Patience is a Virtue at Your Practice

This morning I saw a patient in follow-up to an emergency department (ED) visit. After an extensive evaluation, no cause for the patient's symptoms was found. I prescribed some symptomatic treatment and advised the patient to contact me if not feeling better in a few days. The patient became quite upset that I could not find a cause and that I had recommended a follow-up phone call if there was no improvement.

Tincture of time, I explained to my patient, was one of the most powerful and effective diagnostic and treatment tools we have. When my patient complained that I wouldn't do anything else, I responded that I actually could do quite a bit. Despite an extensive evaluation the day prior in the ED, I could certainly think of other tests to do or ones to repeat "just to be sure." It can be difficult as a physician, just as it can be as a patient, to allow time to work. Sometimes, time reveals a more sinister cause of symptoms. In these cases, it can feel like something should've been done sooner, but often, it is just time declaring a diagnosis that would've been difficult to detect any earlier.

Some fevers are harbingers of serious infections, but most are not. Some pain is the first signal of an insidious cancer, but most is not. Sometimes cough or a persistent itch are the first clue that a life-threatening ailment is present, but most of the time they are not. This is why time is so valuable. It is like a figurative filter, sorting out the common and ordinary from the uncommon and extraordinary. As time shakes back and forth, colds and viruses, muscle strains and allergic reactions filter out until all you have left are the serious and unusual causes.

When a patient is in pain or worried, it can be difficult to ask them to wait. Yet, waiting is so valuable. Waiting eliminates many unnecessary tests, it prevents potentially harmful treatments, and it can provide reassurance or elevate concern. How physicians communicate what we are doing and why we are doing it is often the challenge. Not wanting to seem cavalier or casual with a patient's life or well-being, nonetheless, our admonition to "call if you're not better" can feel like a brush off from a physician either too busy to care or incompetent to know.

I spent time – a physician's most precious commodity – with my patient, gently explaining all that had been done already and why no further investigation was warranted today. I itemized the many tests that I could order but which were, in my opinion, both unnecessary and excessive. I can only hope that my patient feels better both physically and emotionally – in time.