Day 2: Time is so much more than money

Over the past two days, we have identified countless different barriers to care: pressure to finish on time in the OR, the desire to discharge patients as quickly as possible, or the difficulty of having a patient-centered informed consent decision. Consistently, the difficulty seems to be one of time. The doctors don’t feel as if they have time to invest 100% of their attention to speaking with patients, and nurses are tasked with so many things that it almost seems as if we are asking them to be in two places at once.

This recurring appearance of time and temporal pressure suggests a few things. First, “patients” are called such for a reason– they require patience. There are some people that I have met who have a knack for making people feel like they are the center of the world. These people have a special gift that I think the rest of us have to consciously fake. Regardless of how much time we actually spend with the patient, our attention should be fully dedicated to them.

Second, in high school we learned about “attribution bias,” which is when we tend to think that our mistakes are due to situation but other people’s mistakes (e.g. grouchiness) is due to their nature. The incessant hurriedness of the hospital unfortunately makes for a situation that is always stressful. In order to be a good member of the team, then, it seems we have to fight our own biases and realize that a frazzled surgeon or snappish intern might be a bad person– or they might just be overworked.

Finally, this idea of being overworked seems to come up a lot, but I have yet to hear many discussion of this. Here is when we need a MBA or economist to help us out: how much would it cost us to hire more people and decrease workload? How many places would support this? Who would resist this? How many lawsuits would have to be avoided or insurance claims never filed to make this affordable? Time is money, and we probably need to start talking this language if we’re going to convince other players to play the game with us. Also, it seems that ultimately improved patient safety would actually pay for itself; we just need the buy-in. Generally speaking, however, time is so much more than money, and if we could buy a little extra– with more physicians on staff, with compensation for call, with patient advocates to help things run smoothly– then perhaps we would better be able to foster a culture of collegiality rather than stress and care rather than numbness.

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