In their famous good samaritan study, darley and batson (1973) found that

In the rough and tumble world of everyday politics, it often seems that the academic world has little influence and even less relevance. Senator William Proxmire's famous "Golden Fleece" awards used to serve as periodic reminders of our capacity to research seemingly trivial matters. But I have long felt that there ought to be a counterpoint award, which I would call the "Diamond in the Rough" or the "Hidden Gem" award, for those academic efforts that offer significant insights but have received little attention.

My nominee for the first Hidden Gem award sheds a penetrating and unusual light on how we shall maintain the quality of human caring in a health care environment increasingly dominated by questions of cost, efficiency and high technology. A unique and revealing perspective on compassion emerges from a 1973 study of 47 senior divinity students at Princeton University.

The authors, John Darley and C. Daniel Batson, contrived an elaborate experiment to study how personality and various situations were associated with the willingness to help someone in need. The experiment could not be repeated these days because it involved a deception.

The students knew they were being "studied" throughout the year; investigations began with a full battery of psychological tests aimed at measuring "religiosity" and service orientation. But the study's most important moment came as a total surprise.

One day, near the end of the semester, each student was to meet individually with an instructor to deliver a prepared talk. One group was assigned to write a talk about the parable of the Good Samaritan; the others had prepared talks about careers in the ministry.

At the end of the initial interview, each student was directed to a nearby building, where the talk was to be taped. The students were given one of three time constraints: "Hurry, you're already late," "They're ready for you now -- please go right over" or "It will be a few minutes before they're ready for you, but you'd best head over."

On the way to the other building, however, each student encountered a young man writhing in pain on the ground. He was actually a paid, trained observer, playing the role of the modern counterpart of the man encountered millennia ago by the Good Samaritan. His real job was to keep track of which students stopped, what they did once they stopped and how long they stayed.

When the data were analyzed, the only variable that correlated with whether or not a student stopped to offer assistance was the time available before the student's targeted arrival at the taping session. Of the total group, 40 percent offered some form of aid to the victim. Broken down according to the time constraints, 63 percent in the "low hurry" group, 45 percent in the "intermediate hurry" group, and only 10 percent in the "high hurry" group offered aid to the sufferer.

Neither the students' recent in-depth exposure to the parable of the Good Samaritan nor a service-oriented, psychological profile nor the type of "religiosity" evidenced made any difference in the decision to stop and help. There was no escaping the conclusion, the authors wrote in the Journal of Personality and Social Psychology, that the basic decision to care for another person in great distress was strictly a function of having time.

The tragic choice between time and compassion is being played out every day in our nation's hospitals, clinics and doctors' offices.

Recently, as an example, a young physician who had just completed her residency was required by her clinic manager to see expectant mothers for routine prenatal examinations at a rate of one every 10 minutes. She believed that the prenatal visit was an important opportunity to educate the patient and often required more than 10 minutes. Since she could not afford enough medical liability insurance to enter solo private practice and therefore had no good employment alternative, she perceived a serious moral conflict between her duty as a physician and the requirements of her job. Similar scenarios, unfortunately, may be repeated quite often, until we more fully recognize the connection between having sufficient time and caring.

In my own long career in medicine, one of the most valuable lessons I ever learned came from a wonderful physician who said that the most important habit a doctor could force upon herself or himself was to sit down at the bedside of each patient during daily rounds. Giving the feeling of having time, instead of shifting around in the sprinting position ready to take off to the next crisis, serves to unlock from the patient the most important information and concerns, otherwise too often hidden. It goes without saying these days that one of the biggest complaints of patients regarding their doctors and the health system in general is that they don't communicate. It takes time to listen and to communicate. We all know that time is money, and, in health care, people aren't paid for their time; they are paid for their productivity as measured by procedures done or tasks accomplished.

What do you think hard-nosed efficiency experts would do if they were suddenly confronted with an epidemic of nurses and doctors actually sitting down and listening to and talking with their patients? Right now, the efficiency gestalt and the financial incentives do not support such behavior.

We have not arrived yet at a consensus on what is best for the organization of health care in America, but increasingly we are engaging in debate on the real health care issues. The insights described above, and others from academe, can inform our thinking as we strive to create a system we would all like to be as technically excellent, humane, cost-effective and equitable as possible.

Roger J. Bulger, MD, is president of the Association of Academic Health Centers in Washington. His book "Technology, Bureaucracy, and Healing" will be published by the University of Iowa Press this fall.

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