Journal of General Internal Medicine

, Volume 20, Issue 11, pp 1057–1062 | Cite as

The doctor will see you shortly

The ethical significance of time for the patient-physician relationship
Health Policy


Many physicians and health care leaders express concern about the amount of time available for clinical practice. While debates rage on about how much time is truly available, the perception that time is inadequate is now pervasive. This perception has ethical significance, because it may cause clinicians to forego activities and behaviors that promote important aspects of the patient-physician relationship, to shortcut shared decision making, and to fall short of obligations to act as patient advocates. Furthermore, perceived time constraints can hinder the just distribution of physician time. Although creating more time in the clinical encounter would certainly address these ethical concerns, specific strategies—many of which do not take significantly more time—can effectively change the perception that time is inadequate. These approaches are critical for clinicians and health systems to maintain their ethical commitments and simultaneously deal with the realities of time.


medical ethics time management patient-physician relations 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Arnold E, Pulich M. Improving productivity through more effective time management. Health Care Manag (Frederick). 2004;23:65–70.Google Scholar
  2. 2.
    Crosby JW. Ten time-management tips for family physicians. CMAJ. 2004;170:949–50.PubMedGoogle Scholar
  3. 3.
    Lussier MT, Richard C. Doctor-patient communication: taking time to save time. Can Fam Physician. 2004;50:1087–9.PubMedGoogle Scholar
  4. 4.
    McClennan B. Achieving greater patient throughput. Am J Roentgenol. 2004;183(3 suppl):9.Google Scholar
  5. 5.
    Phipps GS. Seven keys to on-time finishing. J Clin Orthod. 2004;38:155–8.PubMedGoogle Scholar
  6. 6.
    Waters DA. The 15-minute appointment: sacred cow? Arch Pediatr Adolesc Med. 2004;158:603.PubMedCrossRefGoogle Scholar
  7. 7.
    Guglielmo WJ. How to set up a concierge practice. Med Econ. 2003;80:64–8.PubMedGoogle Scholar
  8. 8.
    Stafford RS, Saglam D, Causino N, et al. Trends in adult visits to primary care physicians in the United States. Arch Fam Med. 1999;8:26–32.PubMedCrossRefGoogle Scholar
  9. 9.
    Mechanic D, McAlpine DD, Rosenthal M. Are patients’ office visits with physicians getting shorter? N Engl J Med. 2001;344:198–204.PubMedCrossRefGoogle Scholar
  10. 10.
    Linzer M, Konrad TR, Douglas J, et al. Managed care, time pressure, and physician job satisfaction: results from the physician worklife study [see comments]. J Gen Intern Med. 2000;15:441–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Tocher TM, Larson EB. Do physicians spend more time with non-English-speaking patients? [see comments]. J Gen Intern Med. 1999;14:303–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Burdi MD, Baker LC. Physicians’ perceptions of autonomy and satisfaction in California. Health Aff (Millwood). 1999;18:134–45.CrossRefGoogle Scholar
  13. 13.
    Groenewegen PP, Hutten JB. Workload and job satisfaction among general practitioners: a review of the literature. Soc Sci Med. 1991;32:1111–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Grol R, Mokkink H, Smits A, et al. Work satisfaction of general practitioners and the quality of patient care. Fam Pract. 1985;2:128–35.PubMedCrossRefGoogle Scholar
  15. 15.
    Mawardi BH. Satisfactions, dissatisfactions, and causes of stress in medical practice. JAMA. 1979;241:1483–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Pollock K, Grime J. Patients’ perceptions of entitlement to time in general practice consultations for depression: qualitative study. BMJ. 2002;325:687.PubMedCrossRefGoogle Scholar
  17. 17.
    Cape J. Consultation length, patient-estimated consultation length, and satisfaction with the consultation. Br J Gen Pract. 2002;52:1004–6.PubMedGoogle Scholar
  18. 18.
    Lang F, Floyd MR, Beine KL, Buck P. Sequenced questioning to elicit the patient’s perspective on illness: effects on information disclosure, patient satisfaction, and time expenditure. Fam Med. 2002;34:325–30.PubMedGoogle Scholar
  19. 19.
    Kurtz SM, Silverman J, Draper J, Silverman J. Teaching and Learning Communication Skills in Medicine. 2nd ed., Oxford: Radcliffe Pub.; 2005.Google Scholar
  20. 20.
    Lewin SA, Skea ZC, Entwistle V, Zwarenstein M, Dick J. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Syst Rev. 2001;CD003267.Google Scholar
  21. 21.
    Silverman J, Kurtz SM, Draper J, Kurtz SM. Skills for Communicating with Patients. 2nd ed. Oxford, UK: Radcliffe Pub.; 2005.Google Scholar
  22. 22.
    Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA. 1992;267:2221–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Ramsey P. The Patient as Person: Explorations in Medical Ethics. New Haven: Yale University Press; 1975.Google Scholar
  24. 24.
    Veatch RM. Modern vs. contemporary medicine: the patient-provider relation in the twenty-first century. Kennedy Inst Ethics J. 1996;6:366–70.PubMedCrossRefGoogle Scholar
  25. 25.
