The strange time-bending properties of the appointment book.

At various points in my career I’ve been taught time-management skills. Despite this, time seems as slippery as ever, and rarely does what it’s told. When I was a junior doctor, my time was managed by my pager. Now, the appointment book is in charge. Each name in the list stares back at me with a perfect rectangle surrounding it. There’s a gap in the names that corresponds with lunchtime. There are other gaps just waiting to be filled with a name at each new ring of the telephone. It looks like a cage, holding equal segments of time at bay. The bars occur regularly, an even space for each name. Looking at this at the start of the day gives the illusion of order, of equal time for equal-sized problems. And then surgery starts. Almost immediately, time leaks through the bars of the cage. That 10-minute space on the computer screen doesn’t begin to describe the time required for the first person with a relatively simple mix of heart disease and depression. Further on in the morning come the housing forms, the clock mocking me as I concentrate on handwriting within more boxes that refuse to contain the patient’s problems adequately. Walk-in patients needing an urgent appointment have now been added to my list. Their boxes in the appointment book are much narrower, nuzzling in between the regular-sized blocks. If we believe the appointment book they’ll only last a minute or two. In real life, they seem to take as long as a regular consultation. The person who says ‘Won’t keep you long. I just need a script for antibiotics’, doesn’t need a prescription, but a conversation. There’s a teenage boy, non-communicative. He’ll give me a chance to catch up. But, then I remember, he’s a teenage boy. And he’s coming to see a GP. Make it count, make sure he knows this is a safe place. Time again sidesteps and rushes past me, with a laugh. The rectangles on the screen are now two sizes; regular and walk-in, but, if you believe the screen, I’ll still get home on time. My watch shouts something different. The appointment book is our visual representation of time, setting out the day in appointment-sized chunks. What would happen if the sizes adjusted according to how long the appointment took? When people are slotted in, should it remove time from someone else’s appointment, or push the end of clinic to a later time? That is what happens in real life. Would an appointment system that represented real time visually change the conversations at the front desk? ‘Well, Mrs Higgins, I can slot you in, but Dr Hodge already has an estimated finish time of 7 pm.’ When we always work at full capacity, there’s only one thing that can happen: we will always run late. We are never granted enough time to manage complex problems properly. It means patients are frustrated, waiting for us as appointment times come and go. And we get no time for paperwork, meals, or family. It’s been going on for so long that it’s part of the system now. And it’s helped by the appointment book that lies to us about the properties of time.