The Doctor Will See You Shortly
The Ethical Significance of Time for the Patient-Physician Relationship
Clarence H. Braddock, III, MD, MPH,
Lois Snyder, JD
Department of Medicine, Stanford University School of Medicine, Stanford, Calif, USA;
American College of Physicians, Philadelphia, Pa, USA.
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 in-
adequate is now pervasive. This perception has ethical significance, be-
cause 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 hin-
der 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 ap-
proaches are critical for clinicians and health systems to maintain their
ethical commitments and simultaneously deal with the realities of time.
KEYWORDS: medical ethics; time management; patient-physician
J GEN INTERN MED 2005; 20:1057–1062.
Recommendations of the American College of
1. Time is an important element of high quality clinical care,
and a necessary condition for the development of the pa-
tient-physician relationship and trust between patient and
physician. Therefore, efforts to improve how care is deliv-
ered must focus on preserving the patient-physician rela-
tionship, with an emphasis on fostering trust, maintaining
fidelity, demonstrating patient advocacy, exhibiting respect
for the patient as a person, and carrying out the individual
and collective ethical obligations of physicians.
2. Effective communication, especially active listening by the
physician, and the provision of information and recommen-
dations to facilitate informed decision making and patient
education, are critical to the patient-physician relationship
and to respect for patient rights. Health care systems, pay-
ers, government agencies and others should recognize that
these activities require time and be supportive of them.
3. Health plans, institutions, and others should support the
patient advocacy duty and resource stewardship role of the
physician, and minimize barriers to appropriate care, by
recognizing the value of time spent by the physician in his
or her role as patient advocate in an increasingly complex
health care system.
4. Physicians should spend adequate time with patients
based on patient need and uphold their ethical obligations
in doing so. It should be recognized, however, that meas-
ures of ‘‘adequate’’ time for the medical encounter involve
dimensions of caring and trust that are not so easily quan-
tifiable, and that it is not just the actual time a patient
spends with the physician that affects outcomes, but how
the time is used. Research that examines how time is used
and that distinguishes between time spent with patients
(actual care) versus time spent on patient care (tasks asso-
ciated with care) should be encouraged.
Does ‘‘time’’ have ethical significance? Many physicians and
health care leaders talk about time in clinical practice. For in-
stance, a Medline search of the medical subject heading ‘‘time
management’’ returns over 1,500 citations. Most of this liter-
ature concentrates on the practical dimensions of time—how
best to schedule operating room time or to schedule clinic ap-
Short of articles in which clinicians complain
about ‘‘not having enough time,’’ however, there is little in the
literature concerning the ethical significance of time.
line search of the combination, ‘‘time management’’ and ‘‘med-
ical ethics,’’ for example, reveals no citations.
We assert that time has ethical significance, with specific
implications for the patient-physician relationship, for respect
of patient autonomy, for promotion of well being, for mainte-
nance of fidelity, and for preserving justice. In the paragraphs
that follow, we will offer both conceptual and empirical defense
of these claims. Once having established the ethical signifi-
cance of ‘‘time,’’ we will then argue that these connections en-
tail important ethical obligations with regard to time for both
physicians and health care systems. These ethical obligations
can and should guide how physicians and health systems
think about and manage time. In the last portion of this paper,
we will outline some specific practical strategies to address
Accepted for publication June 29, 2005
The authors have no conflicts of interest to report.
This paper is based on a position paper written by Clarence H. Brad-
dock, III, MD, MPH and Lois Snyder, JD for the Ethics and Human Rights
Committee of the American College of Physicians, and approved by the
American College of Physicians Board of Regents on March 31, 2003.
The position paper is available on the American College of Physicians
website. Members of the Committee were: William E. Golden, MD (chair),
University of Arkansas for Medical Sciences, Little Rock, AR; Harmon H.
Davis, II, MD (vice chair), Internal Medicine Group, PC, Cheyenne, WY;
David A. Fleming, MD, University of Missouri, Columbia, MO; Vincent E.
Herrin, MD, National Naval Medical Center, Bethesda, MD; Jay A. Jacob-
son, MD, University of Utah School of Medicine, Salt Lake City, UT; Step-
hen R. Jones, MD, Legacy Good Samaritan Hospital, Portland OR; Allen
S. Keller, MD, New York University School of Medicine, New York, New
York; Steven Z. Pantilat, MD, University of California San Francisco, San
Francisco, California; Daniel P. Sulmasy, OFM, MD, PhD, Saint Vincent
Hospital and Medical Center, New York, New York.
Address correspondence and requests for reprints to Dr. Braddock III:
Division of General Internal Medicine, 251 Campus Drive, MSOB, MS
5475, Stanford University School of Medicine, Stanford, CA 94305