0:04

My greatest

0:04

teachers are my patients, and

0:06

one woman with incurable bowel cancer

0:09

was a great teacher, and we wrote a paper

0:11

together. That's doctor Chris Booth.

0:14

She had some very powerful lines that I still

0:16

remember. The diagnosis of cancer

0:18

quickens time and patients

0:21

lose patients. The good doctor

0:23

will recognize this. As an economist,

0:26

I think about health care in terms of resources.

0:28

Doctors and other providers are resources.

0:31

So are the buildings where they work? and the

0:33

equipment they use, and the

0:35

medications they prescribe. And

0:38

there's another resource that doctors sometimes

0:40

don't pay much attention to. one

0:42

that we'd always like to have more of.

0:45

I think oncologists, we do a pretty good job

0:47

describing the potential benefits of treatments

0:49

and the side effects. I think there's

0:51

a fair bit of attention given these days to the cost

0:54

of cancer medicines and the financial cost of

0:56

care. But we haven't done a good job of really

0:58

quantifying the opportunity cost treatments

1:00

and the most important opportunity cost that

1:02

we thought of was the patient's time.

1:04

Time. When you're a patient with cancer,

1:07

time affects you in a lot of ways. time

1:09

going for treatment, time between appointments,

1:12

time spent not feeling well, time

1:15

spent waiting, and of course,

1:17

How much time is left? It

1:19

all adds up.

1:24

a patient will occasionally look at me and

1:26

just say, well, do I really want to go down that road

1:29

if I'm going to be spending all that time in your

1:31

waiting room or in the chemotherapy unit? And

1:33

so it's very pragmatic comments from

1:35

patients that actually got us thinking about, well,

1:37

is there a way that we could quantify time

1:39

toxicity and begin to at least start

1:41

the conversation in our field? Chris and

1:43

his colleagues started thinking about time

1:46

and how it's used in medicine, especially

1:48

by patients who don't have a lot of it left.

1:51

How can they and all of us best

1:53

use time when it comes to our health?

1:56

From the Freakonomics

1:58

Radio Network, this is Freakonomics MD.

2:01

I'm Bob Bugena. Today on the

2:03

show, we're gonna talk about one of the

2:05

most valuable resources any

2:07

of us has.

2:09

time.

2:10

We'll try not to waste yours. Oncologist

2:13

and researcher doctor Chris Booth will

2:15

tell us how he thinks the medical community

2:17

can address what he and others have

2:19

called time toxicity. When

2:22

we counted up the number of days

2:24

that the patient would spend seeking treatment,

2:26

it could potentially take away every added

2:29

day of survival. But first,

2:31

we're gonna talk about time in a different

2:33

context. Dr. Adam Gaffney's

2:35

new research suggests physicians and

2:37

patients are spending more time together

2:40

now than they were forty years ago.

2:42

Great news. Right? So that

2:44

sounds good, but there's some disturbing trends

2:47

within the broader picture.

3:03

Time has been called the real currency

3:05

of primary care,

3:06

but I think that phrase actually applies

3:09

more broadly. Time is the currency of,

3:11

I think,

3:11

all healthcare. That's doctor Adam

3:13

Gaffney.

3:14

It's what we use to acquire

3:17

a history, perform an exam, make

3:19

a treatment plan, make a diagnosis,

3:22

it really is the currency of what we do

3:24

and act the essence of good medical

3:26

care is time. Adam

3:28

is a pulmonary and critical care doctor

3:30

at Cambridge Health Alliance in Massachusetts,

3:32

which means he takes care of patients in

3:34

the intensive care unit. He's also

3:37

a researcher at Harvard Medical School where

3:39

he studies how to make healthcare more

3:41

equitable. I do think that our good

3:43

things about the American healthcare system. There are things

3:45

that we do well. We certainly have

3:47

cutting edge technology. I'd like to

3:49

think we have pretty good healthcare professionals.

3:52

The biggest problem with the US healthcare system is how

3:54

we finance it, how we pay for care,

3:56

how we fail to make

3:58

sure everyone can get it regardless

3:59

of their ability to pay.

