PracticalDermatology

“Don’t watch the clock; do what it does…keep going.”

– Sam Levenson

One of my favorite phrases in sports, which I’ve taught my six-year-old as we suffer through Wisconsin heartbreaks every year, is “work the clock,” which is when the team that’s ahead tries to run out the clock (except in baseball obviously). But, of course, this can backfire, as it can be a strategy of playing not to lose. The team that is working the clock without a large lead more often than not wins, but the pressure can lead to costly errors, unless execution is optimal. Needless to say, the point guard, quarterback, or center in hockey usually knows what to do or which play to run to work the clock successfully.

As physicians, we’re also groomed in our careers to work the clock, as opposed to watching the clock, as we try to manage problem lists, problem patients, and problems that await. The clock is always working against us, and the 24-hour day is often never enough. Even worse for us are the patients who also work the clock the other way, adding one more complaint to the list about how long s/he waited in the room for the visit to start. Our own experiences grow from time, whether it be spent in the trenches of medicine, away from our loved ones, or on the sidelines as we either enter or exit our time as physicians.

Many of us who have attended virtual meetings, as well as many of the live meetings that have already started, would agree that a shot clock equivalent would be a great idea to stop what I call the “waterfall of echoes.” As we are constantly on the clock, there aren’t too many time drains as exhausting as listening to people hear themselves talk or raise hands to simply agree and pander with whomever just spoke rather than show approval with a head nod or other sign of support. If there were a timer and we could let the clock work in our favor, think how efficient meetings would be, and how many more things we could get done by taking control of the clock for a change.

Dermatology as a specialty has its own clock running as we face continued erosion of our image and scope of practice, not to mention the marginalized formularies and declining budgets for innovation. As we start to get back to business, we have the challenges of balancing efficiency and “optics” (I hate that word!) while trying to keep patient wait time from being too long, from time spent with patients becoming too short, and the bureaucracy that constantly piles on us from draining both our clocks and our sanity. I have been seeing firsthand how many of us play against the clock by double dipping our meetings and overextending to the point of fatigue, which will always influence the quality of our work and dedication. Even as we choose our future leaders, faculty at meetings, and committee members, we check their clocks as we balance “rising” stars who might need more experience despite having talent, or “falling” stars who have nothing more to prove but might be close to having their clocks run out. (I am going to get my clock cleaned for that reference, so there you go.)

As an older father who just turned 54 with young sons and bad family health history, I am constantly trying to avoid the widowmaker and watching the clock with my time with the boys, especially now that the trips away are becoming more frequent. Today I went to a birthday party where the fathers were all in their mid-30s and I had a good laugh talking about “old man” problems. Anyone who has met Suren and Kiran know that they love to talk, and on my birthday a few weeks ago they asked me how old I would be when they turn 54…I laughed and told them if I somehow made it to 104 it would be up to them to take me to their kids’ parties. In the end, my goal is to work the clock so that I can at least be around to go to their graduations, weddings, and maybe be a grandfather one day, but the more the clock works me, the more I worry about just making it to my own next birthday. Therefore, the goal is to run a few smart plays to work the clock and keep going, as Sam Levenson’s quote tells us. After all, to try to stall and beat the clock isn’t as much fun as being active in the game, having learned this the hard way as I try to balance young kids, the happy life/happy wife paradigm, my 80-year-old mom, my own well-being, and those pesky diseases of the skin.

The next time you watch a game, or look at your schedule, or even think about planning your day, think about the clock…and see if you are working it or if it is working you. Take the time to breathe and do something for yourself, especially now as the world starts to open up again. Then take a step back and be grateful that we still get the chance to call most of our own plays, and make working the clock just another way of passing the day.