Time and the consultation - an argument for a ‘certain slowness’


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Abstract

When natural time sequences were replaced by clocks, time became a measurable commodity and the ‘speedy use of time’ a virtue. In medical practice shorter consultations allow more patients to be seen, whereas longer consultations result in a better understanding of the patient and her problems. Crossing the line of time-efficiency and time-effectiveness compromises the balance between short-term turnover and long-term outcomes. The consultation has all the hallmarks of a complex adaptive system whose characteristics are not determined by the characteristics of the components, but by the patterns of interaction among the components. Systems are dynamic and change over time; the dynamic nature is not incidental, but necessary as complex systems operate at conditions far from equilibrium. The central notion when we talk of time and complexity is that of ‘memory’. Memory is carrying something from the past over into the future. Memory is filtered/interpreted, separating noise from information. Memory therefore is not an instantaneous thing, it takes time to develop; it is slow. The dynamics between the participating agents in the consultation will create shared memories that live on to shape future interactions. Shared memories are stronger and contain more relevant knowledge if they are based on frequent interactions and ongoing doctor-patient relationships, leading to a better understanding of the whole person - a process that takes time. Sufficient time, that is, ‘a certain slowness’, is an essential element of the healing relationship in the consultation. It creates a sufficiently stable, but adaptive, environment that can withstand changing demands. Hence a more complete understanding of the consultation and its time demands will not only lead to more effective treatment, it will also humanize a situation which has become to a large extent purely instrumental. This process of humanization is important not only for the patient, but also for the doctor.

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