“Good Care Is Slow Enough to Be Able to Pay Attention”: Primary Care Time Scarcity and Patient Safety

Shannon Shatterwhite, Michelle-Linh T. Nguyen, Vlad Honcharov, Aoife M. McDermott, Urmimala Sarkar*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: There is growing, widespread recognition that expectations of US primary care vastly exceed the time and resources allocated to it. Little research has directly examined how time scarcity contributes to harm or patient safety incidents not readily capturable by population-based quality metrics. Objective: To examine near-miss events identified by primary care physicians in which taking additional time improved patient care or prevented harm. Design: Qualitative study based on semi-structured interviews. Participants: Twenty-five primary care physicians practicing in the USA. Approach: Participants completed a survey that included demographic questions, the Ballard Organizational Temporality Scale and the Mini-Z scale, followed by a one hour qualitative interview over video-conference (Zoom). Iterative thematic qualitative data analysis was conducted. Key Results: Primary care physicians identified several types of near-miss events in which taking extra time during visits changed their clinical management. These were evident in five types of patient care episodes: high-risk social situations, high-risk medication regimens requiring patient education, high acuity conditions requiring immediate workup or treatment, interactions of physical and mental health, and investigating more subtle clinical suspicions. These near-miss events highlight the ways in which unreasonably large patient panels and packed schedules impede adequate responses to patient care episodes that are time sensitive and intensive or require flexibility. Conclusions: Primary care physicians identify and address patient safety issues and high-risk situations by spending more time than allotted for a given patient encounter. Current quality metrics do not account for this critical aspect of primary care work. Current healthcare policy and organization create time scarcity. Interventions to address time scarcity and to measure its prevalence and implications for care quality and safety are urgently needed.

Original languageEnglish
JournalJournal of General Internal Medicine
Early online date15 Feb 2024
Publication statusE-pub ahead of print - 15 Feb 2024

Bibliographical note

Copyright © Springer Nature B.V. 2024. This version of the article has been accepted for publication, after peer review and is subject to Springer Nature’s AM terms of use [https://www.springernature.com/gp/open-research/policies/accepted-manuscript-terms], but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/s11606-024-08658-1


  • primary care, safety, quality, near-miss, time scarcity, work design


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