4:05

These

4:05

flaws as Adam sees them

4:07

can impact how physicians and patients

4:10

spend their time together. in a few

4:12

different ways. The first

4:14

issue is really about

4:16

access and there is only

4:18

a finite amount of health

4:20

care that can be provided in a society,

4:22

at least when you're talking about surfaces.

4:25

Right? And so the question is, how does

4:27

that time get distributed? One

4:29

way is on the basis

4:31

of patient's health needs. A second

4:33

way is on the basis of people's

4:36

ability to pay. ability to

4:38

pay winds up being a very

4:40

important barrier and

4:42

an important determinant of

4:44

how healthcare services are distributed

4:46

in our society.

4:50

Recently, Adam and his colleagues decided

4:52

to look at how healthcare services

4:54

are distributed in the US by

4:56

focusing on time. There's only so

4:58

much of it in each day during each

5:00

appointment. A twenty twenty

5:02

one study found that on average doctors

5:05

spend around eighteen minutes with each

5:07

patient per visit. Is this

5:09

enough? how might time together

5:11

vary by patient or by physician?

5:13

And does it matter? They

5:15

relied on data from the National Ambulatory

5:18

Medical Care Survey from nineteen

5:20

seventy nine to twenty eighteen.

5:23

At

5:25

the beginning

5:27

of the period of our study, we found that

5:29

Americans spent roughly forty

5:31

minutes a year with outpatient

5:33

doctors. And that actually

5:35

increased over the next forty years

5:37

Nowadays, we found that Americans

5:39

spend about sixty minutes a

5:42

year with physicians face

5:44

to face. So that sounds a

5:46

good thing and it is. And I think it's explained

5:48

by the fact that there has been an increase

5:51

in doctors per capita over that time period,

5:53

so there's more doctors who provide that

5:54

time. And I'll say that that's driven

5:56

not so much by not

5:58

at all actually by

5:59

more visits per year, It's

6:02

actually explained by a rise

6:04

in the amount of minutes per

6:06

visit, which probably comes as a surprise because

6:08

we feel very rushed when we see a doctor.

6:10

But there has been an increase in visit length and that's been

6:12

seen by others before us. So that

6:14

sounds good, but there's some disturbing trends

6:16

within the broader picture.

6:18

Can you walk me through how you track

6:20

the actual FaceTime between patients

6:23

and doctors? It seems like it'd be hard to do. We've

6:25

looked at more than one million visit records

6:27

over that period. And for each

6:29

visit, the physician does say

6:31

how long the visit was in

6:33

terms of FaceTime. And then we add

6:35

up the total visit time and

6:37

we know what the races of the patient, we know the age

6:39

of the patient for each visit. So we can sort of

6:41

basically say, okay, how many visit

6:44

minutes do black people

6:46

have one year. And we did that for every year

6:48

from nineteen seventy nine to twenty eighteen. We're

6:50

almost every year. And what did

6:52

you find?

6:53

The first

6:56

thing that is concerning is that

6:58

if you look back over a more recent period,

7:01

since about two thousand five, the

7:03

amount of time Americans spend face to

7:05

face with a primary care physician

7:07

over the course of the year has actually

7:09

fallen. although we are spending more time with

7:11

specialists. Also,

7:13

there's major disparities in the

7:15

amount of time that Americans

7:17

spend with doc depending upon

7:19

their race. So in recent

7:21

years, for instance, white people spend about

7:24

seventy minutes a year face to face with

7:26

a doctor. and that's compared to about

7:28

fifty two minutes among black people

7:30

and fifty three minutes among Hispanic people.

7:32

So there's disparities by race and ethnicity

7:34

and there's also a growing

7:36

divide. We're we're spending less than with primary

7:38

care doctors. And I'm allowed to say this

7:40

because I'm a specialist. But

7:43

really so much of the life saving efficacy

7:45

of modern medical care is delivered by

7:47

primary care doctors, things like high

7:49

blood pressure control and chronic illness

7:51

management There have been a couple recent

7:53

studies that have actually found that medical control

7:55

of blood pressure as well as control

7:57

of diabetes has gotten worse according

7:59

to some recent national survey

8:01

data.

