I am conflicted when I travel. Do I savor the new city and adventure in small doses or try to see as much as I can? I favor the former but often find myself navigating like the latter.
For instance, during a recent visit to NYC, we scurried from activity to activity, hungry pizza rats in the city. During our yearly visits, we seek out basic New York staples. It was a day of bagels at a stand in Chelsea Market, NY pizza in an Uber as we hustled with the kids across town, a cart knish and pretzel outside Central Park, and a hot dog dinner standing up on my sister’s patio on the Upper West Side. As we lingered outside, my wife pointed out that we ate all our meals standing up, constantly on the move. We reached our food goals, without taking the time to enjoy and appreciate our meals.We caught most of the NY foods we wanted but packed in indigestion along with all our activities. Our days were counted via the time to the next meal. We felt like a Jim Gaffigan description of vacation.
“Vacation is just us eating in a place we’ve never been. Why don’t we eat something? Then we’ll get something to eat.” – Gaffigan
My wife and I contrasted that with a recent trip to Italy. Italy is a culture of communal eating – the cornerstone of the community, embodied with hospitality and local food. Talking. Enjoying.
Eating on the go is culture faux pas. The people and the culture favor enjoying mealtime, savoring these moments of communion.
Interestingly, communion and these similar words–community, communal, commune- have a food origin, the religious origin is essentially “breaking bread”.
Breakfast may involve a cup of cappuccino standing at the counter, but that’s standard fare. Lunch and dinner were always afforded the time to enjoy the food and the company. Not surprisingly, it was in Italy where Carlo Petrini’s Slow Food movement originated 30 years ago as a backlash to the planned McDonald’s at the Spanish Steps in Rome.
In the hospital, I eat on the go often, sometimes skipping meals or hurrying through lunch to see my next patient. That’s okay for most days; patients are clearly more important than savoring a meal on work days. However, I often find myself chomping up my histories too quickly as well. I checklist my patients and count down through the list. I’m working 12 hours, and I have 18 patients – six on this floor, and this patient took one hour, so I need to see the next three before 10 and try to finish the list before lunch…
I try to unfetter myself from time burdens, but it’s hard. I’m always looking at the clock, knowing if I fall behind, I’ll have less time for other patients or admissions. It’s a tough balancing act that often has me running through the day. Some of this is unavoidable. I never have a leisurely day of ten patients, but can I see a list of 18-22 and still take the time to slow down from time to time?
Everyone applies a different strategy. I try to balance this out by running a mixed day. A fast and a slow day. I try to be sure everyone is seen promptly in the morning and then take a second chance to see patients in the afternoon without looking at the clock – lingering a little longer, asking more open-ended questions.
There is a movement called Slow Medicine, slowly gaining traction. An extension of the Slow Food movement, it is one of many industries finding ways to slow things down.
The Slow Medicine movement has been discussed here and here, with various iterations. It may seem hard to apply fully in the fast pace of the hospital, but I try to apply aspects to be sure I connect better with my patients. It’s a chance to truly listen and observe when I’m with a patient. To be deliberate and intentional, thoughtful and engaged, and to keep myself sitting with the patient, spending some time getting stories, to keep my hand off the door handle, and to be in the moment with patients and families.
Moving fast may get the patients seen, but ultimately contributes to missed diagnoses, medical errors, poor communication and reduced patient satisfaction. We know medical errors are the third leading cause of death and that interns sit down with patients only nine percent of the time. Maybe moving a bit slower can help. When Cleveland Clinic analyzed what patients wanted out of a hospital stay, they boiled it down to respect, improved communication and happy providers. Slowing down can improve all of those.
Family meals are beneficial; I’ve proven that running around NYC with food in hand leads to heartburn and that sitting for meals with friends and family leads to appreciation of the food and leads to good conversation. I love to eat, and a good meal with family and friends satiates the body and the mind. Satiety, which comes from the Latin, satis, means enough. Eating well, eating slow, satisfies. Doing the same with how we see patients can improve patient satisfaction as well.
Take the time to know the patient in order to know the patient in front of you.
Satiate. Avoid indigestion. Improve patient satisfaction.
Slowing down may allow you to be more satisfied as well.
Jordan is a hospitalist at Morton Plant Hospitalists in Clearwater, Florida. He currently chairs SHM’s Quality and Patient Safety Committee. In addition, he’s been active in several SHM mentoring programs, most recently with Project BOOST and Glycemic Control. He went to medical school at University of South Florida, in Tampa, and completed his residency at Emory University.
He recognizes the challenges of working in a hospital that lines the intracostal waterways of a spring break mecca. Requests that if you want to be selected as a mentored site, you will have a similar location with palm trees and coastline nearby. He tries to find time to sit on the beach with his family to escape the hospital’s miasma. While there, he looks forward to reading about the history of hospitals/medicine, and how it relates to quality (Anti-UpToDate reading material). But inevitably will get a five year old dumping sand on him, and then has to explain why she is buried up to her neck.