I've been criticized multiple times by various preceptors that I spend "too much time" with my patients. "FOCUS! LIKE A LASER BEAM!" and "C'mon C'mon C'mon!" are the mantras one of my docs enters before all of my patient visits.
Admittedly, even some of my patients are exhausted by the end of the interview and I've had a few that needed to take a bathroom break before I started the physical examination. (In one case, it led to chuckles and jokes by the nursing staff who assumed that the patient left in a huff because I overextended their patience.)
I laugh along with them and I understand WHY it can be a bad thing to spend too much time with my patients. There's other people in the waiting room and the schedule gets backed up. I get it.
My take? I'm a friggin' MEDICAL STUDENT. I'm still learning! The best way I learn is by spending time with my patients, thinking through their problem in real time under real pressures, deciding what questions to ask, clarifying parts of the story I'm confused about, which pieces of medical advice to dole out, which path of management I would engage in if I were the doctor (so they can see where I'm coming from before the real doc comes in and says something completely different. ;)
One of my more critical preceptors gave me a lecture this past week: "Look... I'm not saying you shouldn't know all of those things you're sharing with me. But we are trusting other docs to do their job before they come and see me. That's the point of this. You need to get some perspective."
I feel that this is the crux of the issue. There's different philosophies in medicine. One of the "Laws of the House of God" is
10) IF YOU DON’T TAKE A TEMPERATURE, YOU CAN’T FIND A FEVER.
In other words, if you intentionally don't ask the right questions, you won't need to follow up on them.
Some will gloss over parts of the history that are not pertinent to their particular field or interest at the time. Perhaps they have the data readily available on a computer. Perhaps they've seen the patient in the past and have addressed it already, or maybe they've made a referral to a specialist.
As the ignorant medical student seeing a patient for the first time with nothing more than a blank sheet of paper on a clipboard, I don't have those luxuries or assurances. I only have one tool -- the brute force of the consistently thorough history and physical. In many cases, it can take 30+ minutes. But I find all the fevers. And the headaches. And the chest pains. And the dizziness. And I need to talk about them with the patient to learn more.
The law that follows #10 is:
11) SHOW ME A BMS (Best Medical Student, a student at the Best Medical School) WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
Even though I feel harried all of the time (and perhaps rightly so in most cases,) I'm glad that these docs have volunteered half a day out of their week to teach me -- because I don't really add much to their practice. I just make their work harder. I'm the one that takes "too much time."