8:04

So I wanna just follow-up a little

8:06

bit on the race findings. white

8:08

patients spent more time per

8:10

year with doctors face to face

8:12

than black and Hispanic patients. How

8:15

much of that is due to just

8:17

a different number of visits per year

8:19

across those groups versus doctors

8:22

spending more time with white

8:24

patients on any given visit. our

8:27

study, it was driven basically entirely

8:30

by a different number of visits, not

8:32

by mean visit, length, per visit.

8:34

this study was not designed to look at

8:36

the why, which is obviously an important

8:38

question, although I can certainly

8:41

speculate on a number of factors

8:43

that contribute based on what we

8:45

know about American healthcare, what we know

8:47

about American society, we

8:49

know for instance that an insurance rate

8:51

is higher among black and Hispanic people

8:53

relative to white people and we know that that keeps people

8:55

from the doctor. Things like co

8:57

pays and deductibles even

8:59

if they're similar among groups,

9:02

they're going to have a bigger

9:04

impact potentially on lower income

9:06

groups. There could be issues with geographic

9:08

access We know that there isn't

9:10

always a good match of

9:12

population need and the

9:14

supply of care. And there's

9:16

also THE LONG HISTORY

9:18

UNFORTUNATELY AND REALITY TODAY OF

9:20

DISCRIMINATION AND RACISM AND MEDICINE THAT

9:22

COULD INGENDER MISTRUST AND REDUCED

9:24

US OF HEALTH CARE. did you find anything

9:26

different for older patients

9:28

versus younger patients? Like, for example, is

9:30

the race difference the same if you

9:32

look at people above the age of sixty or

9:34

sixty five? Persipilo? It

9:36

was actually strikingly different. The

9:38

overall pattern we observed of

9:40

racial, ethnic disparities was actually

9:43

driven entirely by the under six and the

9:45

sixty five and older crowd, we

9:47

didn't see that pattern play out,

9:49

which probably speaks to the

9:52

existence of a universal health system or payment system

9:54

for people sixty five and older Medicare.

9:56

Right? That no doubt plays a major role. It's

9:58

not to say that there aren't disparities in the

9:59

Medicare population But

10:02

other work has also found that as you

10:04

go from being sixty four

10:06

to sixty five, that there is a

10:08

continuation of reduction in healthcare access

10:10

disparities in that population. So I think

10:12

that this is just one more bit of support

10:15

for the premise that a

10:17

universal system does help to reduce disparities.

10:19

It doesn't eliminate them, but it helps address

10:21

them.

10:21

Could

10:24

more time spent with physician

10:26

perhaps help address some of the fundamental

10:29

disparities that we know exist across

10:31

racial lines? I mean, I think

10:33

in order to really improve

10:35

hypertension control. You do need

10:37

to have the patients in front of you. You do

10:39

need to measure their blood pressure. You

10:41

do need to prescribe them occasion, talk

10:43

about other issues, and we didn't

10:45

find the visit length was the disparity. We

10:47

found the number of visits. So I

10:49

do think that a disproportionate

10:52

allocation of physician

10:54

services to more advantage groups

10:57

contributes we see today. Now we

10:59

know that health disparities are

11:01

not just driven by disparities

11:03

in medical care access. There's

11:05

obviously environmental issue

11:07

issues. There's obviously broader public health

11:09

issues. There's racism. There's all sort of things in our

11:11

society that drive health disparities.

