By LISE ALSCHULER, ND, FABNO
I am a naturopathic doctor, and because I operate outside of insurance-based medicine, I have, what most healthcare providers would consider, lots of time with my patients. My typical first patient appointment is 90 minutes long and my follow-up visits are 30 minutes long.
What, you may ask, do I do with all this time? I get to know my patients by listening to their stories, their concerns and their hopes. We delve into their health concerns, we review their medical records, and we explore lifestyle-based strategies to optimize their healing and wellbeing.
In short, I listen and apply what I know in partnership with each patient with the goal of empowering them towards greater wellness. Over and over, I hear from my patients how unusual this is. They speak about the 5-minute visits with their doctors that feel rushed and disconnected. They express frustration and dismay about being a diagnosis, not a person, when seeing their healthcare providers.
A recent survey conducted by the New York Times found that two-thirds of Americans support some form of change to the current healthcare system and favor moving towards greater insurance coverage for all. My experience for almost 25 years leads me to conclude that underlying this vision of healthcare is a deep-seated desire for patients to be cared for and listened to.
One of my patients, the 32-year old father of 3 daughters under the age of 5, who has just had a brain tumor, along with a significant part of his temporal lobe, surgically removed, wants to know if it is ok to play soccer with his daughters. He didn’t have a chance to ask his surgeon this question.
Another patient, a 50-year old single mom who lives with her adult son with significant mental health issues, was recently started on a new medication for her uncontrolled diabetes. She wonders if there are any other things she can do. She is also worried about how this medication will affect her ability to care for her son. She did not have the chance to discuss these concerns with her doctor.
Minutes matter in healthcare, and how we use those minutes matters even more. According to the Annals of Family Medicine, primary care doctors see an average of 20 patients each day with each visit lasting about 17 minutes. There is a lot that needs to be covered in those 17 minutes and both patients and doctors feel the crunch. Patients often rush through their concerns, refill requests, and referral needs. Doctors rapidly prioritize patient’s concerns all the while resolutely documenting the visit in the electronic health record. This situation is highly unsatisfying for both patients and doctors. Furthermore, this type of medicine doesn’t appear to be working. The United States spends more on healthcare than any other country in the world and yet has more obesity, more infant mortality, and is ranked 26th in terms of life expectancy among developed nations.
Here’s a proposal. Let’s add one minute to each patient visit, but there’s a catch. This one extra minute is devoted to the patient in order to foster a healing relationship, one of the core components of integrative medicine.
Let’s take the young man with the recently resected brain tumor. What would he do with this extra minute? He might use this minute to describe to his doctor the importance of playing with his daughters and how much better he feels when he exercises, and then ask about the safety of this activity. The diabetic patient might use her minute to ask her doctor about how diet could help to control her blood sugar and if she could be referred to a nutritionist. She also might seek reassurance that the new drug will not impair her ability to care for her son. Both patients would, in this additional minute, bring more of their whole self into their relationship with their doctor. They each would ask for acknowledgement, guidance and validation of their own role in their healing.
What about the practitioner?
There is tremendous power in the simple act of active and curious listening, with acknowledgement and validation. We don’t have to have all of the answers, but we can listen to our patients and seek to understand them in a new and broader context. We can be inquisitive and learn about what they value, their capacities and their perceived limitations. From this awareness, a new depth of connection is formed, and care emerges. The only requirements of the practitioner are to be present, curious and attentive to what the patient brings forth.
This one extra minute could transform medicine. Within seconds, a human being can connect with another and transfer compassion and caring. All that is required is presence and intent. Acknowledgement the human being before you through active listening. One minute for one human being, a healthcare practitioner, to recognize and celebrate another human being, a patient. With one more minute, we can begin the process of bringing healing back into healthcare.
Lise Alschuler is Assistant Director of Fellowship in Integrative Medicine, Professor of Clinical Medicine at the University of Arizona and a Public Voices Fellow with The OpEd Project.