Family Practice Advance Access originally published online on June 22, 2005
Family Practice 2005 22(4):470; doi:10.1093/fampra/cmi001
Correspondence |
Different kinds of time
Department of Primary Care and General Practice, The University of Birmingham, Birmingham B15 2TT, UK
Email: M.A.lnnes{at}bham.ac.uk
Ogden et al. deal, in their interesting study, with various different kinds of time, but choose not to explore them in detail.1 Perhaps one should, though, to get a better sense of what might and might not be claimed.
Firstly, there is clock time, objectively measurable and, for present purposes, non-problematical. Secondly, there is subjective time (‘I-time’, to use the phrase that Einstein made popular).2 But this in turn breaks down further: most relevantly into a set of expectations about the typical and desirable range of duration for a consultation.3,4 The former has to do with social expectations: the latter one might describe as ‘content-conditioned time’, the sense that it is desirable for a consultation to vary depending on whether it is an acute A&E emergency, or a complex emotional problem discussed with a hesitant patient.
Thirdly, most problematically, there is subjective time as it is most usually considered, the way that what Flaherty calls ‘the contours of lived duration’ vary with such states as boredom, suffering, novelty and so on.5 This has been a favourite plaything of the philosopher and psychologist since, say, William James6 and within the context of health and illness perhaps was given its most brilliant representation in The Magic Mountain, Thomas Mann's exploration of how time passes for patients in a TB sanatorium.7
With this in mind, we suggest that, with their conclusions, Ogden et al. risk creating the impression that time is the important factor in a consultation. Certainly good communication can create the perception that ‘enough time’ was afforded to a particular consultation. However, truly listening and understanding necessarily involves a dialogue that may take more clock time as well. What is most important for satisfaction and partnership is that the patient and doctor agree on the negotiated meaning of the consultation rather than how long that consultation took.
References
1 Ogden J, Bavalia K, Bull M, Frankum S, Goldie C, Gosslau M, Jones A, Kumar S, Vasant K. "I want more time with my doctor": a quantitative study of time and the consultation. Fam Pract 2004; 21: 479–483.
2 Einstein A. The meaning of relativity (6th edn). London: Methuen; 1956 (first published 1922).
3 Howie JGR, Heaney D, Maxwell M. Quality, core values and the general practice consultation: issues of definition, measurement and delivery. Fam Pract 2004; 21: 458–468.
4 Wilson A, Childs S. The relationship between consultation length, process and outcomes in general practice: a systematic review. Br J Gen Pract 2002; 52: 1012–1020.[Web of Science][Medline]
5 Flaherty MG. A watched pot. New York: New York University Press; 1999.
6 James W. Principles of psychology. Cambridge MA: Harvard University Press; 1981 (first published 1890).
7 Mann T. The magic mountain (trans HT Lowe-Porter). Hardmonsworth: Penguin 1960 (first published 1924).
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