Every organization in healthcare is in a marriage with the “numbers”: gotta get those “numbers” up, need to streamline processes to increase the “numbers,” did you meet your “numbers” this month… (I hear my awesome radical friend’s voice in the back of my head yelling about capitalist healthcare systems…) Numbers, numbers, numbers. And of course we know we are talking about people, right? Or do we? People in the individual, and people in the collective? Sure, there are nods toward quality, but really, those are just more numbers: quality measures of improved test scores, vital signs, and diminishing loss to follow up. What happened to the time when quality care meant the optimal care of people, not just number-driven healthcare? Is not our role as providers to address the spirit as well as the body, the whole person as well as their parts, and their personal fulfillment of their role in this world as well as their physical concerns? When did we ever get to a place where we thought that only attention to the numbers alone would actually have an impact on the outcomes of the numbers as a whole?
My biggest numerical sticking point is the fifteen minutes. If you work in an organization that affords you twenty I’m a bit jealous, if you’re reduced to ten then I send you strength. Generally, now, in the world of healthcare provision, especially in a busy community clinic / federally qualified health center like mine, each appointment is fifteen minutes. (Okay, for my readers who are sticklers, sure sometimes some are lucky enough to have longer visits for procedures, new clients, etc. But really, we all know the fifteen minutes looms at us.) During these fifteen minutes, the person is checked in to the health center, vitaled, discusses the reason for the visit, then the provider takes a history, asks follow-up questions and does an exam, the provider and the individual come to a conclusion about care, and discuss medications and recommendations and results and follow-up, at which point the person leaves. In fifteen minutes. During that time, or the time in-between (which doesn’t exist), or the time later (if you take additional time from your personal life to finish loads of overflowed fifteen minutes), the provider handles all sorts of things that the individual does not know about nor needs to consider: billing codes, correct orders, flowsheets, time outs, point-of-care testing, test results, politics with fellow providers and staff, answering pages and phone calls, lingering thoughts about other patients, paperwork, fighting insurance… of course not all of that will be done in fifteen minutes, which is why the time frame is arbitrary and absurd, and I am done handling things in my professional life that enter into those two categories. My life and my experience will no longer be arbitrary and absurd. I’m revolting, and I’m starting with the numbers. I am done with someone else telling me what each and every fifteen minutes will look like.
I am taking back “the” fifteen minutes. They are now my fifteen minutes. No longer can someone else dominate my time and take away what I would otherwise give to my clients in those precious moments. In my fifteen minutes, I am going to give my own version of quality care, and enjoy every last second of it. I am going to allow myself and my care to spill into my next fifteen minutes, because if I identify them as my own, and not someone else’s, then it all mushes together anyway. These are my fifteen minutes, each and every one of them, each and every time, to do my best and to care with everything I have. And goodness has life been grand since I realized that those could have been my fifteen minutes all along, and from now on they will be. Just this realization has allowed me to provide care from a place of calm, to live the time with ease and appreciation, and to consider new ways to fulfill requirements of “the” fifteen minutes within my own time frame.
Here’s what I’ve been up to with my radical take back of my fifteen minutes, just the past few days. I am so proud of the care I am able to provide that has nothing to do with someone else’s definition of the numbers. These are my moments to share with people who I love in this world and are in my care, and I will care with all I have during each and every moment. I would love to hear what “your” fifteen minutes look like when you ignore “the” fifteen minutes and move forward in the world on your own.
I bounced the baby I cared for while she told me she moved back in with her abuser, with her other kids in the room looking down at the floor.
I sat on the phone with an insurance company to appeal their decision regarding her asthma medication in pregnancy, knowing that no one in insurance thought twice about the safety of the medication in pregnancy that they recommended for her.
I flipped through photos of her wedding plans, and ask about her kids’ graduation.
I waited for her as she showed up 14 minutes late, knowing she’d be late because she is late to every visit, and considered the other ways in her life that she pushes boundaries and points out her presence in this world.
I stood gloved while my medical assistant had to go to another floor and find the staple remover, even though she’d already waited 20 minutes to see me and is already worried about her cesarean scar, apart from the staple removal.
I squeeze OB gel into the refillable bottles, because each of my exam rooms is completely out, after the last bottle sprayed blue liquid remnants all over her and I as I tried to make it work and avoid making her wait longer.
I called multiple women who have missed their last three, four, or five appointments, and reminded each of them how much I care and that I could see them as walk-ins today or anytime they’d want to come in.
I sing “You are my sunshine” with an older brother bursting with excitement about his younger sister’s heartbeat, to hear the baby’s rate change and watch the joy on his face, and watch the tears stream down her face.
I listened to her baby’s heartbeat and watched you smile through the end of our visit, and then I walked out of another room fifteen minutes later only to meet her partner in the hallway asking if he could listen too, since he was running out to feed the meter during her visit and he missed it, and so I listened again and watched them smile together.
I filled out paperwork for her breast pump, and her compression socks, and her pelvic support belt, and for approval of her second ultrasound, thinking about how much of an impact each of these would have on her experience of pregnancy and thinking twice over about whether there is anything else I can do to provide even better care.
I held her as she cried on the one year anniversary of her miscarriage, knowing I wouldn’t let go until she was ready to.
I danced in the OB workstation with my Medical Assistants as an afternoon energizer, laughing and seeing their strength and passion for their work and knowing we feed into each other if we allow ourselves to provide and to be provided for when needed.
I listened radically, spoke kindly, informed intentionally, supported fully, and held space to the best of my ability.
I loved each and every person I served so much that I could barely hold back the tears, and I never thought once about how many minutes were involved.