Time
One of my heroes in medicine is Dr. Faith Fitzgerald (1), perhaps one of the most brilliant diagnosticians, medical educators, writers, and speakers this country has ever known. When I was active clinically, I used to attend the annual meeting of the American College of Physicians, where Faith’s stump the professor sessions were usually a hot ticket. During these sessions, she would attempt to solve a complex diagnostic challenge presented by her current and former residents while also regaling the audience with one of her many entertaining medically related antidotes. I particularly remember her story about proving to her resident team that there are no uninteresting patients by demonstrating that the patient they had just admitted for social reasons, and therefore without any interesting medical problems, was indeed a survivor of the Titanic.
I often tried to emulate Dr. Fitzgerald’s intense interest in her patients and take the time to get to know them as people rather than constellations of signs, symptoms, or diseases. In medical school, this was relatively easy. We were even offered an elective in a special diagnostic clinic, where each student was allowed to spend an entire day working with just one patient. As a resident and later a practicing internist/hospitalist, however, it became more difficult to find the time to really delve into each patient’s personal story the way I would have liked. I trained before the era of resident work rule restrictions and practiced during an era when 10–15 minute office visits or hospital caseloads of 20 plus patients were the norms.
In Dr. Fitzgerald’s defense, I have also read her story about making hospital rounds at 4 AM to give her patients more undivided attention. While I have found myself in the hospital many a morning at 4 AM, I must admit it was not on a voluntary basis.
Now I realize that time and the association of time with money through the fee-for-service reimbursement system, which dominates the healthcare system, is the enemy of those of us who wished or continue to wish to model ourselves after those like Faith Fitzgerald. I further bemoan that time has become even more precious for those on the frontlines of healthcare during the Covid-19 pandemic. Time has joined other precious resources during this plague that seems to be in short supply constantly, along with bed space, staff, equipment, and supplies.
Dr. Fitzgerald’s philosophy (pulled from her bio on the UC Davis website) is as follows:
I decided to become an internist because of the diagnostic and therapeutic challenges of complex disease. I also enjoy having the opportunity to talk with and listen to men and women from all different walks of life. My philosophy of care centers on applying rigorous thought and the knowledge of both medicine and the human experience to making people both feel better and fulfill their full potential. Frankly, a lot of “good health” is good luck, economic, social and genetic. I like helping the unlucky.
My sincere hope is that we will return to a time, even before the end of the pandemic, when all physicians “can enjoy having the opportunity to talk with and listen to those from all walks of life and help them feel better and fulfill their full potential.”
