Lack of time, reposted

Robert L Wears, MD, MS, PhD wears at UFL.EDU
Fri May 3 00:37:57 UTC 2013

Certainly it can often be used as an excuse, but the effects of time/production pressure are 
often more subtle and distributed.  People habituate to various constraints -- if they are 
often time pressured, and must sacrifice thoroughness for efficiency, those behavioural 
patterns tend to carry over into other instances where time pressure may be absent.

I'd suggest reading Erik Hollnagel's book on the efficiency-thoroughness tradeoff.  One idea 
he brings up is that people tend to be biased to favour efficiency over thoroughness, and 
that this is so deeply ingrained one would suspect an evolutionary basis for it.  Saving a bit 
of time is not often important, but in an open system, a world with uncertainty, risk, and 
unexpected events in it, a bit of extra time sometimes turns out to be critical in dealing w/ 
the unexpected.

The full reference is:

Hollnagel,E. (2009). The ETTO Principle:  Efficiency-Thoroughness Tradeoff (Why Things That Go Right 
    Sometimes Go Wrong). Farnham, UK: Ashgate.


On 2 May 2013 at 3:19, Jason Maude wrote:

> I initially saw my GP (very experienced and senior partner in the
> practice) who was certainly not rushed as he even asked me about some
> other things I had seen him with before. The x-ray was carried out at
> the small local hospital that was attached to the practice. There was
> no queue to get the x-ray done so I don't believe that the radiologist
> was rushed. It was then looked at again by a couple of nurse
> practitioners, all in the calm of a sleepy English country town
> hospital!
> This is why I started to conclude that lack of time could often be an
> excuse rather than a legitimate explanation. I also blamed myself for
> too easily accepting what seemed a plausible diagnosis. I should have
> asked "what else could it be" and acted as the trigger for more
> thinking. The whole episode showed me what an easy trap it is to fall
> into.
> So do we either accept this as the norm and say that nothing can be
> done (not enough time etc)- in other words there will be an inbuilt
> industry dx error of 10-20% - or is there a way we can force change.
> My view, reinforced by this episode, remains that the differential (or
> say 3 diagnoses) must be recorded in the medical notes at the time of
> the consultation.

Robert L Wears, MD, MS, PhD
University of Florida  	Imperial College London
wears at       	r.wears at
1-904-244-4405 (ass't) 	+44 (0)791 015 2219
What hits the fan will not be evenly distributed.

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