I simultaneously trained in both family medicine and psychiatry. That road has frequently landed me in a situation where I will be in a general medical clinic when someone comes in having a psychiatric crisis. I am often called upon to intervene. Invariably, when the intervention is successful, the first comment I hear is “I don’t know how you do that.” My usual flip answer is “Magic.” I wondered, myself, for a long time. I watched non-psychiatrically trained colleagues — who were smarter than I, more empathic than I, more experienced than I — struggle with these suffering patients. I could credit my specialized training, my appearance, good fortune, the aura of mystery surrounding psychiatry (a placebo effect?), or the tone of my voice. Doubtless, all play a role. The “magic,” though, ends up being a remarkably simple thing. I shall now reveal the secret:
Time.
Physicians seem to have always led lives characterized by time pressure, but today’s era of corporatized medicine with productivity quotas, capitation, and high-volume clinics has made face-to-face time with patients the most precious commodity in all of health care. By depriving patients of time with their doctors, the health care system is failing in its duty to be humane and to promote health and healing. When the primary goal of health system managers is improving this quarter’s bottom line, health suffers. Without the luxury of time with patients, physicians risk becoming little more than prescription writers, adjusting the physiology while ignoring patients’ mind and spirit. They might still be able to relieve laboratory abnormalities, but they will not relieve suffering.
I first heard the term “tincture of time” during my third year of medical school on a psychiatry rotation at the VA hospital in San Diego. The sense was that for some kinds of psychic injury, the best we can do is to provide a supportive environment and allow the body (which happens to include the brain) to mend itself. In that sense, it applies across all of medicine: “God heals. The doctor sends the bill.”
Time, though, means more than just leaving patients alone to heal by themselves. It means being with them, providing the education, reassurance, empathy, understanding, guidance — and, yes, love — that creates the space in which healing can take place.
If the health care system is ready for a dose of its own medicine, it should begin with tincture of time.
— RonRisley – 23 Feb 2005