The Last Word
By Tom Black, MD, Publications Committee
This article was originally published in the July/August 2026 issue of Tarrant County Physician.
Recently I have found that I am less interested in making new friends, who I will probably associate with for a relatively short time, than I am in renewing past friendships with people who contributed to my being who I am today. I recently visited a friend I had known for, we decided, 49 years. This would clearly be our final visit since his stage IV renal cancer was causing his health to fail quickly. As we reminisced, he asked the rhetorical question often heard under such circumstances, “Where did all the time go?”
Last week I unexpectedly encountered a neonatologist I had worked with 30 years ago, in a hospital far, far away. We, too, reminisced for an hour over lunch. Later, I realized that neither of us had asked, “Where did the time go?” That thought never crossed my mind, and I doubt it crossed hers.
These two encounters made me realize that we physicians should rarely feel the need to ask, “Where did the time go?” because we know where our time goes. It goes to our patients, our families, and often, to other worthwhile activities and groups. My professional time is documented in operative notes, clinic appointments, hospital visits, deliberating over patients, preparing for upcoming procedures, advising fellow physicians, and keeping current with journals and CME. I spend much of my non-professional time with my wife, children, and grandchildren. A significant amount of time is occupied with church-related activities and constructive hobbies. Of the 1,440 minutes allotted to us each day, most of us can account for nearly every one of them.
These days my precious time is being siphoned off in new ways. “Just one more signature on one more form. Don’t forget the date and time. Initial this report. Complete this evaluation and these recredentialing forms.” Another spam call and another five-minute survey. Required medical record documentation occupies more time now than ever. EHRs take more time than paper records ever did. Logging in to the hospital computer takes over a minute while logging in to my office computer program takes 58 interminable seconds; I timed it. Aggravatingly, when I return to my desk after seeing a patient, I’ve been timed out and must log in again. More time lost.
Passwords deserve a special mention. Most of my passwords are now mandatorily sixteen digits, making them even less memorable and more time-consuming to enter. I see only asterisks, so I don’t realize a mistake until I hit “Enter” and must restart. Too many and too complex passwords for any human to remember requires a written list; doesn’t that defeat their purpose? I was recently introduced to multiple-step verification through a separate app and login before I could proceed. We are now subjected to the irony of a non-human computer requiring that we prove we are human by identifying in boxes stop lights or motorcycles that require a magnifying glass to see. Repeat until every pixel that might be a crosswalk is guessed correctly. It’s obvious what’s coming next—AI is already better at identifying school busses in such mini-photos than is a human, so we will be forced to prove somehow that we’re not AI. Good luck with that!
Even more time is consumed by seemingly endless forms I must now complete and “peer-to-(not a) peer” phone calls to justify what I plan to do or, worse, what I have already done. I detest getting a phone call from a secretary who then asks me to hold until the doctor can come to the phone. What is the purpose of a “heads-up” phone call anyway? I don’t need to be called at 2 a.m. to inform me that I might get a call at 4 a.m.! Stop doing that, please. Particularly annoying are required videos instructing me how to comply with governmental and hospital regulations. To complete the training, one must slide this box to that space or click on an arrow so that a door opens to reveal the next bit of information. We have each been through years of medical school, where we learned to learn by drinking from a proverbial fire hose. This type of slow-as-molasses-but-required computerized compliance training both wastes my time and insults my intelligence.
Why mention these “insignificant” intrusions? Because the most important lesson I learned from high school calculus is that enough miniscule—even infinitesimally small—bits of anything do eventually add up to a significant amount of something. Time is the perfect example. All those seconds and minutes wasted every day add up to a significant amount of time, every day, every week, every month, and every year. A Microsoft survey estimated that an average person spends sixteen hours per year entering passwords (not counting failed attempts and resets)—it is significantly longer for physicians. It’s no wonder that old-timers are leaving their medical practices while the younger ones just accept it as normal. Well, it isn’t. At least, it wasn’t.
Our profession demands our time and attention, and in return, we deserve the satisfaction of knowing that the hours of our lives have been well spent. After a busy day filled with office appointments, hospital visits, and surgical procedures, I want never to wonder where my time went—I fully experienced and can account for it. I just don’t want it wasted. Paradoxically, perhaps, it’s my days off from work when I look back in the evenings and wonder where the time went because I don’t seem to have much to show for it. No one’s life was made any better because of anything I did, sometimes including even my own.
That’s not to say that every moment must be spent in the relentless pursuit of professional goals. Stephen Covey taught this in his landmark book, The 7 Habits of Highly Effective People. His seventh habit is the need to Sharpen the Saw. This means to take time to relax and refresh, literally to “re-create,” so you can return to doing whatever you do and do it even better.1
The next time you hear someone say, “Where did all the years go?” you will realize that those words are code for, “My life is passing and I don’t have as much to show for it as I would like.” You, I expect, will think otherwise. My now deceased friend had spent his career in finances. Not that finances aren’t important, but his had been neither a happy nor rewarding life. We are fortunate to be in a profession that can offer that satisfaction, and I applaud the dedication each of you has that allows you to make a difference in people’s lives.
Embrace every opportunity to take control of your time. Rely on physician extenders to help you clinically. Rely on your office staff to do as much paperwork (now computer work—even worse!). Seek out and utilize the short cuts and templates available on many EHR programs. Embrace AI for the unimaginable improvements in time and accuracy it will offer us. Manage time—don’t allow it to manage you. For physicians especially, time is the substance from which healing, compassion, and a meaningful life are made.
References:
- Stephen R. Covey, The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change (Free Press, 1989).
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