‘‘Screw-ups’’ 117
encounters between doctors and patients involve hierarchies, how do
these two kinds of individuals within the same dyadic social interaction
experience and view these issues relative to each other? Though doctors
face multiple competing demands and have limited periods with each
patient, it is not clear how they integrate such time pressures into their
work and handle this conflict each hour and day.
Availability of Less Time
In recent decades, the advents of managed care and of technological in-
terventions have exacerbated each other in diminishing the amount of
time doctors have with patients. Sally, the internist with cancer who
brought her laptop to the ICU, said about the past:
When we used to make rounds, there was time for discussion,
because there were so few things we could do. Now, procedures
and tests totally fill the time and minds of doctors, so they’re a little
lost.
The decreased availability of time both causes, and results from, the avail-
ability of quick quantitative tests. Physicians may become very ‘‘procedure-
oriented,’’ pushing to get tests done rather than examine patients. This
orientation has several other causes as well, including belief in ‘‘the ob-
jectivity of the numbers.’’ Sally said, ‘‘An intern is just too eager to say,
‘‘Let’s get another chest X-ray, another this, another that.’’ They don’t
listen to my chest; they get a chest X-ray.’’ Doctors readily substitute high-
tech procedures for low-tech ones. As we shall see, often this belief in ‘‘the
numbers’’ as powerful and predictive may be illusory. Still, patients may
have little choice but to lower their expectations accordingly.
Differences in Experiences of Time: Waiting as Suffering
‘‘Most difficult for me has been the process of waiting,’’ Steven, the
suburban endocrinologist with HIV, said. Previously, many of these doc-
tors had failed to realize the degree to which patients experienced time
differently—as longer, since uncertainty and disease loom over patients’
heads. Waiting lengthens the experience.
Importantly, these doctor-patients suggested the existence of ‘‘pa-
tient time,’’ ‘‘doctor time,’’ and ‘‘institution time’’ that moved differently
and conflicted—both long-term (e.g., with regard to prognoses) and