January 6th, 2016
Good, Then Fast
“I hate to say it, but in this job it’s better to be fast than good.”
And I hate to hear it. I hate that, as the years go by, it’s a concept that seems to grow in popularity. I hate that the people saying it have been working much longer than me. I should respect them; they should be wiser. I hate what it says about our industry. I hate what it means for our future.
I hate it.
Now this is the part where you tell me that I don’t understand because I am too young, too inexperienced. Of course, I should shy away from fast. I’m the new guy trying to tackle my second specialty in three years. Maybe I’m just rationalizing my own plodding pace. After all, I’m the writer who told you I was fresh off the zebra farm, right?
But I understand the origins of the “better fast than good” mentality. I’ve seen the crowded emergency departments and the packed ICUs. I know how long people wait for a primary care appointment or a specialist referral. I raged at delays while my own mother searched for a diagnosis.
In medicine, time is everything. But at some point we focused more on saving time rather than how we spend it. We became so obsessed with being efficient that we’ve stopped being effective.
No doubt, many areas of the healthcare system are overloaded. But maybe some of that strain is just a symptom of being fast rather than good. Maybe it’s the reason some speed-focused hospitals still keep pneumonia patients days longer than the national average. Maybe it’s the reason people make second and third trips to the emergency department when they don’t understand their diagnosis or treatment plan. Maybe an extra 20 minutes of end-of-life discussion on the oncology ward would have saved a tearful family days in the ICU.
Of course, like any professional should, I’m getting faster. I’ve got the numbers and the metrics to prove it. And I’m sure someone behind a desk somewhere is pretty pleased with that. But I’m not. For me, speed is a byproduct, a downstream result, a reward for striving to do things the right way each time.
That attempt at “good” probably means some of my patients wait a little bit longer than others. And nobody likes that. But at the end of our time together, they rarely seem upset. If they are in a rush, they don’t show it. Some of them even have the time to stop on the way out, turn around, and shake my hand.
And I have the time to stop and shake theirs.
Maybe for some jobs it is better to be fast than good. But I have been a clinician and I have been a patient, and “better fast than good” doesn’t work for me in either case. I guess it’s just a reassuring lie for those who no longer strive for quality.
For the rest of us, it’s better to be good, then fast.