Why I never look at the clock

A patient stopped me halfway through a consult once and said, you have not looked at the clock a single time.

I had not thought about it. But she was right, and the reason matters.

When an insurer pays for the visit, the visit has a length. Fifteen minutes, sometimes less. Everything that happens inside it is shaped by that number, including how much of your story I get to hear.

This practice does not take insurance. That is not a luxury position, it is a clinical one. It means the consult ends when we are finished, not when the clock says so. It means I can tell you that you do not need surgery, which is a conversation that takes longer than telling you that you do.