Take the time

FigureI am halfway through an overbooked clinic when I see a last-minute add-on appear on my schedule: an ED follow-up for hematochezia. Frustration rises in my chest. There is an ongoing problem of inappropriate bookings onto already full schedules. It feels a bit like throwing gas on a fire when all I want is a break from its heat. The patient arrives in clinic, and we learn that she will need an Arabic interpreter. The check-in process takes longer than anticipated with the added time of interpretation. Finally, my nurse informs me that the patient is ready to be seen, 30 minutes past her appointment start time. A young woman accompanied by her husband greets me. I introduce myself and ask what brings her to the office today. She appears fueled by anxiety, and responds with pressured speech. An ugly thought rears its head: "This is going to take a while." I take a deep breath to center myself. In these moments of resentment, I know my feelings are not directed at the person sitting across from me, but at a system that makes patients talk as if they are running out of time. I do my best not to think about the two other patients waiting for me, or the five that have yet to arrive. I focus on the woman's wide brown eyes, rimmed with pain and worry. We spend a long time talking. I make it a point to answer every question to the best of my ability. I ask that she come back in 1 month for a follow-up. At that next visit, I explain her results and her new diagnosis of ulcerative colitis. Again, we speak for over an hour, and I make sure every question is answered. I tell her that we will arrange a follow-up visit with one of our inflammatory bowel disease specialists, but she declines. "I would like to keep seeing you." I have seen her almost every month since. Over time, she has become more relaxed, and I have learned a great deal about her upbringing, her family, and her faith. Now, when I see her on my schedule, my first reaction is to smile. When I precept PA students in clinic, I encourage them to spend extra time with patients who use interpreter services. Oftentimes these patients have more questions, because the language barrier leaves so many unanswered—an unfortunate downstream effect of the time constraints placed on clinicians. One day, my patient came to her usual follow-up, now 9 months pregnant. I ask what she and her husband plan to name their baby. They respond, "We haven't decided yet. We are going back and forth between Leanne and Lucella. What do you think?" "I think both names are beautiful, but I like Leanne." "Leanne it is." At the next visit, I am greeted by a young woman, her husband, and their newborn baby, Leanne. As I looked into the wide brown eyes of their bundle of joy, tears brimming at my own, I was at a loss for words. But I was in no hurry.Box 1