Monday, ten past eight. Twenty-three patients to see and a clinic after lunch.
I come through the double doors already counting beds.
“Right. Who’s first?”
The registrar gets through bed one in forty seconds: history, numbers, plan. Bed two takes thirty. By bed four we’re moving well.
Or moving quickly. From where I’m standing, the two look much the same.
Bed six is an older man with heart failure.
“Obs stable. A bit drowsy overnight. Plan to continue.”
Drowsy. The word was said out loud, in front of all of us. I nodded, and we moved on.
Twenty minutes later the foundation doctor catches me in the corridor.
“Sorry, it’s probably nothing. His wife said he’s been vague since Tuesday. Apparently he’s usually sharp as anything. I wasn’t sure when to say.”
His sodium comes back at 118. We sort it. He was lucky, and so were we.
But stay with the other detail. She wasn’t sure when to say.
A consultant, a registrar and a whole team had stood at his bed, discussed him, made a plan. Somewhere in all that, there hadn’t been a moment.1
I would have stopped
That’s my first reaction, and I notice how fast it arrives.
I like being quick. I do. There’s a list to clear and I enjoy moving things along. But when someone needs to learn, or a problem needs time before it makes sense, I slow down. Always. I’ll go over it again, and again if I have to, because a nod means nothing if the person behind it is still lost.
Even writing this, I feel a little defensive.
I would have stopped. I would have listened.
If I’d known.
And there it is. My willingness to slow down only switches on once someone tells me we need to. Someone else has to decide to interrupt me first.
The room reads the clock
Nobody had to say hurry.
The glance towards the next bed. The half-step away while someone’s still mid-sentence. “Anything else?”, asked with my attention already at bed seven.
People notice. New people notice most, because they’re still working out how things go around here: which questions are welcome, what earns a sigh, whether “anything else?” is a question or a door closing.
From my side, we’re moving quickly until something needs more time. From theirs, you’d better have a good reason to hold everyone up.
A wife’s remark. A feeling that something doesn’t fit.
Is that enough? I’d say yes without hesitating. They may not know that yet.
So the presentation gets shorter. The uncertainty drops out. “His wife mentioned something” gets saved for the corridor, the team looks efficient, and I never hear the version they talked themselves out of.
Whose time are we saving?
This is where Cognitive Oxygen® (COx) comes off the slide and onto the ward.
Thinking needs room. Enough to notice something, wrestle with it for a second, find the words. Sometimes just enough to say, “I don’t know why this bothers me.”
When I arrive already feeling behind, I squeeze that room without meaning to. A few seconds shaved off an explanation. A question answered before it’s quite finished.
I’m ready to give time to the complex thing. The trouble is, the complex thing often turns up as a question someone hasn’t found the words for yet.
That’s awkward. I can care about teaching and still set a pace that makes a junior doctor rehearse her worry three times before she says it. Meanwhile, we’ve reached the next bed.
Pace matters, of course. In an emergency, delay can cost a life. Twenty-three patients aren’t a metaphor, and neither is the clinic. Nobody gets unlimited time.
But I wonder how often we save thirty seconds at the bedside and spend twenty minutes in a corridor, finding our way back to what someone almost said.
Give the half-thought somewhere to land
Red Team Thinking® has a simple tool for this: Think-Write-Share™. Everyone thinks and writes on their own first, then shares. The quiet thought gets onto paper before the loudest voice fills the room.
At a team briefing, or before a hard decision, try two minutes with two questions:
What are we missing? What worries you?
Then let the most junior people speak first, before my answer gives everyone else something to agree with. The half-formed concern already has a place in the conversation, and nobody has to hunt for a gap.
On a ward round the experiment is smaller. Stop walking. Plant your feet.
“Before we move on, is anything bothering anyone?”
Then wait. Longer than feels comfortable. Long enough for someone to decide their thought belongs here, even half-finished.
When it comes, the first response matters more than the question. If I ask for concerns and then glance at the clock while someone answers, they’ll clock that too.
Two minutes won’t undo a hierarchy. One question won’t make everyone brave. Some mornings the clock will still win.
But “I’m always happy to stop” leaves a lot of work to the person who has to stop me.
What I keep coming back to is whether the person beside me knows they can say:
“Actually, can we stay here a moment?”
If this is happening in your team right now, hit reply and tell me what it looks like. I read every reply, and I answer.
The opening scene is a composite, drawn from many ward rounds rather than one patient.”