Was there anything that could counteract the detrimental impact of the three-year financial forecast that now appears on statements by law? The researchers created a wide bracket as a possibility. They presented a credit card statement that included the forecast, but added an additional note. Individuals saw a simple statement that they could pay any amount between zero dollars and the full balance. This simple addition had a big impact. It opened people up to considering the entire range of possible contributions. Those presented with the wide bracket of options intended to pay over twenty times the minimum, amounting to just shy of half of their revolving debt.
Wide-bracket framing pulls us out of focusing on the present. We think bigger-picture and with greater regard for our long-term plans, including how we spend our money. But it also influences how we spend our time. The impulse to save time now is why we continue to choose multitasking solutions even when they don’t fit the situation. But wide brackets can break that pull, orienting us toward rewards that might require we wait for them to arrive, nudging us to choose quality over quantity, doing less in any one moment but doing it better. When the set of choices we consider expands beyond those that lie right in front of our eyes, we plan better for the future.
The Dilemma of Doubling Up
But there’s a caveat. It is not always a mistake to succumb to our in-the-moment wants. There are circumstances where the choices that we feel pulled toward right now also align with our long-term interests. The key is knowing how to recognize these moments.
Diwas KC is a statistics guru at Emory University. He investigated the impact of multitasking on the productivity of emergency room doctors who must choose how best to juggle the care of multiple patients. For three years, he and his team gathered all kinds of data on the amount of time these physicians spent with patients, how they diagnosed their maladies, and whether the patients returned to the hospital with further complications. KC wondered whether physicians are more or less effective as their patient load grows larger. Does multitasking improve the quality of care and the efficiency of ER visits for these patients?
To understand how and when emergency room doctors multitask, consider the usual chain of events after you or I arrive at the hospital. A triage nurse evaluates our condition. The nurse enters our patient information into a virtual queue, and our electronic record is color coded to indicate how serious our symptoms are. Someone makes a physical folder documenting all of our medical information. An emergency room physician monitors the electronic queue to pick up new patients. The most severe cases are seen first. The physician also reviews the electronic and paper records, triage notes, and medical history reports. He or she orders diagnostic tests like X-rays or blood work, and seeks expert opinions from others, such as neurosurgeons or cardiologists. The doctor examines us and questions the family or friends who are present, in addition to reviewing test results as they come in from the lab. In the window of time when he or she is waiting for a specialist to weigh in or lab work to be done, the doctor could multitask. The discharge status of the last patient is in limbo as the diagnosis and course of treatment are being determined. Should the physician move on to the next patient during this time, or focus on the last patient fresh without muddying the cognitive waters with a new case? Would the patients be better off if the doctor multitasked?
Professor KC followed the experiences of more than 145,000 patients that physicians in this emergency room processed during a three-year period. He found that multitasking during the waiting window was both good and bad.
First off, multitasking when the patient load was minimal was linked to faster rates of patient discharge. Physicians used the idle time they had while waiting for test results to see new patients or attend to ones already in the queue. Multitasking sped up the process of evaluation and diagnosis for the entire caseload. When the demands on their time and mental resources increased, physicians doubled down on the job and worked faster.
To make this concrete: On average, KC’s data showed, it took about one hour and forty minutes for any one patient to be released from the emergency room. Say a physician in the hospital was seeing three patients at once. Now, imagine that another patient arrived and the physician was suddenly handling four patients at the same time. You might think that the wait time would increase substantially for everyone. You might do the math like this: An hour and forty minutes divided by three people is about thirty-three minutes of face time per person with the doctor. So adding another patient to the mix would add another thirty-three minutes to everyone’s wait time. Not so. Because multitasking can be beneficial, adding another person to the rotation actually led the doctors to work more efficiently. In fact, emergency room physicians increased their pace of discharging patients by about 25 percent when their load went from three patients to four. When that fourth person showed up, it added only about seven minutes to the discharge time for any one patient despite the doctor now simultaneously attending to more individuals.
Adding to our workload when things are relatively easy improves performance because low levels of stress actually assist in cognitive functioning. When we experience something new, unpredictable, or out of our control, our bodies respond by producing hormones—including cortisol, adrenaline, and noradrenaline—that prepare us to deal with that stress. These hormones impact the functioning of our hippocampus, amygdala, and frontal lobes—our most important brain structures for learning and memory. Multitasking, by indirectly engaging these parts of our cognitive system, helps us do our jobs better.
The problem is that the benefits of multitasking have a limit. At some point the mental cost of switching between tasks exceeds the benefits that low levels of stress offer us. For the emergency room doctors, as their patient load grew, there was a point—between patients five and six—at which the strain of multitasking among numerous patients became counterproductive. Whereas adding one more patient when the load was pretty small motivated the physicians to work more efficiently, adding one when the load was high crippled their efficiency. Because it took time to review the case files, remember the pending diagnoses, and recall what tests had been ordered for whom, the ability to move quickly through a patient load slowed down drastically as their caseload increased beyond five patients. The physicians’ mental bandwidth wasn’t able to keep up with the demands placed upon them. In fact, their pace per patient slowed down by 6 percent. To put that in perspective, when the doctors handled five patients at a time, any one patient sat in the ER for a little over two hours. When a sixth patient came in, that jumped to two hours and forty minutes.
The same pattern of effects emerged when KC examined the quality of the physicians’ performance. With a small patient load, new admits increased the number of diagnoses per patient made by the physicians. This is a good thing, because a diagnosis ensures that symptoms are being addressed and the patient’s problems are being solved. Multitasking when the caseload was small improved the quality of care for each patient. However, when the patient load increased beyond a tipping point, the physicians couldn’t keep up. Once the number of patients exceeded four, physicians made fewer diagnoses per patient. Some patients even left without a diagnosis. When the caseload was high, patients were also more likely to revisit the emergency room within twenty-four hours, suggesting they were more likely to be discharged without their symptoms being fully remedied.