Time

You can't see, touch, smell, or taste it, but we spend tens of billions of health care dollars on it every year. To many patients and their physicians, it is precious, maybe the most precious of all medical resources. Yet we know only a little about how to use it efficiently or about the impact of using more or less of it, and we spend virtually nothing for research on its diagnostic and therapeutic implications. It is, of course, time.

Physicians have always been busy people, although they have generally controlled the way they use their time. In 1993, for example, family practitioners were seeing, on average, one patient every 20 minutes; general internists were seeing one every 26 minutes [1]. These visit times were not long but perhaps were not unreasonable, particularly considering that they represented a mix of new and follow-up visits and that “fast” and “slow” British general practitioners had mean visit lengths of 7 and 9 minutes, respectively [2]. Recently, however, the invisible hand of the marketplace has squeezed appointment schedules in an ever-tightening grip: In late 1995, 41% of physicians in an important U.S. survey reported that the amount of time they spent with their patients had decreased during the previous 3 years [3]. This erosion of encounter time has taken its toll on physicians [1, 3]. Moreover, it is equally distressing to patients because patients value their physicians' “information giving” highly [4] and, as Howard Waitzkin has sensibly pointed out, “Information giving takes time. We cannot expect it to go well if we are too busy” [5]. It does not take a rocket scientist (in the current parlance) to understand why both patients and their physicians have become increasingly dissatisfied as visit lengths have grown shorter [2, 6]. …