Time in the gaze

Soledad Delgado
 

I often find myself intensely focused on the keyboard, pounding the keys quickly so as not to leave any detail out, striving to relay a very complete medical history - many times so complete that several chapters of a book could be written on subjects as trivial as a simple toothache. Speeding up to the last paragraph all the while noticing the ongoing growth of the patients’ list.

When I finally look up, I cross reality and meet eyes looking at me with a mixture of fear and doubt, a body that is more than a name on a list and a story that goes beyond a record in medical history. As John Launer affirms, patients always have two stories to tell, the biological and the biographical, and we, the physicians must know that the two are inseparable. There are days when, unconsciously, or very consciously, I try not to meet that gaze, mechanize the questions, control my movements and not go outside the established protocol. That is the day when looking into the eyes of the patient, I am overcome by the fear of saying that phrase on which everything can depend: "Tell me what is happening to you, what can I do for you?"

As a doctor, I grew in an emergency department, a place where time is a second or an eternity. Where you learn the history quickly, explore, diagnose quickly, but... no one teaches you to manage time in the office.

Time management in the emergency room is essential. Quality criteria for urgent patient care are perfectly established according to their priority: the critical patient must be seen instantly, the priority patient in less than 15 minutes, but who determines how much time must be devoted to each patient? How do you decide who needs more and who needs less?

The pandemic has "cleaned up" the emergency services of a large amount of banal pathology that took time away from what was important, but also from the non-banal one: comparing the numbers of assistance to critical patients in a county hospital, such as mine, in 2019 and 2020, critical patients are seen in the emergency department have decreased by 32.5% (figures taken from the scorecard of the hospital emergency services in Andalusia). And this data is not a good sign.

Has this decrease in the emergency care burden helped with the time spent with the patient? Practically all the hospitals in Andalusia have improved the efficiency index in emergencies, which indicates that the time of direct assistance to the patient has increased compared to the waiting time without assistance. Even so, I am still wondering if it's enough time and, above all, if it’s quality time.

Time is so important that nobody teaches us how to use it wisely, we have to learn to manage it alone. Now, after a few years, I find myself typing on a computer in a hurry, but I also find myself raising my head, looking the patient in the eye and saying: "Tell me what is wrong with you, how can I help you?" Because we have to give the patient time to speak, or the monologue of the patients, as Danielle Ofri would say, and give ourselves the time to listen and learn how to establish a new system of priorities tailored to each person. After the pain, the fever, the dyspnoea, there is a look that reflects a life and feelings, that has a story to tell. And each look needs its time.