledge.

Knowing my own Kolbe was very empowering both in my personal and professional life. It has also been empowering to know that other people, my friends, family, coworkers and patients also have Kolbes—they won’t change. Understanding Kolbes has also helped me understand why some patients are thrilled when I can assess and treat them quickly, allowing them to get back to their own lives, and other may perceive the same visit as “not enough time.”

I am a doctor, but I am also a patient. I now notice the Kolbes of my own doctors—and how I respond to them. With this perspective I would advise patients to spend “enough time” with themselves getting to know how they like to receive information and also getting clarity about what they want when seeking the help of a professional such as a doctor. Perhaps one should get one’s Kolbe profile. Sometimes we expect doctors to address needs that are simply out of their scope of practice—they will fail no matter how much time they spend with us.   And in these times when many people live alone, work from home, shop on line and consider text messaging a relationship, make sure you are getting the human contact you need. No matter how attentive your doctor is, a doctor’s visit should not be your only outlet for touch and face-to-face interactions. As we move into an age of artificial intelligence, even that outlet may not be available in the future.

This blog post is longer than many of my others. I hope I spent “enough time” writing it.

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Posted in: Commentary