John Goldie is a retired GP and medical educator.
Time is not simply a tool for scheduling health care; it is the very medium through which care’s quality, safety, and justice are realised. In general practice, time can be understood as if it were a physical force. It compresses attention, creates inertia, imposes thresholds, and dissipates energy. These effects are not abstract. They determine what patients receive and what clinicians can give. If we want to understand why care sometimes fails to be humane, safe, or just, we must begin with time.
Care is not a checklist to be completed in sequence. I saw this starkly during mass COVID-19 vaccination sessions, where technical success — efficient delivery, targets met, harm avoided — coexisted with a lack of relational connection. Care unfolds over time, where listening, understanding, trust, safety, and justice are cultivated. When time is squeezed, these capacities are the first to degrade. Systems often assume that care can be compressed without consequence, but clinical experience and the inverse care law suggest otherwise.1
“When systems ration time, they ration narrative space, dignity, and the possibility of justice.”
A typical consultation illustrates this clearly. A single unhurried minute can allow a patient to share concerns that a checklist would miss. Consider a 10-minute appointment for a sore throat, the clinical target may be met and a prescription issued. Yet it is often in the unofficial ’11th minute’ that the patient’s posture shifts and the real concern emerges — a fear of the malignancy that claimed a loved one. Interruptions and cognitive overload introduce friction, pulling attention away from the patient’s world.2 When time is insufficient, narrative emergence and diagnostic accuracy become less likely, and care becomes increasingly unsafe, regardless of clinical skill.
Time scarcity is not neutral; it is a mechanism of structural unfairness. When systems ration time, they ration narrative space, dignity, and the possibility of justice. Justice in health care is not an abstract ideal — it is the condition that allows a patient to be heard, understood, and treated with moral adequacy, what philosophers call epistemic justice.3 Under time pressure, clinicians interrupt sooner, close down stories more quickly, and rely more heavily on cognitive shortcuts. These effects are not evenly distributed. Existing social hierarchies are amplified: women’s symptoms are more readily dismissed,4 people of ethnic minority are afforded less narrative space, and patients with chronic pain, mental illness, or complex social needs are penalised for requiring more time than the system allows.5 Time for care should therefore be relative to need, not fixed by a universal appointment length.
Clinicians are subject to the same temporal constraints. Cognitive load theory shows that when the demands of a task exceed working-memory capacity, performance degrades in predictable ways.6 Compress the minutes and distortions follow: moral fatigue, narrative flattening, and a contraction of compassion — an entropic effect of time-pressured care.7 A system that demands relational excellence while rationing relational time is not merely flawed; it is structurally incoherent.
Across traditions, time is recognised as the medium of recognition. Confucian ethics treats time as the substance of respect; Buddhist thought frames attention as disciplined presence. Phenomenology reminds us that time structures lived experience itself. To give time to a patient is not a courtesy; it is the act by which we recognise them as a person rather than a problem to be processed.
“Some patients require more time precisely because society has given them less.”
Reforms that ignore time are not reforms of care. Digital tools that save seconds while fragmenting attention, and metrics that count tasks but not time, distort the moral structure of practice. Some technologies may free time for relational care — but only when designed and implemented with that explicit aim. Policies that promise continuity, empathy, and shared decision making while compressing the time in which these must occur make promises the system cannot support.8
If we take the physics of care seriously, temporal justice must become a design principle. This does not require idealised solutions, but practical commitments: protecting narrative time within consultations, allowing flexible appointment lengths for complexity, reducing workflow friction, and preserving continuity where it matters most. It also requires supporting clinicians’ temporal wellbeing through rest, manageable caseloads, and realistic expectations. Some patients require more time precisely because society has given them less.9
Time is the essential medium for humane and just health care; when time is rationed, patient narratives and relational connection suffer, amplifying injustice and straining clinicians. Technologies and policies that overlook time risk undermining care’s moral foundation, so restoring time — allocating it according to patient need and supporting clinicians — is fundamental for health care to remain truly humane.
References
1. Hart JT. The inverse care law. Lancet 1971; 1(7696): 405–412.
2. Heritage J, Robinson JD. Soliciting patients’ presenting concerns: physicians’ opening questions. Health Commun 2006; 19(2): 89–102.
3. Fricker M. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press; 2007.
4. Côté CI. “They are not almighty god, they are doctors, they are human”: a qualitative study of mechanisms underlying epistemic injustices in chronic pain patients’ testimonies. Soc Theory Health 2025; DOI: 10.1057/s41285-025-00218-9.
5. Nielsen KM, Nordgaard J, Henriksen MG. Fundamental issues in epistemic injustice in healthcare. Med Health Care Philos 2025; 28(2): 291–301.
6. Sweller J. Cognitive load theory, learning difficulty, and instructional design. Learn Instr 1994; 4(4): 295–312.
7. Moscrop A. ‘Heartsink’ patients in general practice: a defining paper, its impact, and psychodynamic potential. Br J Gen Pract 2011; DOI: https://doi.org/10.3399/bjgp11X572490.
8. Ladds E. The value of time. Br J Gen Pract 2026; DOI: https://doi.org/10.3399/bjgp26X743937.
9. Pearson-Stuttard J, Ezzati M, Gregg EW. Multimorbidity — a defining challenge for health systems. Lancet Public Health 2019; 4(12): e599–e600.
Featured photo by Asse Slotendijk on Unsplash.
