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Step 1: Calming the Chaos and Cultivating Harmony - Time

This week, we will look at one of 3 key areas you can clean up to gain some control and improve harmony in your career and life outside of work. 


Today we will discuss gaining more control of your time.  I know, I know – you don’t have much control, and you feel you have way too much to do to fit it all in. Trust me. I know.


According to author Laura Vanderkam, we all have 168 hours a week. I checked her math. She’s right. Many residents, maxing out on their work hour rules, average 80 hours of clinical duties. Let’s say those residents are winning in the sleep arena - 8 hours of sleep each night. How many non-work hours does that leave per week? 32. We all see that number differently -- “Wow, that’s actually a lot.” “That is so little.” “Well, that’s at least something.”


No matter how you view it, let’s learn to capitalize on those hours for our good.  Also, we will look to see how we can try to reclaim some of the 80 hours of clinical work, or at least not let documentation spill into our non-clinical time.


First, let’s review Parkinson’s Law used in business but easily translatable to medicine. “Work expands to fill the time allotted.” What has been demonstrated repeatedly is when you give yourself an hour to complete something, even if it could be done in 30 minutes, it somehow morphs into taking up the hour.  Think of what happens when there is no set end time. So, you want to be strategic in your schedule. I utilize this in my outpatient work to complete my patient note before I see the next one (with rare exception). Actually, I do parts of it with the patient -- many enjoy seeing their record as you input. Why do I do this? First, I’ll never have the information so easily accessible from my brain than fresh out of the encounter. Second, having that time pressure of the next patient waiting, I am the most efficient I can be. Back when I saved notes for the end of the morning session, I was eating lunch and charting, and it took the whole time. Now, I enjoy a little mental downtime with lunch. (I didn’t get there overnight, there are a ton of strategies that can be used to build this skill, and it’s worth it.)


Second, let’s leverage your schedule. List all the things you need to get done for the week – this should include your rejuvenation time. Prioritize the tasks. Schedule the highest priority first. (By the way – your “you” time should be first on the schedule. I promise you; you will be most efficient when you keep your own batteries charged.) Now allot each task just enough time, applying Parkinson’s law. Use larger gaps of time for larger tasks. If you have an hour or two all at once, plan your didactic or grand rounds, etc. It’s much easier for larger tasks to be devoted to larger chunks of time to avoid task swapping.  Then those little openings – the few minutes before huddle after your computer is on, when you have a no-show, a little of your lunch break, etc., knock out a few inbox messages or emails. View your emails and inbox as a lot of little items rather than two big items.


Third, look for wasted time. Where can you reclaim time by cutting back on social media scrolling, reading the news? You don't have to give it up completely, but be mindful of how strategic you are being with your time. Also, are you task swapping, i.e., “multitasking”? That’s known to be inefficient. Where do chats with colleagues cross the line into excessive venting? You get to decide. I once walked into the call room to get ready for table rounds and listened while one resident vented about not having enough time to get things done for at least 15 minutes. Her colleagues had learned the art of headphones so they could focus. That’s not to say you shouldn’t find empathy for your colleagues or address issues that need to be changed, but at some point, it becomes a time sink that starts doing more harm than good. Where do you want to draw the line as the venter? What about as the empathetic ear and encourager?


Fourth, look for things that can be adequately done by someone other than you. Off-load them. Give things that your MA is better at to your MA. Give things that the social workers are better at to them. Adopting the mentality that you must be the doer of all things will drain your time. Some laundry mats wash and fold inexpensively. Curbside pick-up at grocery stores is usually free or has a minimal fee. Helping the kid down the street get volunteer hours or paying them to do the lawn is a possibility. Brainstorm – what are the things you can give up, and how can you do that?


Last, develop and stick to boundaries. When I need focused time but can’t control the busy environment I’m sitting in, the earphones keep me focused and send an external cue to others. (Thank you, residents, for the tip!) Rarely does anyone cross the boundary, and when they do, it’s usually because of an acute patient issue. At my private office, the staff has learned that I’m focused on my note when I exit the patient room, and once it’s done, I can breathe and hear their questions with my full attention.  When I was core faculty, I closed my door when I needed focused and dedicated time for more important tasks and opened it when I was doing shorter, less intense tasks. You can develop your boundaries that work for you. 


A note about efficiency in the exam room: the altruistic part of us that wants to give 110% to every patient, even if that means “going long,” often skews our view. It’s not as if we either give 110% or we don’t to that patient. It’s zooming out and seeing the big picture. If I go late with this patient, I’m taking from another patient or my lunch, or going home late or taking notes home to complete, and it’s affecting my self-care, health, and/or relationships.  So, on occasion, we can make that conscious choice after looking at the adverse time outcomes and accepting them. But if we make that the rule rather than the exception, it becomes toxic altruism instead of healthy altruism. 


Okay, so in recap – leverage Parkinson’s law and your schedule FOR you. Reclaim wasted time and off-load tasks that don’t have to be done by you. Set your boundaries and keep them FOR you – for your harmony in life.  Next week, we will look at the second key area.


Have a joy-filled harmonious week!  Tonya

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