Intended for healthcare professionals

Observations Letter from New England

Staying ahead of getting behind: reflections on “scarcity”

BMJ 2014; 348 doi: (Published 10 April 2014) Cite this as: BMJ 2014;348:g2634
  1. David Loxterkamp, medical director
  1. 1Seaport Community Health Center, Belfast, ME 04915, USA
  1. david.loxterkamp{at}

No one is busier or needs more bandwidth than a generalist physician

You ramble into the exam room 45 minutes late. The patient is startled, annoyed, but you apologize and ask how you could help. He reaches for a crumpled list and begins a rambling oratory that you are clearly no longer listening to. Slumping on your stool, you stare at a computer screen that displays the “quality measures” you must address today. And so the stage is set . . .

We have all been there. We will be there later today: hurried, behind, distracted by everything except the one question the patient doesn’t know he needs answered today. Our problem is scarcity of time—if only we had enough to do today’s work well.

A new book by Sendhil Mullainathan and Eldar Shafir1 explores the costs of feeling perpetually behind. Scarcity: Why Having Too Little Means So Much begins as a study about poverty and why people who are poor stay poor. The authors cite numerous laboratory experiments and field studies that elucidate the decision making process of people perpetually on the financial margin. When faced with a money …

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