Prioritisation. We get taught that in medical school. There are at least twenty, if not more, patients per doctor on any ward. We look after all of them. There are jobs to do for them on a daily basis: blood tests to take and results to chase, scans to request, specialties to discuss management with, discharge letters to write, families to update, etc.

We have to prioritise. The person who suddenly became unwell and has a temperature will need to be seen first. The stable patient's family will need to be updated at some point during that day. The discharge letter is of least priority -- although the bed managers would beg to differ. The venflon insertion for antibiotics is also of lower priority, but not so low that the patient misses their next dose. Everyone else has different priorities and will interrupt you during your job so they can finish their tasks. So that discharge letter, interrupted three times requiring five minutes each time for you to find your 'space' again to continue writing, will take an extra fifteen minutes longer -- assuming you don't also make mistakes along the way because you were distracted.

We can factor in things that take time. On a familiar ward, we can find all the equipment we need to insert that venflon. But I can't factor in a patient's lack of veins or super-chattiness (or anxiety about being in a hospital that requires reassurance), so that will end up taking more time. I can factor in time needed to update a patient whom I know well, but I can't factor in another patient's family kidnapping me aside for an update just as I reach that bay, or the emergency buzzer that will go off because a patient has just blacked out and fell over in the toilet.

The theory is so simple. Prioritise the clinically unwell cases and work your way through, but there are factors that affect more than just how well or unwell the patient is. Blood tests take time to get to the labs and then to be processed, so although people are well, you don't want to wait to the end of the day to do it. Scans take time to be vetted and a slot allocated for the patient, so if you don't request it early in the day, that scan will not happen for today, or tomorrow, or even the day after.

It comes with practice... eventually.