The 15-minute Hour

On Halley's Comment today … a saddening and inspiring discussion about a family member's death.  Death .. as we family physicians are educated .. is part of life.  We witness and guide our patients toward this event … with respect and understanding.

I'm often struck by the paucity of such "behavioral science" training in other specialties.  We teach our residents to be active listeners, so that the can take advantage of the 15-minute hour.  The Internists seem to have discovered this recently too.

A year or so ago I was in the emergency department ..called down there for the 3rd time in a week to admit a patient who "refused to go home."   The previous two had happily departed after we (I was rounding in the hospital with our family medicine residents that week) arrived and BATHEd them.  The Emergency Department attending physician happened to be the Department Chair.  He challenged me as we arrived in the Emergency Department:  "THIS one really won't go.  No way she'll leave.  I'm certain of it."  

A 40ish woman with anxiety and abdominal pain was lying on her side in the room.  All bloodwork, a CT scan of her abdomen, pelvic exam, and abdominal exam were all negative.   A family member had recently been admitted to the hospital in California for appendicitis.  She was scared that she might have appendicitis as well.

After we listened to her story for about 10 minutes, I asked her what else was going on in her life, how she was feeling, what troubled her the most about her situation, and how she was handling it all.  I affirmed her predicament by restating her concern about her abdominal pain, and I remarked how I was impressed with her ability to "hold it all together" in the context of so many life stressors.

I asked her if she would like to go home, and she eagerly agreed that this was the best course of action.    A follow-up was arranged in the office for the following day.

On the way out of the Emergency Department, our colleagues were in awe.  Dr ED Chairman exclaimed:  "How did you do that!?"  "I was in there talking to her for 30 minutes!"   …. "That was the problem"  I smugly replied.  "We listened."