THE GOLDEN MINUTE
You see small and large water droplets on a spider’s web. But look more closely. The water droplets become tiny lenses that invert the image of the world around them.
Learning the ropes as a GP trainee, I have noticed how easy it is to become caught up in the web of my own thoughts during consultations. The water droplets — the patient’s obvious narrative — are clear to see. But the finer details — the hidden agenda — require closer observation. Yet finding these lenses onto the patient’s life leads you straight to the heart of a consultation.
The concept of ‘the golden minute’ is mentioned a great deal during training. There is no denying the potency of silence in history taking. But perhaps what is more important than the silence itself, is being an active observer in it. In a fast-moving clinic, it is easy to let thoughts slide away to your last patient, or your computer screen, or what is for supper? Before you know it, your devoted time of shutting up has passed, and you are still none the wiser. You have been a passive passenger of the golden minute. You may have missed the lack of eye contact, or the nuance of agitation, or the weariness etched onto a face. The tiny lenses onto a patient’s life.
FIRST OBSERVE THE PATIENT
The power of observation is underestimated. ‘To observe’ in the Oxford dictionary is ‘to notice or perceive (something) and register it as being significant’. True observation employs multiple senses. It is an active process of recognising, probing, and feeling. It goes beyond merely ‘seeing’ or ‘hearing’. Arguably it is an art form and a skill that takes time and experience to refine.
The importance of observation has been emphasised by countless great medical teachers over the centuries. Hippocrates, known as the ‘father of medicine’, was renowned for the emphasis he paid to clinical inspection and observation. Indeed, as a fresh-faced young medical student, the clinical examination was always introduced with the need to first observe the patient.
PAYING ACTIVE ATTENTION
In fact, recognising the importance of observation in clinical training, one team in the US went the extra mile.1 In an effort to improve medical students’ observation skills, researchers at the University of Pennsylvania looked to the visual arts to assess if an education in art observation and interpretation could be applied to medical training. They named it the ‘Artful Thinking’ approach. Instruction included sessions in front of works of art, group discussions, and training in visual arts vocabulary. It was designed to encourage creative questioning, reasoning, and perspective taking. The course was a success, with a significant improvement in the observational skills among students. The art training developed their ability to see the whole clinical picture and helped them to become more emotionally attuned to their patients. Furthermore, these students were better able to navigate visually complex clinical situations.
The importance of observation stretches far beyond the surgery though. It is a fundamental way of understanding the world around us. Life has more depth and character when active attention is paid to it. With imaginative, inquisitive looking, experiences are enriched. The trouble is, we are typically so busy existing in our own minds that we devote only a meagre portion of our cerebral resources to the here and now. It is a challenge, in our demanding electronic world, to pay attention. Half your mind is usually off checking your inbox or worrying about the children.
Observation plays a crucial role in medicine, and also in life beyond work. It is easy to be caught up in our own thoughts, and just catch a glimpse of the water droplets. But mindful observation is a powerful tool and can offer an insightful lens onto a hidden world.
- © British Journal of General Practice 2019