The Moral Choice to Be Late
“How are physicians supposed to make every patient feel like they're the ONLY one that physician sees, when most of us are responsible for somewhere between 600 and 2,000 patients with multiple medical issues?” laments a doctor-client via text one day.
How, indeed?
There is never enough time when you're a physician.
The system, which often has physicians doubling as scribes, makes it nearly impossible to fit it all in.
The standard 15-minute time slot is, arguably, one of the major contributors to moral injury.
To rush through a complex visit in a world where listening alone has been proven to have a healing effect, is morally untenable. So, at least one physician I know is always late.
On purpose.
And his patients (mostly) love him for it…
They believe they are getting something worth waiting for: A fully-engaged physician, who seems to have all the time in the world for their questions and concerns — a doctor who makes them feel they are his only patient.
Some physicians are finding the answer lies in making an uneasy peace with being late.
“Most of my patients know I tend to run behind,” says a primary care physician. “So I always apologize for making them wait, but then when I am in the room, I give them my full attention—the same that I did the person before.”
In specialties focused on preventative medicine or where “cures” are few and far between, this unhurried time with one’s doctor is a deeply compassionate interaction.
Compassion is where the healing lies.
“I can’t sacrifice time with the patient,” says the primary care physician.”It leads to too much moral injury. The patient is the whole reason I went into medicine in the first place, and it is that patient interaction that energizes me.”
Yet, this choice comes with a steep price.
“During the day, I only have so much allotted time to see patients, do notes, answer messages, interact with coworkers, etc.,” says my client. “As a result, I ultimately have to give something up. It’s always a balance between what energizes me, and what zaps my energy. While spending the time that I need with the patient is what fulfills me, it does come at a cost.”
The cost for him is the postponement of his notes and in-basket demands. While he has learned to live with this, to a point, it’s exhausting. Putting off charts and administrative duties is like holding a small hand-weigh in an outstretched arm, he says.
“With enough time, it gets to be almost impossible to hold up,” he says. “Then I have to find ways to catch up, leading to an ebb and flow of being behind and caught up.”
Many physicians are forced to make this same choice: Trying to honor their highest values, while not drowning under postponed paperwork.
“If I get really burned out, then my patience with the patients wears thin. I feel the moral injury of that—not being authentic to the people that I took the oath to help,” he says.
It becomes a choice between moral injury and burnout. It’s a battle in which both physician and patient are the losers.
“In the end, we are asked to do so much, and are asked to do more all the time. We all have to give something up,” says the primary care physician. “I refuse to have that be time with the patient. If not for that, then the whole reason I became a physician becomes a moot point.”
How do you navigate timeliness with your calling to be a physician?