11:13

But I do think medical care disparities

11:15

matter. and I do think that

11:17

ensuring equitable access to

11:19

services is an important

11:22

critical and necessary tool

11:24

to addressing

11:25

them. Do you

11:28

think that we spend enough time

11:30

with patients? Overall,

11:32

I do think that we

11:34

could benefit from spending more time with our

11:36

primary care physicians. Now the

11:39

problem is there's just a lot of people who aren't

11:41

seeing a primary care physician at all. There

11:43

are people who go years without seeing a doctor

11:45

who have health needs. I

11:47

can't speak to any one archetypal

11:49

visit and how long it should take. I don't

11:51

know. but I can say that there's a lot

11:53

of people who could benefit from getting more

11:55

medical care that aren't getting it

11:57

today.

12:00

There might also be some people who could

12:02

benefit from getting less medical

12:04

care to optimize their time.

12:06

After the break, when time

12:08

is scarce, Should it change the decisions

12:10

we make about our health? That

12:12

added cost of time could be really

12:15

important for someone who has

12:17

very little time left. I'm Bob

12:19

Bugena, and this is FreakonomicsMD.

12:34

My name

12:36

is Chris Booth. I'm a professor of

12:38

oncology and public health sciences at Queen's

12:40

University in Kingston Canada. I've also had

12:42

a long standing interest in magnitude

12:44

of benefit and to what extent cancer

12:46

treatments offer meaningful gains to our

12:48

patients. In cancer care,

12:50

meaningful gains are often measured by

12:53

time. How much did a drug or

12:55

therapy improve survival? Did

12:57

a patient live longer or not?

12:59

Longer can have different meanings. If

13:01

a patient with advanced cancer gains

13:04

a few extra months as a result

13:06

of treatment, It's important to

13:08

also think about how and where

13:10

they're spending that time.

13:12

Within oncology, we have some

13:14

treatments that transformative impacts on

13:16

patients and provide large benefits. And

13:18

that's what you read about in the newspaper. But

13:20

we also have a whole bunch of treatments that have

13:22

very, very small benefits. and

13:24

we've not done a good job in our field

13:26

of distinguishing one treatment from

13:28

the other. So the average

13:30

cancer drug that is now approved by the

13:32

FDA or other regulators worldwide

13:34

for use in patients with cancer

13:36

extends life by about two or three

13:38

months. clearly, there's some drugs that are

13:40

home runs and really transformative for

13:42

care. But most of them, these gains are fairly

13:44

modest. And so those

13:46

modest survival gains need to be balanced

13:48

against the downside. The downside is

13:50

something we talked about earlier, time

13:52

toxicity.

13:56

So broadly is the time spent

13:58

pursuing medical care, and so we see that as

13:59

being a decision that a patient has

14:02

to make. We're not proposing that

14:04

we have the answer about how patients that

14:06

spend their time. We feel that

14:08

our job as oncologists and as scientists

14:10

is to generate data so that clinicians

14:13

can present information to

14:15

patients so they can make informed choices about

14:17

whether they to pursue treatment. Chris and a

14:19

few other researchers have studied

14:21

time toxicity to help patients

14:23

and physicians figure out,

14:25

together, the best use of

14:27

their time, when it's not clear, they've

14:29

got much left. It might sound

14:31

like an obvious thing to do, but it

14:33

can be hard to quantify time in

14:35

this way. under these circumstances.

14:38

So Chris and his colleagues designed

14:40

a formula to try to make it easier.

14:42

The time toxicity measurement we've

14:44

proposed is most useful in the

14:46

context of an advanced incurable

14:48

malignancy when life expectancy

14:50

is probably less than a year.

14:52

And we've tried to keep it pretty simple and we quantified

14:55

it as a home day, which is a day when the

14:57

patient's at home and does not need to leave the

14:59

house to seek medical care or

15:01

a health system day where there's physical

15:03

contact with the health system. And so

15:05

we've been able to do some retrospective

15:07

analysis of clinical trials and observational

15:09

data to try to estimate that.

15:11

Their findings haven't been terribly

15:13

encouraging. There's an example that we

15:15

used in one of our recent papers

15:17

for advanced biliary cancer

15:19

where treatment improved overall

15:21

survival by about two months And what

15:23

we showed is the number of days that the

15:25

patient would spend seeking treatment to

15:27

get that care, it could

15:29

potentially take away every added day

15:31

of survival would be one extra day in

15:33

the hospital or in the chemotherapy unit. And

15:35

I think that's important information for patients

15:38

to know.

