Counseling and Consultation Time

by Academy of Clinical Excellence on November 17, 2010

 Is there anything that we give our patient that is more valuable than our time? We are encouraged to see patients for shorter and shorter periods of time, but time is the one thing that our patients really appreciate. I see a lot of patients referred by other physicians who've seen outside neurologists.I've yet to see a patient who didn't receive: a reasonable work up, a reasonable differential and nice concise note.But most patients say the same thing, "he didn't spend time with me”, “he didn't explain what was going on”, "he didn't tell me why this is happening to me”.

At the request of one of my favorite internal medicine faculty I called a patient I've never seen before in Arkansas who had just been given the diagnosis of ALS. I saw the records, the thought processes, and evaluation, were all correct. Every ‘I’ dotted every ‘T’ was crossed correctly.That's what he has, ALS.I called him while I was driving into work one morning during some particularly bad traffic. He and I spoke for about 45 minutes. He told me all about himself. How worried he was that his illness would decimate what he's able to leave his wife and family financially and about how we plan to work until the very end. He also told me a story about something he said to his neurologist. He told his neurologist that since he had such a rare and unusual type of ALS that maybe the neurologist should be paying him. I burst out laughing. The man told me that his neurologist didn’t even crack a smile.

It is said that William Osler, MD could spend five minutes with a patient and make them feel like he had spent an hour. Perhaps this was the surest sign of his genius and his most important contribution to the patients who taught him everything he knew.

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Rafael H. Llinás, MD
Associate Professor of Neurology
Johns Hopkins University School of Medicine


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