(Comment) – Once in residency, time was fully commodified. As Neil Postman writes, “In the eternal struggle between God and Mammon, the clock quite unpredictably favored the latter.” As the pandemic made telemedicine routine, we were nudged to draw out five-minute telephone visits across a billable threshold of six minutes. Our notes closed with obscure timestamps like “greater than 50 percent of this twenty minute visit was spent in consultation with the patient.” Once in consultation with the patient, I was trained to set temporal boundaries: “We only have time to discuss one problem today.”

I was barely out of training before I began receiving frenetic promotions for telemedicine platforms promising to reduce my work time so I could see more patients and generate more revenue “immediately.” Through clinical machine-learning, I could quickly churn though “low acuity asynchronous visits . . . amounting to ten visits in one fifteen minute block.” One platform proudly boasted reducing “a single visit to 89 seconds of physician time.” (Read More)