15:38

Why

15:41

don't they know it? How can oncologists

15:43

like Chris help guide

15:45

patients using data at a

15:47

time when emotion tends to take

15:49

over? And should measures

15:51

of time toxicity be routine

15:53

across medicine? I think it very much

15:55

generalizes. In fact, I think oncology is late to the

15:57

game. Our colleagues in critical care in surgery

15:59

have quantified this in other

16:02

settings. The complex thing with oncology is

16:04

the timeline is a little bit longer. It's not these

16:06

thirty or sixty or ninety day post

16:08

acute care episodes. It's

16:10

longer than that. So I think it's

16:12

a really important conversation to have, especially

16:14

when we're talking about treatments that have

16:16

very real side effects and can certainly

16:18

interrupt quality of life.

16:21

So

16:24

why is oncology behind the game on this?

16:26

Why do you think it took so long start talking

16:28

about these issues. I think

16:30

one of the issues, Vapu, is that the

16:32

narrative in oncology for many

16:34

years has been every treatment

16:36

is a step forward and in advance.

16:38

And we've gotten ourselves into a

16:40

bit of trouble, and I say when I

16:42

lecture the students that we have a value

16:44

cry basis right now in oncology whereby we

16:46

have an explosive number of new medicines.

16:49

Some of them are very useful, but most of

16:51

them are pretty modest with their benefits.

16:53

They have very real side effects

16:56

and only a handful of these medicines

16:58

have actually been shown to even improve

17:00

overall survival. we've become obsessed in

17:02

oncology about tumor measurements on a

17:04

CT scan, something called progression free

17:06

survival. Many new cancer medicines

17:08

that are now approved and used every

17:10

day there's no proven benefit that

17:12

they help people live longer lives or

17:14

better lives. What they've been shown to do is

17:16

delay growth of a tumor on a CAT scan.

17:18

So in that context, I think it's been tricky

17:20

to even, you know, start broaching other

17:23

endpoints. I think it's time for us to start

17:25

measuring the amount of time spent pursuing

17:27

medical care and then sharing that with patients so they can

17:29

make decisions, especially near the end of life,

17:31

but how they want to spend their time.

17:33

have you work you've presented patients with this

17:35

information to see if their decision making

17:38

changes? As I've gained experience clinically,

17:40

I've started, I think, be a bit more

17:42

explicit in this and try to explain to

17:45

patients some of the limitations of our

17:47

treatment. And we've been doing

17:49

work lately than presenting information to

17:51

patients about whether they would want to

17:53

have a cancer treatment that will

17:55

not improve overall survival.

17:57

We'll have side effects, but we'll control

17:59

tumor

17:59

growth on a CAT scan for a period

18:02

of time. And we found that when we

18:04

use plain

18:04

language and don't use the word survival

18:07

because progression free survival, of course, the

18:09

third word in that phrase has very

18:11

strong meanings for patients. But when we describe the tumor

18:13

measurement paradigm, the vast majority

18:15

of patients say, actually, I wouldn't want that

18:17

treatment. I wouldn't take that treatment for

18:20

just tumor control. If it's not going to help me live longer and

18:22

it's going to have side effects. And so I think that's an

18:24

important point for all of us as

18:26

oncologists to consider because A

18:28

lot of what we do is based on that endpoint. And

18:30

so I think we really need to go

18:32

back to the drawing

18:34

board. Can

18:36

you think of an instance where

18:38

you felt pulled to treat

18:40

a patient even though you

18:43

suspected that it might not make a difference. It might

18:45

even waste their time. To be honest,

18:47

in oncology, this happens more than we'd want

18:49

to admit. The battle narrative in cancer,

18:51

I think, has been problematic for

18:53

years, the idea that it's a fight and a war and you have to keep

18:55

on fighting. And so it's

18:58

not uncommon for us

19:00

to in the second or third

19:02

line have these very difficult conversations with

19:04

patients where we say the current

19:06

treatment you're on is not working. We have a

19:08

treatment that we could offer, and I try to be pretty

19:10

clear about the magnitude of benefit.

