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On the Brain
April 5, 2021

No Time for This

Author Affiliations
  • 1University of Kentucky College of Medicine, Lexington
JAMA Neurol. 2021;78(5):519-520. doi:10.1001/jamaneurol.2021.0481

“Give me the problem list.”


“………………. A…”

“…A-a-a-a-cute on chro-chro-c-chronic kidney failure. ………H-hyp-… hypo-… hyponatremia. H-h-h-h-hypomagnes-hyp-hypomagnesemia. Sepsis…”

“I don’t have time for this. Just tell me the plan.”

My stutter makes it hard for me to speak as quickly or as efficiently as people expect. To get through our morning rounds, we have to see 19 patients in 90 minutes. That is 1 patient every 4.7 minutes. He, the attending physician I am working with, has “no time for this,” and I have no time to unlock words. I know the problem list. In fact, I have rehearsed the problem list. Familiarity can loosen the lock on words and make them more acceptable. I could tell you all about the sepsis complicated by subsequent acute kidney injury and electrolyte imbalance. I could tell you about the imminent concern for seizures and cardiac arrest. But in this case, familiarity does not matter. I just cannot get it out. I keep quiet, and morning rounds march on.

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    6 Comments for this article
    Astute Observations
    David Peters, D.O. | Michigan State University, College of Osteopathic Medicine
    I have always had greater respect for the one who stutters then for those eloquently gifted.
    Even the well educated lay person thrust into our hyperdrive medical system of the 21st century is at a loss. Yet when time is money, we are all at a disadvantage.
    In over 30 years of medicine it was the human interaction that sustained me, not the balance sheet.
    When a doctor-patient or social relationship becomes one of a mere cash transaction everyone loses.
    Things need to be done, yet the mere presence effect of someone you can trust,
    who was not abrupt, always worked better and quicker than eloquent explanations. Stop, look and listen, then touch. I think I heard those words before. One does have time for this. Those who do not are being short changed in their own lives, full and active as they may seem on the outside.
    Human Suffering
    Paul Nelson, MS, MD | Family Health Care, PC retired
    Our uniquely human capability is its sentient, Reflective Cognition. Casted within the cosmological and biological realms of reality, the final expression of this capability begins to evolve for each person from the communal caring relationships that originate before each person's birth. During each person's early dependency, we begin to acquire, or not, the adaptive skills to form our own "convoy" of caring relationships (viz a family) for mentoring our courage. I suspect that my own social anxiety is likely a common, albeit shrowded, attribute among the caring professions (aka Charlie Brown enactors). Thanks to Samuel for acknowledging his own.
    Anne Sydor, PhD | VTFour
    Recognizing how high burnout is for physicians at all levels, I am sympathetic to the shortage of time that is chronic in medicine and applaud this thoughtful approach to resisting the time pressure in order to better serve patients. I also appreciate the author as a role model for aspiring physicians with communication differences (eg, stutter, dyspraxia, dyslexia, and more), including my own adolescent.
    I also want to appeal to teachers of all types at all levels to never say "I don't have time for this (you)" to a student. It is
    equivalent to saying, I don't have time to accommodate you and your differences and it translates to: I don't have time for you, the patient, and your chronic or acute illness. We must stop seeing the people we are supposed to serve as inconveniences. Giving them and ourselves the gift of time may be the real (and no, not easy) way to stop burnout.
    Marsha Epstein, MD MPH | Retired
    Thank you for sharing your experiences with listening and not being listened to. We need to schedule more time to listen. Good luck with your training.
    Thank You
    Senthil Rajasekaran, MD, MMHPE | Wayne State University School of Mediicne
    Thank you for penning this very well-written personal experience and shining light on this unconducive learning environment. We are far from individualizing learning experiences even in settings with a much smaller student-learner ratio, let alone large settings that are relatively more common in preclerkship years. Learner-centric approaches to medical education are still a unicorn that we are chasing. While I fully empathize with the student author here, I also want to add that the "I don't have time for this" attitude is not limited to students who have challenges like the author here. Addressing this is not simply creating more awareness and education among teaching faculty, it also involves recognizing teaching as a significant element of one’s responsibility and allocating appropriate time and effort so that the faculty can engage in both professional development activities and also spend quality time with learners.
    Thank you
    Paul Clifford, PhD |
    It's rare for me to comment on any article I encounter here, but I am compelled to say a heartfelt "Thank You". We all have a responsibility to work for the day when "I don't have time for this" is an attitude only of the past, not just for teacher-student relationships, but for all of our social and professional relationships. Thank you for so thoughtfully and generously sharing your experiences.