The challenge of time

On occasion, as an office visit ends, a patient will say to me, “Thank you for your time; I know how busy you are.” While I appreciate the recognition that my schedule might be busy, the comment makes me pause and ask myself a few questions. Did I appear particularly harried? Did I rush the patient through issues that needed more time to explore? Did I look at my watch?

Our days are all run on a schedule, whether clinical or administrative. It is simply unavoidable. But I wonder whether my schedule runs my life excessively. Do I have adequate control over how I spend my time? Time pressure during the work week can be oppressive. On weekends, I don't wear my watch in order to feel symbolically liberated.

I've thought how much time plays a role in our lives as physicians. Our clinical lives are run by schedules with office visit slots as short as 15 minutes. Often that is not enough time to handle the issues for a given patient. Yet we feel pressured to push through, and the person shortchanged is typically the patient. No doubt, we are also adversely affected because in addition to the time spent with the patient on the schedule, we are likely needing extra time to finish the documentation for that visit. ACP recognizes the administrative burdens that devour our time and is working on ways to reduce them, as is noted in a position paper published May 2017 by Annals of Internal Medicine and available online.

Time also factors in as we determine billing for visits. Our largely cognitive services as internal medicine specialists are still undervalued in our complex coding and billing systems. ACP's Medical Practice and Quality Committee and Coding and Payment Policy Subcommittee are working to ensure that the evaluation and management codes used in billing accurately reflect the work we do in the office. All the evaluation, management, counseling, data interpretation, and documentation take time. Useless repetition and requirements for clinically irrelevant information remain problematic, and ACP continues to advocate strongly in this area.

Things that matter take time: talking to patients, developing relationships, thinking, problem solving.

When faced with myriad requests, I frequently think or say, “I don't have the time.” But is that true? I have started to ask myself if what I really mean is, “I am not willing to make the time.”

We know we cannot really make time. It is finite, and all we think we can do is adjust our priorities. But perhaps we can actually make more time by changing how we perceive it.

Perceptions of time vary depending on the situation. We all yearn for more days where “time flew by” because we were busy with work that was gratifying, important, helpful to others. But there are other busy days where we might be helping patients in office visits yet hit roadblocks of administrative burdens or encounter challenging interactions. Those workdays become interminably long and unpleasant and seem to “last forever.” Those two experiences occur in the same quantity of time, yet our perceptions are vastly different.

Remember the days as a medical student learning to take a history and physical and being told by the resident or attending to “take as much time as you need.” Pressures on our time understandably build through training as our responsibilities increase. We ultimately reach a point where our medical profession is our financial livelihood, and we are then frequently reminded internally and externally of Benjamin Franklin's adage, “Time is money.”

But a 21st-century modification might more appropriately state, “Time has value.” And further, the value attached to time for a given individual is directly related to one's behavioral economics at that specific point. How else to explain the different choices individuals make? Sometimes time is more valuable than money because it is so finite. Studies have shown that when given a choice between more vacation time and more pay, some people will choose more vacation time. Or when given the choice of more pay or moving from a five-day to a four-day work week, they choose the latter. The frequently discussed topic of “work-life balance” is really one of time and where one derives value.

Psychological studies demonstrate that the way time is spent also affects time perception. Being generous with our time does more than just make us feel good. When we help others through teaching activities or volunteering and effectively “giving away time,” we actually experience less time pressure overall, as noted by Mogilner and colleagues in their article “Giving time gives you time,” which was published in September 2012 by Psychological Science. As physicians, serving the needs of so many others, we spend lots of time directed externally. Frequently we push aside our own or our family's time needs to meet patient needs. We accept that as part of our profession, but we must acknowledge that lack of control over our time can be frustrating and disempowering.

So take the time to evaluate your time. Are you spending it as you really want, both at work and at home? Are you doing what you can to improve your own perceptions of your time? And I wish everyone more joyful days when “time just flies by.”