For many professionals, and almost all patients , the value of time is more precious than money
Pieterse A.M., Stiggelbout A.M., Montori V.M.
JAMA. Published online April 19, 2019. doi:10.1001/jama.2019.3785
This weeks Paper of the Week is brought to you by Sir Muir Gray, Founding Director.
“health care professionals, patient advocates, health care systems, and policy makers need to recognise that time is not simply a resource, its minutes indifferent and interchangeable like dollars or euros. A minute spent in providing information may turn out to be less important than a minute spent waiting silently for patient questions, or a minute responding emphatically to angst and loss, or a minute discussing when the plan will be reviewed and revised if necessary. Time for care is precious. The health care system must place a much higher value on and invest in innovations that create time and realise the possibility of time for patient care.”
3VH – Implications for value
Money is only one of the resources in a health service. Time is another finite resource for both clinicians and patients and this paper highlights this much neglected topic. One of the Authors, Victor Montori, has played a leading part in getting health services to recognises that as well as ‘the burden of disease’ there is also ‘the burden of treatment’ first described in an article with Frances Mair, professor of General Practice in Glasgow. The burden of treatment borne by patients and carers “includes the work of developing an understanding of treatments,
interacting with others to organise care, attending appointments, taking medications,
enacting lifestyle measures, and appraising treatments. Factors that patients reported as increasing treatment burden included too many medications and appointments, barriers to accessing services, fragmented and poorly organised care, lack of continuity,
and inadequate communication between health professionals.” (1).
They also developed the concept of “…minimally disruptive medicine that seeks to tailor treatment regimens to the realities of the daily lives of patients.”(2)
The time of clinicians is another matter and time is a resource that clinicians value very highly.
One point the authors could have considered in more depth was the limitations of the face to face interaction, no matter how much time is made available. Firstly, there is evidence that even if given more time some clinicians just do not understand probabilities themselves, never mind how to communicate them to the people we call patients. The work of Gerd Gigerenzer is of outstanding importance in illuminating this (3). Secondly there is the fact that the emotional tension is, understandably, so high for many people that even if the clinician is fully informed and a good communicator much of what is said is not remembered.
The key therefore is to supplement and complement the face to face consultation with the use of emails to communicate and collect information, for example to ask the person called the patient to think about and write before they come the answer to the question “what is really bothering you most?” This would then allow the clinician more time for what may well be the unique contribution of the human being -empathy
- Gallacher, K., May, CR., Montori, VM, Mair, FS. (2011) Understanding Patients’ Experiences of Treatment Burden in Chronic Heart Failure Using Normalization Process Theory. Annals of Family Medicine, 9 (p.235-43).
- May, C., Montori, V., Mair, F.S. ( 2014) We need minimally disruptive medicine. BMJ 399(7719)485-487.
- Gigerenzer G. and Gray M (2013) Better Doctors, Better Patients, Better Decisions: Volume 6: Envisioning Health Care 2020 (Strungmann Forum Reports)