The value of time

Emma Ladds is a GP partner in West Oxfordshire and a DPhil student at the University of Oxford researching the GP-patient relationship in contemporary general practice.

‘So are you enjoying retirement?’ I enquired of our recently departed senior partner at the annual partners’ reunion. As he described a recent holiday, ‘perhaps the last one with all the family’, a newly discovered proficiency in the trumpet, and the relief of being removed from the daily pressure of general practice business, he looked happy and relaxed. I could almost feel myself willing away my own intervening years.

In sociology, research around ‘speed theory’ has become increasingly popular in recent years. This explores how the structures and technologies introduced throughout the 19^th, 20^th, and 21^st centuries have led to an acceleration of our experience of time and pace of life. From clocks and timetables that temporally dictate our lives, to email, Amazon, and social media, the modern world has become subsumed by speed and the dominance of immediacy – what Virilio calls the ‘Tyranny of real time.’¹

However, such speed has not freed up nor generated more time. How often have you exclaimed that you ‘wish there were more hours in the day’, lamented where the ‘day has gone’, or complained about how some activity has ‘robbed you of time’ you will ‘never get back’. In all these framings, time is an asset, a resource, something that has value and worth. And yet in our fast-paced world, it is speed that dominates.

General practice too has been swept up in this world of speed. From the ’10-minute consultation’ to ‘same day access’, phone waiting times, and referral and annual QOF targets, temporal structures – often imposed through centralised policies, or as part of regulatory monitoring processes – have come to control our everyday activities.

And yet it is time itself that has value, not speed.

The slow food movement was born in 1986 in Italy as a protest to the opening of a McDonald’s at the base of the Spanish Steps in Rome. In contrast to the speed and industrial uniformity proclaimed by the golden arches, the movement aimed to promote local, traditional, and sustainable food production and valued quality over quantity.

In recent decades, medical training too has become increasingly industrialised. Following the introduction of the Modernizing Medical Careers programme in 2005, systematized training schemes, eportfolio records, annual reviews of progress and appraisals, and most recently, the Medical Licensing Assessment, it has become very easy to consider medicine as a uniform practice – a single profession. The complexity of being a doctor and the wealth of beings this can describe feels lost in the political drive to produce more and more of them, faster and faster.

For enthusiasts of artificial intelligence (AI) or those who believe in ‘taskification’, whereby roles are broken into a sequence of production line tasks, this is just common sense. Why wouldn’t we want to devise ways to perform such tasks faster, more efficiently, accurately, and of course cheaply?

Of course, there are many ways that AI could improve my life as a GP and make it both faster and more efficient. Wouldn’t it be great if it could automatically summarize and code the hospital discharge letters, add the suggested medication changes, and book the recommended blood tests or follow-up appointments? What about if it could automatically run the recall searches, invite patients for their investigations, file any normal results, and add the next recall date? Or maybe if it could automatically contact patients for their chronic disease or medication reviews, conducting and actioning them remotely using an intelligent template and protocolised outcomes?

And yet, medicine is relational and integrative. It is human. Whilst all of these innovations might make both my life and those of my patients quicker and easier, they overlook the benefit I get from reviewing the hospital letters and witnessing what my patient have been going through; they underestimate the value of being reminded that a patient has thyroid trouble or is chronically hyponatraemic, mildly anaemic, or on particular medications – knowledge that may be essential to integrate into fast-paced triaging decisions or ironically may make my consultations more efficient.

More importantly, patients are not just looking for diagnoses and treatments from their doctors. They are looking for care. They are looking for someone to witness the ups and downs and absurdities of life with them, to hold their hands and meet their gaze. Perhaps one day an automated online template will be able to do just that, or perhaps we will have become accustomed – or resigned – to it. But for now, there is still a value in watching the gasp of an inhaler effort or see the twinkle in the patient’s eye as they explain that they do normally remember their blood pressure tablets. There may still be a value in the slow old ways.

Perhaps there is a value in the few minutes it takes to administer a vaccination for a scared little boy who only wants the doctor he knows to do it. Perhaps there is a value in the half an hour each week spent visiting the deaf old lady, who is dying with an ulcerating carcinoma spreading across her face – even if nothing measurable is done. Perhaps there is also value to the hours spent listening to and acknowledging a patient who feels your split-second decision was the wrong one and caused them harm. Perhaps the effort of trying to rebuild a relationship and the broken trust is worth more than any number of automated processes.

How can an App and a virtual consultation replace all of that?

So whilst we can embrace some values of speed, technology, and AI, perhaps we should also celebrate slowing down, taking time, and building long-term relationships – both with patients and colleagues. Perhaps I should instead be glad my own retirement hopefully lies many decades away.

Reference:

Paul Virilio (2002) Desert-Screen: War at the Speed of Light. London: Continuum

Featured photo by Aron Visuals on Unsplash