The Country Doc Rule Number Two- 16 Seconds Won’t Cut the Gig

        “Sixteen seconds won’t cut the gig.”  There’s  a song in there somewhere.

         I think it was Dr. Groopman who quoted the study.  On a routine encounter Docs let their patient talk sixteen seconds before they interrupt them, make a diagnosis, and reach for a script pad.   

          Wow.  I hope I am not that bad.  If I am, me and Julius are gonna go to the River and get baptized and rededicate ourselves to our profession.  Sixteen seconds is unacceptable.

        There is an old saying in medicine, and like many cliches it is true.  “If you let the patient talk they will tell you what is wrong with them.”   And I have found it only takes them a little while to do it.

        It is time well invested.  I have been told I have a reputation as a good diagnostician.  If I am I’m humbly grateful for that and hope to never take that blessing for granted.  Today though I must tell you this reputation is because I have good patients. 

        My standard routine is to ask the patient, “Hey Ms. Smith, what’s troubling you today?” and then let them talk until they have finished telling me.  95% of the time they have done so in five minutes.  At what it costs to go to the Doc these days, it doesn’t seem like much to ask for to me.

         Some of this works because most of my people have been seeing me for decades and I know them inside out.  What I can’t figure out has been sorted through by the best army of specialists on the East Coast this old boy could assemble.  I know which ones are reliable (and most of the Docs out there) and I count on them to help me out.  The few who proved indifferent were cast aside long ago.  I don’t give a $@^^ if they send me a country ham ever Christmas till Hades freezes over, they ain’t gonna see my people.  

        Here is a technique I recommend.  If we have anything close to a slow day, and sometimes we do mid summer, Julius and I will go into a room and I’ll issue my standard greeting.  Then I’ll sit down, prop my feet up and say,  “Look.  We’re having a good old lazy summer day, and I had a cancellation.  We got time for you to tell me anything you want.”

        The only problem is often folks are so shocked they can’t remember why they came to to the Doctor.  Then I’ll say, “That’s O.K.  Everyone has the same reaction.  It is a sign I haven’t been giving you enough time.”  Then they relax again and we get serious about the issue at hand.

         I wish I could tell you I am perfect, and do it right every time.  I don’t.  But when I fail I am sorry for it.  I remember one day when everything was going wrong.  I was rushed and distracted.  Late that morning, one fellow called me back.

        “Doc, I know you were having a bad day, but you cut me short.  I didn’t get to tell you what was wrong with me.”

          Dang it.  “Tell you what, Joe.  You come back over here at 12:30 and we’ll sit down and eat lunch together.  I’ll hear out anything you need to tell me.  We go back a long way, and if I get run over by a truck tomorrow I don’t want your last memory of me to be that I let you down.”

          He is still my patient.  In fact I am proud to say my last chart transfer other than someone moving has been a long time.  If we have someone leave, I’ll call ’em and ask why.  That what I did with the last one and  think it was three years ago.

         16 seconds.  Man, I am not sure how I am gonna be remembered, but I want it to be better than that.  I believe Julius does too, so I think I will make the 16 second rule my next lesson for him.

Dr. B

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6 Comments on “The Country Doc Rule Number Two- 16 Seconds Won’t Cut the Gig”


  1. Hi Dr B
    The fact that your patients can call you on your mistakes without feeling they’ll be rebuffed says a lot about you as a doctor and a human being. Making mistakes is a symptom of being human, knowing when to admit it is a symptom of experience.
    If my doc spent only sixteen seconds listening we never would have found out about my diabetes. I’m grateful for him and his thoroughness.

    • drtombibey Says:

      Ms Sharon,

      It is sort of like working with the nurses. If they think you are gonna snap at them every time they ask a question, pretty soon they stop. Then you’re gonna miss something.

      I am glad your Doc listened longer than 16 seconds too. My guess is they were on it pretty quick though. I am glad we have better treatment for diabetes these days.

      Dr. B

  2. Danny Fulks Says:

    What do your patients do while you review their records on a hand held computer? If they talk, it’s probably distractive. If they read it seems awkward. Do you listen first, then go to the computer? Still use charts? Never happened to me, but I had a friend tell me his doc brought in and was reading someone else’s chart. Have you ever handed the stethoscope to a patient and had him or her listen to YOUR heart?

    • drtombibey Says:

      Dan,

      We haven’t gone to EMR yet, but I guess I’ll handle it like some other crazy things we have to do. I often say something like, “Hey let me dispense of this dumb paperwork so I can have the privilege of taking care of you.”

      I do that reverse stethoscope thing with kids all the time. They love it. One said, “Hey it’s beating.”

      I responded, “I love your diagnosis, kid.”

      Dr. B

  3. mandogrin Says:

    Doc,

    What a great lesson for all of us … Whether we are repairing bodies, souls, minds, or worn out machinery… Patience and genuine concern reflected in our undivided attention .. is vital.

    Oh yes, and the that “humbly grateful” phrase triggerd a reminder of an old saying I once heard … Kind of fits here….

    “Those who aren’t Humbly Grateful …. Become Grumbly Hateful”

    Julius is a lucky dude to be walkin in your shadow.

    • drtombibey Says:

      mandogrin

      Turns out I am lucky too. He is a bluegrass kid, and likes to drive late at night so Doc can sleep. We get along famously.

      Dr. B


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