19:12

And I do leave it up to the patient

19:14

about where they want to pursue treatment.

19:16

I won't, you know, count them because of my best advice.

19:18

But the end of the day, It's their decision to be made.

19:20

And I think all of us have

19:22

seen patients adopt treatments that maybe we wouldn't

19:24

have done in our own decision making, but our

19:26

job is to provide information, support the

19:29

patient through that process.

19:31

What kind of

19:34

conversations surrounding time

19:36

toxicity should patients and

19:38

physicians be having both before

19:40

and during treatment. I

19:42

think the first step is for our community

19:44

to generate this information. tried to

19:46

keep this metric of home days pretty simple and

19:48

pragmatic. And I think then, at least, we

19:50

could present informations to say, look,

19:53

your cancer is grown. We have a treatment

19:55

or we could focus on symptom management,

19:57

hospice and palliative care.

19:59

And on

19:59

average, patients who went on

20:02

this clinical trial. They live for about

20:04

nine months. Of those nine

20:06

months, they spent about, you know, three

20:08

months pursuing treatment, extra biopsies,

20:10

extra emergency room visits. So

20:12

there's a trade off And with no treatment, your

20:14

home days might be about seven months.

20:16

With treatment, you'll live nine months, but have

20:18

about six months of home days. And

20:21

I think The first step is to generate the

20:23

information, but then most importantly, it's to

20:25

do the hard mixed

20:27

methods, qualitative work with patients to

20:29

understand how they want this information presented

20:31

with the best ways to present it

20:33

and how real patients would

20:35

value and weigh these competing

20:37

priorities. So, Chris, one way to

20:39

think about The time toxicity

20:41

of medical care for cancer patients at

20:43

the end of life is the time that they

20:45

spend seeing the doctor that they

20:47

might not want to spend if they

20:49

knew how much time it was gonna take.

20:52

But there's another channel that

20:54

is operating here, which is

20:56

That time is being spent by doctors and

20:58

other providers in the medical system and could

21:00

be spent on other people

21:02

whose cancer care might be delayed,

21:05

for example, because of these issues. So

21:07

how do you think about time toxicity as

21:09

it parlays into the broader cost of the

21:11

medical system? This is a really important

21:13

point. So these are opportunity cost kind beyond

21:15

the individual patient's time. Another

21:17

opportunity cost is to recognize that about

21:19

three quarters of patients with cancer

21:22

come to their appointments with a family member or a loved one.

21:24

So when we think about opportunity cost and

21:26

time, there's also a time cost for the family

21:29

member. there's opportunity cost

21:31

for the health system where

21:33

physicians, nurses, and other

21:35

elements of the system time taken

21:37

away from delivering other care The

21:39

other kind of potential opportunity cost

21:41

here is if we're designing very large

21:43

clinical trials to identify

21:45

very small benefits, In the

21:47

research ecosystem, the most precious

21:49

resources are patients that are willing to go on trials

21:51

plus funding to support the

21:53

research. And so we've done a modeling

21:55

exercise where If you design a large

21:57

clinical trial, twelve hundred patients with

21:59

advanced cancer detect a fairly small

22:01

benefit, while for the same dollar

22:03

cost, in the same number of patients, you could run

22:05

three clinical trials to answer

22:07

three separate questions and you're trying

22:09

to identify a treatment benefit that would be

22:11

larger and more beneficial for patients. So there's

22:13

all these complex trade

22:16

offs.

22:16

The other issue

22:19

is the broken system of cancer drug pricing.

