Physicians Are Excellent At Floccinaucinihilipilification. What Is That?

Physicians are excellent at floccinaucinihilipilification, which is seeing something as unimportant or worthless. We engage in floccinaucinihilipilification every time we see a patient. We listen to their story and symptoms, and quickly filter, accept, or discard information until we arrive at our presumed diagnosis.

The 18-second rule

In 1984, Beckman and Frankel wrote in the Annals of Internal Medicine that the average time it takes a physician to interrupt a patient who is describing their symptoms is just 18 seconds. In identifying this “18-second rule,” Beckman and Frankel concluded, “physicians play an active role in regulating the quantity of information elicited at the beginning of the clinical encounter, and use closed-ended questioning to control the discourse. The consequence of this controlled style is the premature interruption of patients, resulting in the potential loss of relevant information.” We begin learning this technique of sifting out the dross on the first day of medical school, and most of us become experts at it.

Time scarcity

In today’s practice of medicine, we have even more reasons to floccinaucinihilipilificate. Time scarcity, having to document enormous amounts of information in the electronic medical record, and institutional pressure to increase productivity are only a few of the reasons. We become so good at discarding information we deem worthless, that it can spill over into other parts of our lives. Generally, this translates into practicing the 18-second rule with our loved ones, rather than actively listening and taking time to really hear them. When our “doctor fix-it” mode spills over into the rest of life, along with feelings of time pressure, we may manifest anger, frustration, and withdrawal. These feelings are early signs of burn-out.

So, how do we, as time-constrained providers, let go of our floccinaucinihilipilification in an effort to improve our own well-being? We must learn to recognize when we are doing it and how it might be affecting us and others. For instance, closed ended-questioning is not always bad. Sometimes it is very clear what is affecting the patient, and we can zone in on the issue. However, we must be alert for this habit working to our detriment. We must be mindful of engaging in active listening when we are not in “doctor-mode.” Not everything in life needs fixing. Sometimes we just need to sit and listen.

Self-criticism

In addition, we routinely engage in the habit of floccinaucinihilipilification with our internal voice. Think of the voice in your head that speaks to you during your day, assessing and judging your actions. We routinely review whether our actions were well-received or whether we failed at communicating our point. We may have a tendency to ignore our positive behaviors and focus more on the negative. This self-critical voice often dominates our internal conversations. Marshall Rosenberg, in his book Non-Violent Communication, stresses the importance of listening and using sympathetic, rather than judging language when we talk to ourselves. Answering these four questions can set the stage for improved communication with ourselves and others:

What am I observing?

What am I feeling?

What do I need right now?

Do I have a request for myself or someone else?

Self-compassion

Changing critical self-talk requires self-compassion. As physicians, we generally have compassion for the plight of others. We may be so giving of compassion to others that there is little left for ourselves.

There are three core components to self-compassion. Dr. Kristin Neff, in her book, Self-Compassion: The Proven Power of Being Kind to Yourself, lists these as self-kindness, recognizing our common humanity, and mindfulness. It is ok to be kind and gentle with yourself as you move through the intensity of your day. Recognize your critical internal voice and turn it off. Know that we are all connected through the common experience of life, which includes suffering. Hold yourself in a balanced awareness of your moments, rather than ignoring pain or exaggerating it. Take time to practice anti-floccinaucinihilipilification, and self-compassion, and know that you are valuable and worthy.

Susan MacLellan-Tobert is a pediatric cardiologist.

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