Time Pressure Makes Us Less Likely to Help
What Does That Do to Your Doctor?
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I have been thinking a lot about time and trust recently. Particularly about time and trust within the context of medical care. A few months ago, I heard about a psychology study that was conducted over 50 years ago. In the study, a group of seminary students were told they needed to make their way across campus. Half were told, “Oh, you’re late. They were expecting you a few minutes ago. We’d better get moving.” The other half were told, “It’ll be a few minutes before they’re ready for you, but you might as well head on over.”
On their way across campus, there was a man slumped in a doorway, moaning and coughing, clearly in distress. They found that only 10% of the students in the hurried condition stopped to help the man, while 63% stopped in the unhurried condition.
I think about this within the context of healthcare, where doctors feel rushed nearly all the time. I think it contributes to the frustration many patients feel in their interactions with doctors. I hear many stories about patients with symptoms that significantly impact their quality of life. They go to great effort to see a specialist, only to hear a more diplomatic version of, “Not my problem.” When doctors are under time pressure, they are more inclined to see that a person’s problem is outside of their area of expertise than to examine whether they have any skills that might help to provide relief. When doctors are under time pressure, they think that the person in their office is seeking a diagnosis, rather than seeking someone to listen to them and help them strategize a way to relieve their suffering.
Why are doctors so rushed all the time? There are pressures from a lot of directions, many related to corporate greed from insurance companies and healthcare administrators. The way doctors are paid and measured as “good doctors” incentivizes rushing, like:
12-15 minute appointment windows
Assessing number of patients seen per hour
Metrics of time to cath lab or time to clot-busting drugs as a measure of whether you did a “good” job
It’s not only that though, many people have gotten so used to being able to get what they want when they want it, that they become aggressive and hostile when wait times in clinics and emergency rooms are long. I’m a tremendously impatient person, I can definitely relate to the restlessness that occurs while I wait for a doctor. On the other hand, what do you think your doctor is doing while you are waiting? I can nearly guarantee they haven't forgotten about you. They aren’t leisurely sipping coffee and listening to Mozart. They are taking care of someone else who needs care as urgently, if not more urgently than you do. Not just in medicine, but throughout the culture, we have lost the ability to assume someone is doing the best they can.
This is where trust comes in. Throughout many industries, we no longer trust that a professional can use their judgment to determine the right timing and right course of action. I was talking to my daughter’s kindergarten teacher about this. The conditions my daughter needs to thrive like lots of time and space to move are really difficult to meet because of state requirements about how many minutes of math and reading need to be taught each week.
It’s similar in healthcare. What happens if I take the time to sit down with someone with an urgent medical decision and really make sure they understand the risks and benefits, the advantages and disadvantages of the decision, and that puts me 10 minutes past the goal time to give that medicine? Do I receive praise from a supervisor for doing the right thing for the patient? Almost never. It is far more likely I would be chastised for not meeting that metric.
I also think this time pressure is how palliative care became a separate specialty in medicine. Palliative care is a beautiful thing for managing symptoms, for gaining clarity on the likelihood of success with a treatment, and for understanding what a person’s goals are in receiving healthcare treatment. However, in theory, these conversations should be something all doctors are capable of having. Doctors trained in palliative care are excellent listeners and communicators, but I think the biggest resource they have that other doctors don’t is time. They can take 1.5 hours to have an in depth conversation about what a patient is and is not hoping to get out of treatment. I applaud them, and they have certainly helped me in my work. But these conversations are important and I should be given the autonomy to prioritize having that conversation over less urgent issues when I think the situation merits it, rather than delegating it to someone else simply because of time pressure.
I assume these regulations develop because of “bad” actors who are lazy, so don’t teach kindergarteners anything, or ignorant, so don’t know that heart attacks are bad and should be treated right away. However, I suspect these “bad” actors are much more rare than regulators think. I suspect that when people aren’t doing the “right” thing there is a reason for it. What if we looked into the reasons for it and addressed them, rather than regulating what we “must” do? Usually those regulations are imposed without any genuine look at the barriers to making them happen. Understanding and addressing those barriers with your staff shows that you trust, respect, and support them. And while it is a good thing to do, it is not a purely selfless thing to do, we all benefit from this change in approach. Compared with people at low-trust companies, people at high-trust companies report: 74% less stress, 106% more energy at work, 50% higher productivity, 13% fewer sick days, 76% more engagement, 29% more satisfaction with their lives, 40% less burnout.
I looked briefly at leadership and social science research about rebuilding trust. I’m sure there is good research out there if I went more in depth, but I got overwhelmed by the platitudes and cliches and gave up. The actions I hope to take forward after this reflection are:
Real-time awareness of when a problem is truly urgent versus when there are outside pressures creating false urgency
Assuming best intent when someone is late or not taking action I think they should
When assuming best intent seems unrealistic, asking questions about what happened and why.
I think there is value in taking this on at an individual level, but imagine if hospital leaders or school leaders or university leaders or governmental leaders adopted similar strategies. There is something powerful about working with or for someone who trusts you to do your best and supports you when there are barriers to your doing that.