This book is written by two American academics. Its message is that: ‘the bandwidth of the mind is narrowed if it is distracted by other more pressing problems’. By bandwidth they mean the ability of the mind to cope with a current problem. It is a singular strength of the book that their results cover a range of cultures from the US to the Indian poor. The problem at the heart of the book is poverty, but their results also hold if the mind is preoccupied with other forms of scarcity such as time pressure and loneliness. Their results are impressive; the loss of function, both IQ and ‘executive control’, they can demonstrate is often as great as that produced by a sleepless night. When the mind loses bandwidth it not only functions more poorly but also focuses exclusively on the problems at hand and on the present: the problems in what the authors call ‘the tunnel’.
What remains outside the tunnel and, in particular, future needs are ignored. This, as they demonstrate, is why payday loans at exorbitant rates are so attractive to the poor. Similarly, with colleagues I have described how asylum seekers simply do not attend to their health needs while waiting for an asylum decision, a situation that we called ‘Home Office syndrome’. The good news is that, in their tests, what makes the poor have a lower bandwidth is not their personality, but the context. If we lived their lives we would experience similar impairments.
How can the book’s findings be used to help those suffering from scarcity or reduced bandwidth? From a GP’s point of view the main benefit may simply be empathy; we need no longer get so frustrated that an unemployed man mired in debt does not take his tablets or attend appointments. Lack of bandwidth helps to explain why the poor have worse compliance. A general remedy the book offers to lack of bandwidth is building in slack.
For GPs, suffering from scarcity of time, this may mean keeping the scheduled appointment length at the average length for that consulter and building in 15-minute breaks at regular intervals to allow catch-up. For young offenders on probation it means offering mental health facilities at the same time and place as their probation appointment; they simply do not have sufficient bandwidth to attend both separately. Read the book yourself and see if you can apply its insights to your daily lives and those of your patients!
- © British Journal of General Practice 2015