Author Affiliations: Rotman School of Management, University of Toronto, Toronto, Ontario, Canada (Dr Christianson); and Department of Medicine and Critical Care Program, Kingston General Hospital, Queen's University, Kingston, Ontario (Dr Ilan).
We appreciate the opportunity to respond to Jones and colleagues' comment on our recent publication.1 Brevity constraints of the Research Letter prevented our supplying a fuller discussion that might have obviated the authors' main misunderstanding. We did not claim that the problem facing clinicians when they use their scarce handoff time to discuss a portfolio of patients could be reduced to a formal portfolio management problem. We completely agree with the authors that the formal conditions for such a framing are not met in actual practice. Furthermore, we fully agree that psychological evidence shows clearly that human beings perform badly in time allocation problems. It is just such results that suggest to us that the bias toward spending excess time on early cases that was measured in our original report is probably widespread. On the possible confounds, we can agree that it would be interesting to measure other variables and relate them to length of patient discussions. However, as we pointed out in our Research Letter and online supplement, the possibly related variables are effectively randomized by following lists in bed number or alphabetical order.
Christianson MK, Ilan R. End-of-Round Time Compression in Physician Handoff Sessions—Reply. JAMA Intern Med. 2013;173(11):1033-1034. doi:10.1001/jamainternmed.2013.1254