You may be forgiven for equating a fix with the high which becomes part of the addiction cycle; yet our modern, western world seems not far removed from a similar phenomenon whereby short term and transient ‘reward’ has become the norm for the evaluation of so many aspects of our complex lives.

This starts at the top in governments who have their eyes on electability rather than the long-term benefits of their policy making. In health care, the same is true. It has become more attractive to talk about short-term cost savings than the work needed to attain long term goals.

When it comes to doctors spending time with patients, there is increasing pressure for us to see more people, or perform more operations or procedures, while at the same time we are told we must provide quality care. Hard working doctors who are berated for spending too long seeing their patients are far more likely to order tests and investigations or prescribe unnecessary drugs in order to close the patient consultation. This is short-sighted and dangerous, even more so when it comes to patients who have emotional crises, undiagnosed physical symptoms or who are returning to care repeatedly.

This sad approach to pressurising the work force is not new. Even way back, when I was a teenager prior to medical school, I took a holiday job working as a healthcare assistant in a nursing home; I remember the matron constantly on my back telling me to hurry up, when it came to feeding, washing, or dressing the elderly clients.

A few years ago, when I was working for a charity which supported homeless people in America, I encountered a similar attitude from my supervisor who was not keen on me ‘giving clients time’. Instead, he would rather that I didn’t miss out on what he saw as more valuable – giving an extra five minutes to make sure that the homeless clients who cleaned the premises did their jobs.

 Yet my experience was that giving someone time reaped dividends. A memorable example was when a client who had been very abusive and aggressive came to the office door asking for help. I invited her into the room, making sure that she knew that I had time to listen to her.  When we were both seated, suddenly she started to open up and I listened as she related her extremely moving and tragic life story. What happened next was a moment of genuine connection as I held her close, reassuring her that she was neither wicked, nor unforgiveable while desperate sobs erupted from somewhere deep within. It certainly transformed our relationship. A short time later, she allowed me to call for help on her behalf; she was seriously suicidal, and I agreed to accompany her for an evaluation by the mental health team. Unfortunately, the appointment could not have been more disastrous.

The pair of professionals sat at a distance from us, as though she was suffering from a seriously infectious disease. Their body language emanated judgement even before they voiced their dismissal of her distress. What could have been a meaningful and helpful time, instead sent her back to a place where she totally disengaged from the system, and I couldn’t blame her for that. It was no surprised that she simply disappeared off the radar, but I was exceedingly worried for her wellbeing.

It should have been a relief to find out she was alive, but I learnt she had been taken into custody and was now incarcerated in a prison, something to do with being in possession of a lethal weapon.  What a wasted opportunity and a crying shame that one of the most vulnerable members of society had been so let down, and at what cost?  And I am sure it was substantial to keep her locked within the expensive criminal justice system.

But returning to the present day, I can describe an example from only last week. The Emergency Department is always busy, but when an elderly man suddenly breaks down in tears, surely he deserves our focussed attention. He had been triggered and told me of his traumatic experience when he haemorrhaged after surgery.

When I related this experience to a colleague later on, they said “but it’s difficult when there are so many patients waiting to be seen.” I could see the alarm in her face as she worried that I might be advocating to spend more time with patients. Her fears are justified but we also have to be true to ourselves and not rush these precious moments of connection. While it may take longer in the short term, apart from being the good and human response, it will also save time in the long run.

Patients who have not felt listened to, or who feel misunderstood are far more likely to require another visit to the doctor. This may be counterintuitive but the kind of anxiety that leads to health-seeking behaviour is often both strong and pervasive. Either that or they may become angry or disillusioned and fail to report significant issues.

Spending a few minutes more to discover what is really going on with a patient will pay dividends.  But this notion is not popular with managers in the stress-filled NHS urgent and emergency services. They do not prioritise quality over perceived productivity. While personalised care is gaining traction, there is still significant dissonance when it comes to practice. The concept of putting more time and resources into an individual patients’ care in front line services is met with horror and dismay. There is a perception that patients will ‘demand’ more tests and will use services more, rather than less. Furthermore, it will not give the policy makers the satisfaction of more throughput, the truly political quick fix.

The failure of current practice is by no means exclusive to but may be particularly obvious within psychiatric services and in primary care where more and more patients are leaving with prescriptions for psychiatric drugs. Prescribing has multiplied on a logarithmic scale and despite the fact that many more resources have been put into the system, still the work continues to increase with more and more people seeking diagnoses and treatment for their distress. Surely this demonstrates that the system is broken, the drugs are not making people better and there are continual cries, that now is time for change.

What has changed across the board in the NHS, is that doctors are spending less time with patients. Solutions are not being sought in their lives and communities, rather quick fixes are sought, and has become the norm for medical practice.

Yet we continue doing more of the same and now we are reaping the consequences of what has gone before. There are more consultations, more investigations, more drugs prescribed, and more patients being treated than ever before, but the health of the nation is not improving.