    Kurtz S, Silverman J, Benson J, Draper J. Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides. Acad Med. 2003;78:802–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Kurtz SM, Silverman JD. The Calgary-Cambridge Referenced Observation Guides: an aid to defining the curriculum and organizing the teaching in communication training programmes. Med Educ. 1996;30:83–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Cote L, Belanger N, Blais J. The patient-centered interview and the way it is taught. What do family physicians who have recently received their degree think? Can Fam Physician. 2002;48:1800–5.PubMedGoogle Scholar
  28. 28.
    Lipkin M Jr., Quill TE, Napodano RJ. The medical interview: a core curriculum for residencies in internal medicine. Ann Intern Med. 1984;100:277–84.PubMedGoogle Scholar
  29. 29.
    Platt FW, Gaspar DL, Coulehan JL, et al. “Tell me about yourself”: The patient-centered interview. Ann Intern Med. 2001;134:1079–85.PubMedGoogle Scholar
  30. 30.
    Fiscella K, Meldrum S, Franks P, et al. Patient trust: is it related to patient-centered behavior of primary care physicians? Med Care. 2004;42:1049–55.PubMedCrossRefGoogle Scholar
  31. 31.
    Teutsch C. Patient-doctor communication. Med Clin North Am. 2003;87:1115–45.PubMedCrossRefGoogle Scholar
  32. 32.
    Deckard G, Meterko M, Field D. Physician burnout: an examination of personal, professional, and organizational relationships. Med Care. 1994;32:745–54.PubMedCrossRefGoogle Scholar
  33. 33.
    Kao A, Green D, Davis N, Koplan J, Cleary P. Patients’ trust in their physicians: effects of choice, continuity, and payment method. J Gen Intern Med. 1998;13:681–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Kao A, Green D, Zaslavsky A, Koplan J, Cleary P. The relationship between method ofphysician payment and patient trust. JAMA. 1998;280:323–9.CrossRefGoogle Scholar
  35. 35.
    Safran D, Kosinski M, Tarlov A. The Primary Care Assessment Survey: test of data quality and measurement performance. Med Care. 1998;36:728–39.PubMedCrossRefGoogle Scholar
  36. 36.
    Braddock CH III, Micek MA, Fryer-Edwards K, Levinson W. Factors that predict better informed consent. J Clin Ethics. 2002;13:344–52.PubMedGoogle Scholar
  37. 37.
    Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49:796–804.PubMedGoogle Scholar
  38. 38.
    Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 5th ed. New York, NY: Oxford University Press; 2001.Google Scholar
  39. 39.
    Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: have we improved? JAMA. 1999;281:283–7.PubMedCrossRefGoogle Scholar
  40. 40.
    American College of Physicians Ethics manual. Fourth edition. Ann Intern Med. 1998;128:576–94.Google Scholar
  41. 41.
    Morreim EH. From advocacy to tenacity: finding the limits. J Am Geriatr Soc. 1995;43:1170–2.PubMedGoogle Scholar
  42. 42.
    Daniels N. Just Health Care. Cambridge: Cambridge University Press; 1985.Google Scholar
  43. 43.
    Buller MK, Buller DB. Physicians’ communication style and patient satisfaction. J Health Soc Behav. 1987;28:375–88.PubMedCrossRefGoogle Scholar
  44. 44.
    Like R, Zyzanski SJ. Patient satisfaction with the clinical encounter: social psychological determinants. Soc Sci Med. 1987;24:351–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Robbins JA, Bertakis KD, Helms LJ, Azari R, Callahan EJ, Creten DA. The influence of physician practice behaviors on patient satisfaction. Fam Med. 1993;25:17–20.PubMedGoogle Scholar
  46. 46.
    Giron M, Manjon-Arce P, Puerto-Barber J. Clinical interview skills and identification of emotional disorders in primary care. Am J Psychol. 1998;155:530–5.Google Scholar
  47. 47.
    Hemenway D, Killen A, Cashman S, Parks C, Bicknell W. Physicians’ responses to financial incentives: evidence from a for-profit ambulatory care center. N Engl J Med. 1990;322:1059–63.PubMedCrossRefGoogle Scholar
  48. 48.
    Radecki S, Kane R, Solomon D, Mendenhall R, Beck J. Do physicians spend less time with older patients? J Am Geriatr Soc. 1988;36:713–8.PubMedGoogle Scholar
  49. 49.
    Stiles W, Putnam S, Wolf M, James S. Interaction exchange structure and patient satisfaction with medical interviews. Med Care. 1979;17:667–81.PubMedCrossRefGoogle Scholar
  50. 50.
    Kass-Bartelmes BL, Hughes R. Advance care planning: preferences for care at the end of life. J Pain Palliat Care Pharmacother. 2004;18:87–109.PubMedGoogle Scholar
  51. 51.
    Lang F, Quill T. Making decisions with families at the end of life. Am Fam Physician. 2004;70:719–23.PubMedGoogle Scholar
  52. 52.
    Forjuoh SN, Averitt WM, Cauthen DB, Couchman GR, Symm B, Mitchell M. Open-access appointment scheduling in family practice: comparison of a demand prediction grid with actual appointments. J Am Board Fam Pract. 2001;14:259–65.PubMedGoogle Scholar
  53. 53.
    Institute for Healthcare Improvement. Idealized Design of Clinical Office Practices. Boston, MA: Institute for Healthcare Improvement; 2000.Google Scholar
  54. 54.
    O’Hare CD, Corlett J. The outcomes of open-access scheduling. Fam Pract Manage. 2004;11:35–8.Google Scholar
  55. 55.
    Scott JC, Conner DA, Venohr I, et al. Effectiveness of a group outpatient visit model for chronically ill older health maintenance organization members: a 2-year randomized trial of the cooperative health care clinic. J Am Geriatr Soc. 2004;2:1463–70.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  1. 1.Department of MedicineStanford University School of MedicineStanfordUSA
  2. 2.American College of PhysiciansPhiladelphiaUSA
  3. 3.Division of General Internal MedicineStanford University School of MedicineStanford

Personalised recommendations