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Your patient list for the day is long, family meetings are scheduled, and you are starting your day 20 minutes late because the dog barfed on your kid’s homework. The triple latte you guzzled on the way in with a mountain dew chaser isn’t going to give you enough energy to get through the day. In addition, your pager is chirping like a manic parrot and your receptionist is waving a stack of messages at you as you stagger by, briefcase heavy with the charts and projects you optimistically thought you’d do.
Short of cloning yourself ala Dolly the Lamb, what’s a conscientious doctor to do? Hospitalists are extremely busy physicians, with large, high acuity patient loads and anxious patients and families. In order to be an effective, caring physician, you need to learn to manage your time.
Following are some tried and true time savers from actual physicians who walk in your shoes:
*Chunk your phone calls and family meetings: Set aside a specific time of day when you return phone calls, rather than interrupting your day constantly to talk to patients and family. It is entirely appropriate to tell a family that you will call at a certain time, and get a number where they will be. Try to do all your phone calls at the same time. A CEO of a company wouldn’t take calls at any given time and nor should you. This not only makes good time management sense, but is good patient care as well. If you have spent lots of time on phone calls before you have finished seeing your patients, you are potentially delaying timely patient care.
Delegate: as a physician, you have a certain skill set that you do best, just as nurses, ward clerks and medical assistants do. Focus on doctoring–let nurses and aides help patients get up and check vital signs. This is not to say that you shouldn’t help patients with daily needs, but remember, if you are consistently doing nurse’s aide duty, you are not doing physician duties.
*Watch chit-chat: Interaction with fellow doctors and staff is one of the things that make our days enjoyable, but watch that you aren’t hanging out at the ward clerk’s desk or in the physician lounge excessively.
*Use email: Use email when ever possible. This avoids endless telephone tag for non-urgent matters.
*Pages: When you are paged, respond to the page, and ask if anyone else wants to speak to you before hanging up. This decreases the amount of times you dial and wait for someone to come to the phone. This is especially important when dealing with the ED as frequently more than one doctor will be paging you at once.
*Charting: for pity’s sake, write legibly. That’s one less page you will get because you took the time to write lanoxin carefully so they didn’t call you to ask about the levofloxin dose. Carry admission paperwork around with you, so you are not searching for it.
*Computers: drink the Kool-Aid. Computers are here to stay and your secret war against them is unwinnable. Learn how to type (there’s typing programs you can do at home. My 9 year old learned to type this way, and so can you!) Learn all the short cuts you can on them to speed your charting.
*Computers: part II: EMRs are a great resource, but you can get sucked into finding TOO MUCH information. Did you really need to know that your patient lists MOM as an allergy because she gets a milk mustache? Once you have found what you need–STOP!
*Patient education: patients need to be educated by us all. Remember, studies have shown that patient material needs to be at the 5th grade level, with simple instructions. Save your long winded CHF explanation for your medical student and focus on the basics: “your heart doesn’t squeeze blood out very well but we have medicines that will help.” Enlist nurse educators–remember this is part of delegation!
*Start on time! Duh, but do it!
*Try NOT to multitask. Yes, do fill out a form if you are on hold, but don’t write orders while talking to a patient’s family on the phone. Focus on each task deliberately, and it will actually go much faster. Also, talk less and listen more, AND STOP INTERRUPTING! Conversations can be completed faster if you take the time to hear what the person is saying, rather then readying your response, or thinking about something else.
*Patient exams: pay attention to what you are doing. Listen to the lungs, not your pager going off! Ask the ROS while examining the patient. To bring the meeting to a close, ask if the patient/family has any concerns or questions. When they respond, answer accordingly, and ask “Anything else?” and then stand up and shake hands. Tell them you are available if needed and the nurse can page you if any issues arise.
*Take a break. Get a cup of tea, rest your brain and calm your senses for at least 5 minutes every two hours. Go to the bath room if you need to! A refreshed physician is much more efficient then a frazzled one.
Lastly, take the time to try various tips. Some will work for you right away, others won’t work at all. The key points here are: trying to chunk your tasks (group phone calls, patient meetings) and to focus on what you are doing rather than being distracted and multitasking. Being a hospitalist has led to what I call “PADHD” disorder–Physician attention disorder/hyperactivity disorder. We can nip this disorder in the bud, and live calmer more focused lives that benefit our patients as well as ourselves.
write by Jerome