22:21

I'm not an economist, but in my

22:23

world, if I'm shopping for a bicycle and

22:25

I spend more money, I'm likely to

22:27

get a faster bicycle. if I'm looking for

22:29

a house and I spend more money, I'll get

22:31

a nicer home. And we asked this

22:33

question empirically if cancer medicines a few years

22:35

ago and published the results in Lancet

22:38

oncology, and we found that not only is there no relationship

22:41

between the magnitude of benefit of the

22:43

cancer medicine and its drug price

22:45

If anything, there's an inverse relationship

22:48

whereby the drugs that have the smallest

22:50

clinical benefits have the largest

22:52

price tags I don't think

22:54

you need to be in a conscious note that that system is

22:56

broken. So we've got a number

22:58

of competing opportunity costs

23:00

here in addition to the time for the

23:02

individual

23:03

patient. Are you starting

23:06

to see time toxicity being

23:08

factored into patient's decisions

23:11

at all? We just started publishing this

23:13

work in the last year, and so I think it's

23:15

probably too early to see empirically as it

23:17

changed conversations, but the concept has

23:19

really taken off. So I've

23:21

been approached many, many times by colleagues who are doing

23:23

work in this space. We've inspired a number of other

23:25

teams to start doing work actively. There's

23:27

large clinical trial cooperative groups

23:29

throughout can, the US, they're now engaged

23:32

and actually going to measure time

23:34

toxicity. So I think it's probably a concept that

23:36

was hidden Everyone knew it

23:38

existed but just wasn't really being talked about.

23:40

And now that we started to approach the subject, it's

23:42

really taking off.

23:45

As Adam

23:47

Gaffney pointed out earlier, time

23:49

is a finite resource within

23:51

medicine. We only have so much of it

23:53

both to give and to receive

23:56

care. How do we want to use

23:58

it? In some cases, it might mean

23:59

spending more time with the physician.

24:02

In other cases, when a patient doesn't have much

24:04

time left, spending less of it

24:06

getting medical care may

24:09

actually prove their quality of life. Like

24:11

much of medicine, it's a balancing

24:13

act and not an easy one.

24:15

And on that note, My time's

24:17

up on today's show, but there

24:19

is one idea that I'd like to leave

24:21

you with. Measuring how much

24:23

time people spend face to face

24:25

with doctors is hard. You either need to rely on

24:28

surveys, which can be inaccurate,

24:30

or literally have someone use

24:32

a stopwatch. I

24:34

recently had a chance to work with some

24:36

interesting data on face to face

24:38

time that's based on electronic sensors.

24:41

That data, which is early, and from

24:43

a company called damper, shows that patients spend

24:45

on average about one hour and

24:47

four minutes in doctor's offices, but

24:50

only twenty minutes of that

24:52

time is spent face to face with a doctor.

24:54

That's a lot of time

24:56

waiting. Anyway, I'd like

24:58

to thank my guests, Adam Gaffney,

25:01

and Chris spooth. And thanks to

25:03

you of course for listening. Let

25:05

us know what you thought about this episode.

25:07

Do you think doctors and patients

25:09

spend enough time together? How can we

25:11

deal with the problem of time toxicity?

25:13

Send us an email at babu

25:15

at freakonomics dot com.

25:18

at BAPU at

25:20

freakonomics dot com. Coming

25:22

up next week, odds are at

25:24

some point you or a loved

25:26

one has been or will be

25:28

seen in the medical setting by

25:30

someone who is not a doctor. rather

25:32

a physician assistant or a nurse

25:35

practitioner. So what do we know about

25:37

the care and costs they

25:39

generate? compared to doctors.

25:41

We surprisingly know very little.

25:43

In next week's episode, we'll find

25:45

out a bit more. After balancing

25:47

for those factors, we were surprised

25:49

we expected that to be the same. That's

25:52

all coming up on Freakonomics MD.

25:54

Thanks again for listening.

25:57

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26:22

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Mankure. Our staff also

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27:02

Scotland has gotten rid of parking

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fees at hospitals. And I think we should have

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that. You know you can't say something like that to

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me and expect you not to want to study

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it. Scotland delivered it at the cost of parking a

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egg. Look at what result of that. We're gonna

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change the whole episode now.

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