All of us hate waiting in lines. Our society breeds a 'me-first' attitude. Often the lines in which we wait are slow to move and, we become irritable and angry. Somehow there is always someone who is able to outsmart the system and get served ahead of their place in the queue. In the typical queue at the grocery store, (or at the apple store genius bar) we become impatient because we want to get what we need and move on with our lives. The surgical/procedural waiting room is an entirely different beast. Here, stress, anxiety, uncertainty and fear serve to make even the shortest of waits seem unbearable. Families sit crouched forward in their uncomfortable chairs watching the door in hopes of seeing the smiling face of their surgeon with every turn of the doorknob. Here the wait may be rewarded by preservation of a life or, unfortunately, sometimes by a less desirable outcome.
Recently, I had the uncomfortable experience of sitting in the surgical waiting room in support of a patient, not as the physician breezing in to deliver the much anticipated news. Needless to say this experience has left me wanting to better communicate with my patients' families as they sit and wait for me to complete a procedure.
While waiting in support of the patient, I began to wonder how families cope with the surgical waiting room. After a 2 hour journey through the pre-operative process, the patient I was supporting was eventually taken to the operating room and the real wait for family and friends began. After saying our goodbyes, we were escorted out to a bare bones waiting area and started to stare at the clock. Most of my hospital experience has been on the 'other side' of the restricted area'time always moved quickly there. However, on the patient and family side, time crawled and the hands on the clock seemed to be stuck in place'In order to kill time and occupy my mind, I opened my laptop and began to research what had been written in peer reviewed journals concerning waiting for the doctor.
What I found was quite helpful to me.
Much has been written about the psychology of waiting as it relates to medicine and doctors. Several principles are common in literature:
1. Unoccupied time feels longer than occupied time
'Lots of friends came by and checked on our group while we were waiting. The conversation was a much needed diversion and stopped me from watching the clock so frequently. In addition, I was on call and my beeper and phone had to be answered several times during the wait. The occasional distraction from clock watching really made time jump forward a few times during the ordeal.
2. Anxiety makes waits seem longer
'Boy, is this a true statement. The procedure was not without risk. Pulmonary Embolus, tearing of venous structures , bleeding and other catastrophic complications were possible. As I fretted, the clock seemed to stand still. I began to run thru possible scenarios and how life would be different if a serious complication occurred. During this time, I heard every click of the second hand on the clock. The surgeon called back to the waiting room and spoke to our group via his staff during the procedure to let us know what he had found and what his intraoperative plan was. This really helped and significantly reduced our anxiety level. The power of the single phone call update was amazing and will become a routine part of my practice going forward.
3. Uncertain waits seem longer than known finite waits
'When certain expectations are provided, even longer waits become more tolerable. Providing reasonable estimations of time required for a procedure really makes a significant difference in the quality of the wait. Certainly, I try to provide family with a time estimate on the high side rather than the low side as to not produce alarm if the procedure goes longer than expected. Our surgeon did just that and I appreciated the fact that I had reasonable expectations going in.
4. Solo waits seem longer than group waits.
'Having support and company in the waiting room was essential. Even though I think of myself as tough and able to stand on my own, one cannot underestimate the value of friends, family and clergy during the hours spent in the surgical waiting area. Fortunately, all three support groups were available during our wait.
Luckily, our story has a good outcome thus far. The acute issue was successfully treated and an uncomplicated recovery is expected. This experience has helped me grow as a physician. I now have a better understanding of the surgical waiting room and the psychological stressors it places upon loved ones. I have always emphasized good communication with family members in my practice but I think I can do a better job. Going forward, I will make every effort to provide each family guidance for the wait. I will strive to set reasonable expectations as to time, suggest family support during the wait, call from the procedure with updates and provide immediate feedback post-operatively. Most importantly, I will share these personal observations with my colleagues, medical students, residents and fellows in hopes that they will provide the same courtesy to their patients and families in the future.