The Farmer's Table: Rethinking Stewardship in Medicine

When we talk about stewardship in medicine, it usually means handling precious resources wisely:

• Blood bank stewardship (don’t squander that O-negative so it’s there in a crisis)
• Antibiotic stewardship (use the narrowest spectrum possible, so we don’t fuel resistance)
• Resource stewardship (choose wisely, avoid unnecessary costs)

These practices are ingrained in how we train and practice. They’re respected. They matter.

But there’s one resource we rarely name as such: time.

We want more of it everywhere. Time with each patient, time to finish our note and inbox, time to rest outside the clinic walls. Yet we practice medicine in an era of workforce shortages and financial strain. The tension is real.

What if we began to talk about time stewardship? Not just time management, but a collective ethic: honoring time as finite, precious, and shared.

[Related Read: https://edhub.ama-assn.org/steps-forward/module/2813034]

The Saturday clinic lesson As a resident moonlighting in a Saturday walk-in clinic, I learned efficiency the hard way. The rule was simple: everyone who arrived by the cut-off time had to be seen before anyone went home.

I discovered quickly that giving enough time to each patient mattered more than giving all the time to a few. Stewarding my minutes meant patients felt heard, care was delivered, and the staff didn’t stay into the night.

The farmer’s table Years later, I coached a resident who took pride in being “the doctor who really spends time.” His patients loved him. But he was burning out, staying late to finish notes, then showing up exhausted at home.

I shared a metaphor: If you’re the farmer who delivers produce and milk to the whole village because you see the need, but your own table is empty, how do you feel about that?

He paused, thought, and then said it himself: “So I need to be a good steward of time.” (Obviously his word stuck with me!)

That pivot helped him see the trade-offs more clearly. Stewardship meant not just giving generously, but giving wisely. Protecting enough time for patients and for his family & own well-being.

Reflection: Where in your week could “time stewardship” help you balance the trade-offs, so your patients feel cared for, your team gets home, and your own table isn’t left empty?