Time to choose and time to save

‘Time watches from the shadow

And coughs when you would kiss’

WH Auden 1907–1973

It is snowing again and the grey of the sky is offset

by the light on the land. Time to reflect. Time to

wonder why people run down escalators to catch

London underground trains that run every 3 min, or

risk their lives in traffic rather than wait a couple of

minutes for the green man’s permission to cross the

road. Time is not to be squandered as it is the foun-

dation we cannot escape and what we do with time

determines how we balance life’s priorities.

Medicine consumes our time, invading time for

family and friends. We welcome grandchildren

because we can give them the time we were unable

and failed to provide for our own children. Work

overwhelms the time we have – early starts, late fin-

ishes, mobile correspondence and emails apologising

for the article or editorial being late (snowed under!)

Does lack of time, that is perceived lack of time,

influence our medical decisions? Correctly, we rush

to open the coronary artery occluded at the time of

a myocardial infarction, but do we need to rush to

invasive therapy for the stable angina patient? When

there is time we need to respect its importance.

Although, we may feel we have ‘no time to lose’

quality time on many occasions exceeds quantity

time in relevance and value.

This coming week I have taken ‘time-out’ to catch

up on promises, walk and think and plan my time

over the next 3–4 months. It’s Valentine’s Day today,

when romance should be time’s mentor rather than

writing an editorial about the better use of time, but

like everyone else I am vulnerable to falling through

time’s trap-door.

‘Making time’ sounds rather like baking a cake –

it is a recipe to be followed – but as a part of our

medical life, it is an essential component of commu-

nication, especially when the news to be transmitted

is not pleasant. A month before Christmas I was

asked to see a 60-year-old lady who was short of

breath. My clinic was full and the day was long, but

my secretary said she sounded very worried (always

listen to your secretary) so I added her to the end of

my list. A very anxious woman sat in front of me

and I was immediately glad I had made the time.

Her undiagnosed breast cancer had led to a large

pleural effusion and within 24 h we had established

hepatic and bone deposits. The following day I made

unlimited time to talk to her and her husband about

the diagnosis and positively what we were going to

do. Her breathing improved after pleural aspiration

and she was referred to the appropriate specialised

services. At Christmas I made sure my time was

devoted to my family and new grandchild, but I

thought of her – Christmas Day was also her birth-

day and I had delivered what no one wanted. A New

Year card from her husband thanked me for not

‘wasting time’ and said she was responding well to

treatment.

The hour-glass of time threatens, whereas the

refreshing river of time rewards.

Disclosure

None.

G. JacksonEditor

doi: 10.1111/j.1742-1241.2010.02366.x

ED ITORIAL

Insulin, insulin analogues and cancer: no cause for panic

Cancer is one of the leading causes of death in devel-

oped countries, and is understandably feared by

human populations. Thus it is hardly surprising that

whenever a new, or apparently new, association with

increased cancer risk emerges there is much public,

scientific and media attention. 2009 saw the publica-

tion of a series of articles examining the risk of

malignancies with various diabetes therapies (1,2),

and this has led to much interest. It has been known

for at least a decade that both obesity (3,4) and dia-

betes (5) increase cancer incidence. Indeed, the Uni-

ted Kingdom national cancer reform strategy (6)

clearly reflects the increased risks and highlights a

need for changes in population lifestyles combined

Linked Comment: Pollak and Russell-Jones. Int J Clin Pract 2010; 64: 628–36.

EDITORIAL

ª 2010 Blackwell Publishing Ltd Int J Clin Pract, April 2010, 64, 5, 525–540 525

Do we need

to rush to

invasive

therapy for the

stable angina

patient?