The Seven Minutes I Did Not Have

My clinic runs in slots. On paper each one is fifteen minutes; in practice, by the middle of the afternoon, it is seven. I used to think of that as a logistics problem — something the appointments team could fix if they cared to.

I no longer think that. I think it is a clinical problem, and I think I have been getting it wrong for most of my career.

What she actually came to ask

A woman in her fifties, newly diagnosed, surgery planned. I had given her the treatment plan clearly. I had drawn the little diagram I always draw. She had nodded in the right places and asked two sensible questions about timing, and I had answered them, and I was standing up.

My hand was on the door handle when she said: "Will my husband still want to look at me?"

I want to be honest about what happened next, because the honest version is the useful one. What happened next was that I felt a flicker of impatience. There were four people waiting. I had answered the questions that seemed to me to be the medical ones. And here was a question I had no protocol for, arriving at the worst possible moment, from a woman who had been sitting on it for twenty-five minutes while I talked about margins.

I sat back down. It cost me about seven minutes, which I did not have, and which I found anyway, in the way you always can.

The order in which people ask things

What I learned that afternoon was about sequencing. She had not saved that question for the end because it was the least important. She had saved it because it was the most.

Patients put the question that frightens them most at the end, and we design our appointments so that the end is the moment we are already standing up.

Think about the structure we have built. The clinician front-loads information. The patient is given the floor at the point when the clinician's body language has already announced that the consultation is over. So the questions that get asked out loud are the ones that feel legitimate — dosing, dates, side effects — and the ones that actually govern how a person will experience the next two years get asked in the doorway, or not at all.

I had thought of myself as a good communicator because I explained things well. Explaining things well is the easy half. It is entirely compatible with never once finding out what the person in front of you is afraid of.

What I changed

Two small things, and I am slightly embarrassed by how much difference they have made.

The first is that I ask, early — not at the end, when there is no time left to respond to the answer — "before I go through the plan, is there something you are particularly worried about?" It takes fifteen seconds. Roughly a third of the time it completely changes what I spend the rest of the appointment on.

The second is that I sit down again when it happens anyway. Because it still happens. Some things cannot be asked at the start; they have to be earned. When someone reaches for the door handle question, I now understand that as the appointment finally starting, rather than as an overrun.

What it is not

This is not an argument that oncology should be gentler at the expense of being precise. Her margins mattered. The diagram mattered. If I get the staging wrong, no amount of warmth will save her.

But I have never once had a patient come back to tell me that my explanation of adjuvant therapy changed how they got through it. I have had several come back to tell me about seven minutes.

No patient is identifiable here. Details of age, presentation, family and timeline have been changed or removed, and the exchange described is a composite drawn from several clinics over many years.