By Dr. Khashayar Rafat Zand
Always too eager for the future,
We pick up bad habits of expectancy. …
— Philip Larkin, “Next, Please”
1. Introduction
Modern healthcare often feels like a colossal machine—an assembly line where clinicians swiftly move from one patient to the next. The words “next” can carry a potent symbolism: it embodies the perpetual forward motion of a system pressed for time, but it can also obscure the artistry and empathy inherent to medicine.
In this article, I reflect on a personal encounter that reawakened the sense of purpose often lost in high-volume settings and explore how we might combat “next-ism” through thoughtful leadership, deep patient engagement, and ethical stewardship.
2. A Personal Encounter: Anna’s Full-Body MRI
2.1. Rediscovering Follow-Up in Private Practice
One of the most gratifying aspects of private practice is having the autonomy to follow a patient’s journey from diagnosis to resolution. Recently, I encountered “Anna” and her mother, who arrived for a full-body MRI. This wasn’t just a perfunctory scan; it was an investigative tool aimed at pinpointing elusive symptoms that had baffled other clinicians.
“Once in a while, you get a chance to make a real difference for a patient.”
Where a rushed environment might have settled for superficial imaging, we had the time and resources for thoroughness. The results raised legitimate concerns that required further evaluation. By 11 p.m. on a weekday, emails with additional details were already circulating among the care team. By Friday, Anna had a clear path forward—one that might have been lost in a more fragmented healthcare system.
2.2. The Reward of Seeing It Through
This rapid, complete diagnostic process gave Anna and her family clarity and spared them the anxiety of weeks—or months—of limbo. For me, it rekindled the core satisfaction of medicine: diagnosing accurately, communicating effectively, and actively participating in the solution. In a system often designed to process volume, having the chance to truly “wrap” a case felt like reclaiming the art of medicine.
3. The Massive Machine vs. The Artist’s Workshop
3.1. Sausage Factory Mentality
Healthcare structures often measure success by numbers: how many patients seen, how quickly, how many tests ordered. The end result can be a “sausage factory” approach—patients become products moved along a conveyor belt from one station to the next with minimal room for individualized attention.
Clinicians themselves may feel reduced to mechanical roles, echoing the refrain “Next!” after each brief encounter. Over time, this mindset can engender burnout, moral distress, and a disconnection from the very essence of care.
3.2. The Artist’s Workshop
In contrast, consider the “artist’s workshop” model. Here, each case is unique, akin to a canvas awaiting the painter’s expertise. The physician invests time in nuance, diving deep into each patient’s story, symptoms, and psychosocial circumstances. This approach doesn’t equate to inefficiency. Rather, it seeks thoroughness—leveraging technology and collaboration to expedite accurate diagnoses without sacrificing humanity.
4. The “Next” Theory: Breaking Down the Concept
4.1. “Next” as Burnout Cue
In overloaded settings like emergency rooms, doctors may quietly (or even openly) wish for the “next” patient—the one who might offer a quicker fix or a more dramatic “save.” It’s human nature to gravitate toward scenarios where one can make a clear impact.
However, this mindset can marginalize complex or chronic cases:
- 90-year-old with multiple comorbidities: “We can’t fix everything, so maybe there’s little point trying.”
- Chronic abdominal pain with no clear etiology: “They’ll need a specialist, or they’ve been here before—there’s nothing I can do.”
The physician inadvertently checks out, moving physically and mentally to the next slot, hoping for an easier or more “meaningful” situation.
4.2. The Dreadful Waiting Place
In this “next” environment, both patients and physicians wait:
- Patients: Waiting for their turn, waiting in lines, waiting for scans, waiting for someone to offer them hope.
- Physicians: Waiting for the next interesting case, waiting for that one “big” save that justifies all the administrative and emotional burdens.
This mutual waiting cultivates a sterile atmosphere where empathy and personalized care fade into the background, replaced by throughput metrics and standardized protocols.
5. Reclaiming Purpose and Ethical Leadership
5.1. Creating Space for Impact
One antidote to “next-ism” is to consciously build systems and schedules that allow for pivotal moments. In private practice, this might mean setting aside blocks of time for complex cases, ensuring prompt follow-up, or leveraging digital tools (email, telehealth) to sustain conversations beyond the clinic walls.
“Healthcare has become a massive element, and we need to investigate our work environment to differentiate between the sausage factory and the artist’s workshop.”
5.2. Collaboration and Rapid Response
Healthcare doesn’t have to be slow to be thoughtful. Anna’s case demonstrated how a focused team, armed with technology and a shared commitment to thoroughness, can rapidly move from suspicion to solution. This demands:
- Open communication channels (e.g., direct physician-to-physician emails, secure messaging)
- Swift scheduling (e.g., same-week scans or subspecialty consults)
- Clear accountability (e.g., identifying who coordinates and follows up each step)
5.3. Ethical Stewardship in a High-Volume World
Responsible leadership means valuing both efficiency and depth. This may involve:
- Transparent Communication: As with cost discussions, being straightforward about the time and attention certain cases require fosters patient understanding and institutional support.
- Cultivating Expertise: Encouraging ongoing learning and specialization so physicians feel equipped to handle the intricate, less “heroic” cases as well.
- Advocacy for System Change: Urging policymakers and administrators to recognize that metrics alone cannot capture the quality of patient care.
6. The Human Dimension: Balancing Heroic Saves and Chronic Cases
6.1. The Teenager in Crisis vs. the Complex Elderly Patient
The heroic rescue of an opioid overdose in a teenager is an undeniably dramatic moment—often the stuff of headlines and commendations. Yet the 90-year-old with multiple ailments deserves the same attentiveness, even if the result is palliative or incremental.
By reframing every patient as someone who might benefit—some in small but crucial ways—physicians can shift from “waiting for the next big save” to making a meaningful difference in each encounter.
6.2. Restoring Empathy as the Default
Empathy doesn’t have to slow clinicians down. Rather, it can streamline decision-making by:
- Building patient trust early
- Reducing repeated visits through thorough explanation and follow-up
- Fostering compliance with recommended interventions
In short, empathy and efficiency are not adversaries; they can be synergistic when embedded in well-designed care pathways.
7. Concluding Reflections
Healthcare systems are under immense pressure, and the refrain of “Next!” is symptomatic of this strain. Yet the story of Anna’s MRI illustrates that even within a demanding ecosystem, pockets of excellence can flourish. By rejecting the sausage-factory mentality and embracing the artist’s workshop ethos, physicians can rediscover the soul of medicine—diagnostic curiosity, collaborative problem-solving, and genuine compassion.
The “Next” Theory challenges us to recognize that both patients and doctors inhabit the same waiting room, each hoping for the moment of clarity where true healing can begin. Through mindful leadership, improved system design, and relentless empathy, we can transform this waiting space into a place of action, resolution, and renewed purpose.
8. References
- Shanafelt, T. D., & Noseworthy, J. H. (2017). Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129-146.
- Berwick, D. M. (2009). What ‘patient-centered’ should mean: confessions of an extremist. Health Affairs, 28(4), w555-w565.
- Institute of Medicine (US). (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press.
- Laine, C., & Davidoff, F. (1996). Patient-centered medicine: a professional evolution. JAMA, 275(2), 152-156.
Disclaimer: This article is based on personal reflections and experiences. Individual clinical cases and administrative conditions will vary, and specific approaches should be tailored to local regulations and patient circumstances.