Embrace the Golden Minute
Here’s where things get even stranger. The concept of chronos is fairly universal but kairos is individualized. It is fascinating to think that when two people are in the same room during a 60-minute clinical consult each person is experiencing time distinctly. One challenge for the practicing rheumatologist is to coordinate this time so that it feels less discordant. A busy rheumatologist may be looking at the clock to ensure their clinic schedule is on time. The patient, on the other hand, may be noticing the passage of time in context to the long trip to the office, the anticipation in the waiting room and prior experiences in the examination room.
The clinician may be tactically using the time to extract the most information from the patient, but the patient may in turn be using that time to relay all the information since their last appointment they wish to share. That time is valuable to both people, but what they invest in each minute of the encounter may be radically different. How do we reconcile this?
Patient experience experts have long talked about the golden minute—the first minute of an encounter in which the clinician should pay full attention to the patient without any interruptions or distractions. There’s some evidence to support its utility. Data from a scoping review in 2022 suggest that patients’ opening statements last approximately 40 seconds, but physicians tend to interrupt them after about 20 seconds.1 Rheumatology-specific information is sparse, but it stands to reason that rates are similar in our specialty.
But why stop at a minute at the beginning of the encounter? Rheumatologists should aim to minimize interruptions throughout the entire course of the encounter. Of course, rheumatologists sometimes need to engage in redirection and facilitation, but that should be the exception rather than the norm. If we minimize interruptions, we can not only receive vital information but also gain insights into how our patients sense the passage of time.
Maintain the Flow
It’s not just in the clinic that we see time isn’t always neatly ordered. I’m sure you’ve had instances in which you’ve lost track of time doing something really enjoyable, like watching or participating in sports or video games. First named in 1970 by the psychologist Mihály Csíkszentmihályi, this phenomenon of being completely immersed in an activity leading to alterations in sensing time has been called flow.2
