I have always been fascinated by speed. I have always enjoyed driving sports cars and have recently found myself checking out the Formula 1 and NASCAR activities in the Savannah Morning News. For Christmas 2003, my loving wife gave me a gift certificate for one day’s lesson and twenty-four laps driving a Formula 1 race car under the cautious direction of a professional driving instructor. For those normal folks unschooled in auto-speak, Formula 1 cars are the open-cockpit, rear-winged rockets on wheels seemingly driven only by thin, tanned, Italian or Brazilian drivers who can’t speak a word of English. I had wished for a chance to drive one of these things and last week I got my chance.

After months of anticipation, rearranging my schedule, and tucking in the practice for a week-end, the day finally arrived. There I was, on the track of the Nashville Speedway with about twenty other dreamers. I was given classroom instruction, a tour of the track, (“drop below the yellow line and you’re toast!”), a dry run of the mechanics of the car (“if the car doesn’t stop, try another pedal and aim for the grass!), and then slipped into the cockpit of my 550 horsepower, yellow Formula 1 race car. Of course, my wife snapped a picture of me in my protective suit and helmet. With the helmet on and the face shield down, the photo did not capture my rising anxiety and sweat. I fired up the engine and followed my instructor’s car as ordered onto the track. I held the steering wheel in a death-grip for the first six laps as speeds slowly picked up. I was given a few more instructions and drove another eight laps in a relatively less panicked mode. For the final ten laps, I drove that rocket happily at speeds of nearly 170 mph on the straight-aways and had a top lap speed of nearly 160 mph (tops in my class I might add.) After what seemed a blink of an eye, I was in the pit, climbing out of the car. It was done, finished. I had waited six months for this and suddenly it was over. The adventure was completed safely and successfully. Still I was left with the sense that it all occurred too quickly. I replayed the morning in my mind: drive to the track, sign the waivers, instructions, photos, track time, pick up the photos, and leave the track. The company was organized, professional, serious, practical; and while expensive, the experience proved all that had been promised.

What then was missing? I didn’t have time for the ritual, time to savor the moments individually. Everything was so well organized and professionally executed by the race car instructor and company that it all passed nearly too smoothly. True, I was ready to get out of that car all in one piece. The race company staff had provided the essentials. To them it was all very clear- teach, drive, and keep it safe. There was no time for the rituals to complete my experience. They had a business to run. I did understand, I guess.

In medicine, things have become much like my race car driving experience. A patient recently made that quite clear to me. As in many doctors’ offices, patients are given a questionnaire after several visits and are asked to critique their experience. This is done in an effort to improve care. The patient in question attached an additional page for her comments. (That is usually not a good sign.) In reviewing her office visit and endoscopy procedure experience, she gave very high marks for the staff, the facilities, and the colonoscopy (painless and diagnostic); the doctor (yours truly) did not fare so well. Her vivid criticisms related to time. I did not listen to her complaints long enough (about twenty minutes), did not offer her a visit for return soon enough following her colonoscopy (scheduled for six weeks after initiation of a treatment plan). She was not happy with me one bit. After all, she had had her problem for twenty years, had waited five weeks for an appointment, and had “other issues” she wished to pursue. I wrote a letter of apology but stated that I was comfortable with the results of the tests and the treatment plan and wished her well. The patient was rightly angry because I had not given her the necessary time for her (not just me) to feel comfortable about the medical experience. In other words, I had not allowed the “ritual” time for the patient to be at the same place as the physician in the course of the care program. In a previous century, ritual time was called part of “bedside manner,” namely the time and approach given in order for the patient to be comfortable with the doctor and to believe that the doctor was indeed a caring individual.

In this era of rising medical costs, HMO programs, limited reimbursements and escalating costs for physicians to run an office and practicing medicine, doctors are forced to see more patients in less and less time. Hence, the patient had a right to be critical. In fact, if patients and physicians are asked about the major problems in medicine, both groups rank less-than-desired time spent with each patient as a leading complaint. The pressures to assess patients efficiently, professionally, and accurately have taken over the desires and wishes of physicians to do all of the above plus allow patients time to savor, review, reflect, and freely discuss their health concerns to their own satisfaction. There seems to be insufficient time for this important “ritual” component of the doctor-patient interaction in most physicians’ offices. Hopefully, we can all find ways to improve this worsening problem in health care. Until then, all doctors continue efforts to balance the forces that limit patient contact time against their clinical desire to serve patients as they each would like and expect.

In the little time I have not dedicated to the practice of medicine, I will savor and enjoy the moments I had driving that Formula 1 race car. Still, they could have given me flowers and champagne in the winner’s circle. I had expected it.

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