Ever since I heard about the concept of a 15-minute city I have wondered if a 15-minute hospital would work, and if it would be worth the effort of planning it.

Some building where everything (I do mean everything) is within a short walking distance, where things happen as quickly as possible and of course it's all a bit greener and promotes healthy living.

The vast majority of my time as a doctor has been spent in relatively small hospitals, so maybe I have already experienced this place. 15 minutes could get me from one corner to the other of nearly every hospital I have ever worked in, though for some it would be a close call relying on those weird shortcuts through darkened corridors that we all manage to find.

A small hospital allows you to find the people you need. In North Tyneside Hospital, where I have worked for 25 years, there is a very long main corridor. In my early days as a consultant, if ever I needed advice or a second opinion, I could reliably find someone just by walking up and down that corridor a couple of times. 15 minutes was all it took. Email and Teams eventually spoiled that and made me more sedentary (low back pain to follow). Those corridors are quieter now, the number of passing “-ologists” has dropped markedly, but I suppose they are easier and quicker to find on email or phone now.

A discussion would follow about tests, the best timing, the best approach, the differential diagnosis and a clear logical plan would be made. It took about fifteen minutes.

Something has been lost when you only communicate instantaneously by device. I so enjoy bumping into people, it's how I work. Medicine needs nuance, discussion and debate. Having to arrange and schedule every conversation feels wooden, less humane. Time ends up being used less efficiently, those conversations have to be scheduled into the Microsoft default 30 minute diary slot, things can't intersect, we can't be fluid. I wish I had that 15 minute corridor wander again.

There is an assumption that having people and things available within moments is better, it isn't. As an example, getting anything done out of hours used to be a challenge. It required a completed request form (signed with real ink) and a trip round to the relevant department. You could find yourself hunting the on-call radiologist, breaching a darkened room after a timid knock, wondering if you were going to barge in on a barium enema. Or trying to find a surgeon in the mystical, unexplored rooms near theatres, where your lack of a disposable head covering made you feel like an uninitiated amateur. Or perhaps you were tackling the 3 gatekeepers of histopathology: doors; distance and departmental secretaries before you could get anywhere near the urgent histology tray.

A discussion would follow about tests, the best timing, the best approach, the differential diagnosis and a clear logical plan would be made. It took about fifteen minutes. Now we have 24 hour access to most things, requesting an out of hours test is much more routine, it takes mere moments. We know that this is increasing the amount of unnecessary tests with all the consequent problems that causes.

The 15-minute hospital isn't quite what I am after.  That grand title pushes us to do things more and more quickly. What we actually need is a return to the “take at least fifteen minutes”  hospital, where complex things must take at least fifteen minutes to be talked through with a real person. People and biology are far too complex to be rushed or squeezed into a flow chart or a series of check boxes on an electronic request form.

Read more about the concepts of clinical reasoning and use the resources on the UK Clinical Reasoning in Medical Education website