Time pressure is infectious and can itself create further lack of time.

It is not possible to measure time pressure objectively, as it is the subjective experience of limited supplies of time. This also means that I can influence how I experience time pressure and cope with it. This in turns means that I can train myself to tolerate time pressure, instead of constantly feeling impotent under its influence. Whoever learns to tolerate shortness of time and time pressure will not mention his limited time again and again, thereby releasing the feeling of time pressure in the person he is talking to, and not disturb something very important that has just come up in the discussion.

It has become fashionable not to have much time; full diaries and overcrowded, loaded desks are supposed to be a status symbol; however they are certainly not evidence of an economical way of dealing with the time available. It is also not a sign of composure to brag about one’s lack of time and to wear time pressure like a badge of merit.

make an exact note of the number of times you glance at the time. Something is wrong if this is more than 5 times in half an hour: this can be either your attitude to time or your way of dealing with it.

The most important time-saving factors in discussion are those which, at the same time, are essential to a good discussion: active listening, empathy, an adequate interview technique and the ability to find a mutual reality.

Uncompleted tasks set off restlessness and stress. It is only a completely finished assignment which releases this burden. Because of this, it is advisable to complete one task after another, rather than to try to take on too many at one time. In fact, a completed task brings one much further on than 10 which are incomplete. A task which, in principle, will be repeated many times should be carried out the very first time in such a way (even if it takes longer) that the procedure can be used in similar tasks in the future, and then involve the use of less time.

Tasks should be put into blocks. It is an uneconomical use of time to telephone, to talk to a patient, to visit the laboratory, to chat to a colleague and then leaf through a journal in colourful succession. Putting these tasks into blocks of time means that continuous and effective work can be performed in each of these areas. Putting off a more difficult task by appearing busy (clearing up, reorganization etc) is only a substitute for work, and actually only puts off achievement of the major task.

make a clear offer of time, and stick to it whatever happens. This forces the other person to make his objectives and requirements clear without beating around the bush. If you have made it clear to your discussion partner that you have only 10 minutes available, it is not impolite to signal the dose of the discussion at the end of this time. It is much more difficult if you did not make this clear before the discussion commenced.

Most people are unwilling to delegate work, either because they do not trust those with whom they work or haven’t trained them well enough, or because they have the attitude that they are the only person would could do it all correctly. In fact new tasks can often motivate those that work for you and can be an incentive for a more responsible way of working. Not only the task, but also the responsibility for it should be delegated. The stress is removed when both are passed on.

Check list: to save time

Examine your own attitude to time

Learn to tolerate lack of time

Do not infect others with your time-pressure

Classify tasks into vital, important, and unimportant

It is better to complete one task than start ten

Work in blocks of tasks

Develop an efficient system of reading

Don’t put off tasks by substituting bustle

Match tasks to your own daily efficiency profile

Spring-clean your surroundings

Recognize “time thieves”

Be able to say “No”

Make clearly defined offers of time

Don’t let others interfere with your time plan

Learn how to delegate both a task and responsibility for it

Remember: The best time-saver is the successful discussion between doctor and patient

Tasks which are approached with less enthusiasm and motivation need an over-proportional amount of time. However pleasure in the work is the result of experiencing satisfaction with the results of one’s own work. This completes the circle: the discussion which is successful is the one which is understanding” therefore an understanding discussion is not one that steals time. In fact the successful discussion between doctor and patient represents the optimal economy of time.

The climate of the discussion

The bases for a fruitful climate of discussion are: a trusting atmosphere, openness and willingness to listen, as well as the ability to relate to the patient and to be on the “same wavelength”. No aggression arises in such a discussion, which is factual and not driven by emotions, allows recognition of resonance and does not create anxiety. Respect and appreciation characterize the relationship between the two people, and the discussion proceeds symmetrically.

Where the conversation is optimal, both partners are at the same level in discussion of the subject matter, and are communicating emotionally on the same level. Both sides profit from such a discussion: the patient because he feels that his problem has been accepted and the doctor, who finds it easier to obtain the necessary information.

Posted from Diigo. The rest of my favorite links are here.

advantages:

• allows Pt to get a grip on his internal experiences, feelings, attitudes, ways of behaviour, desires, objectives, & to manage them better.
• allows Dr to choose correct distancing or closeness to his Pt.
• most impressive way of signalling to the Pt that the Dr is listening to him actively.

procedure: not done mechanically by a facade or echo.
foremost to mirror are : all emotional statements, objectives & presumptions/biased judgements.
try to mirror:

• all imp statements as soon as possible, briefly, concretely, clearly.
• make the attempt to workout the meaning for the Pt
• use term ‘you’ not i, we or one
• interject to make sure you understood the Pt
• use synonymns/antonymns to replay/verbalise Pt’s emotions.

if the Pt doent feel undestood: either directly intervene with a verbal confirmation or indirectly imply by describing Pt’s experience.

ability for empathetic behaviour comes from

• ethical attitude & social involvement
• sensibility level & coping level
• perceiving the relation & influencing it

“If you can discover a person
who is peaceful,
without affectation
who, with presence of mind,
with true involvement,
can quietly listen to needs,
who does not interrupt, who does not pose two questions at the same time,
who waits for the answer and grasps it all,
who does not peer into the future or past,
who does not fix you with a studied look, and put you down,
who does not avoid your gaze, looking upwards or downwards,
who is as prudent as he is at ease, then -
then you will think that you have found treasure in a field,
then you will think that you have found a pearl”.

art of questioning:

good questioning is like a zipper technique decreasing digressions from flow or contact & increases willingness & trust in communication. it shows that the Dr is interested & understands, so decreases Pt’s anxiety/anger/shame.

bad questioning is always with impricse wording & at an inappropriate timing which increases resistance of the Pt to answer.

open Q conveys interest & attention. Pt describes freely in his own words & attempts to make himself understood, this, increases confrontation with the conflicting matter leading to effective learning & better management. disadv – avoids unpleasant topics & is easier to digress.

closed Q is used only for extracting rapidly some precise info or to keep to the subject from excursions. it shouldnt be used at the onset since it decreases unravelling dimensions or building relations by preventing thinking & active listening.

inappropriate questioning arises from impatience & inexperience:

• multiple Qs overwhelms the Pt. so take time to ask one Q at a time.
• hold up Qs elicits irrelevant or aggressive Ans
• leading Qs have a backdrop of prejudice or wishful thinking of the Dr, exerting subconscious pressure on the Pt to avoid unpleasant topics
• ambush Qs suggest impoliteness or unawareness & makes the Pt defensive or aggressive. its easier to reply painful Qs if the A can be constructed on a preceeding fact.

forbidden Qs do not account for Pt’s autonomy:

• [epistaxis fingering]trap Qs trip up or over ride the A
• [potency, breastfeeding]curiosity satisfies the questioner but doesnt deepen relation & shames the Pt or evokes a climate of police interrogation
• [adi,nonlocalers]socratice Qs gives self-assurance to the questioner that others cannot answer & conveys to the Pt thatt he doesnt know what he believed he knew
• why instead of what reason]judgemental Qs puts Pt on defensive
• [esra doctors]aggressive Qs achieve the very opposite of the intended behaviour
• [status quo girls]flowery rhetorical Qs are hollow & insincere & maintain only superficial flow

questioning behavior of the Pt:

• need for info, contact, help, critism
• why is Pt asking at this time
• what is the overlying real Q
• why doe Pt repeat the same Q
• why doesnt Pt ask – out of anxiety, time pressure, speech barriers, different realities, insufficient stimulus