Published in the June 2007 issue of Today’s Hospitalst.
Your patient list for the day is growing, with family meetings scheduled back to back. You’re starting your day 20 minutes late because the dog got sick on your kid’s homework, and your pager is already chirping like a manic parrot.
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Short of cloning yourself, what’s a conscientious doctor to do? As hospitalists, we carry large, high-acuity patient loads, and we care for anxious patients and families. But we also suffer from what I call “PADHD”: physician attention deficit/hyperactivity disorder. We allow ourselves to be constantly distracted or we try to do too many things at once, and we end up not doing some of them well.
We can nip this disorder in the bud and live calmer, more focused lives that benefit our patients as well as ourselves. But to do so, we have to learn how to better manage our time. As a locum tenens hospitalist who has been practicing for six years in Colorado, here are some tried and true time-savers that, used together, can save me up to one hour of every busy day.
● Chunk your phone calls and family meetings. Set aside a specific time to return phone calls, rather than continuously interrupting your day to talk to patients and family. It is entirely appropriate to tell family members that you will call at a certain time and to get a number where they can be reached.
I also try to do all my phone calls at the same time. This not only makes good time-management sense, but is good patient care as well. If you spend lots of time on phone calls before you have finished seeing your patients, you are potentially delaying timely patient care.
When I’m working the day shift, I try to do all my phone calls around 2 p.m., and actually set my watch to go off at that time to remind me. I find that it usually doesn’t take me more than 15 minutes to touch base with families.
And while the thought may horrify some physicians, I also occasionally give families my pager number and ask them to call in the afternoon. I find that that’s easier than playing telephone tag with them.
● Consolidate your pages. Speaking of pagers, when you are paged, respond “and ask if anyone else wants to speak to you before hanging up. This cuts down on the number of times you have to 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 is paging you at once. It also saves time to learn how to use text paging, sending a text message to pagers, not just numbers. We use text paging to remind physicians about meetings, so we don’t have to call or page each physician individually.
● 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, and let nurses and aides check vital signs and help patients get in and out of bed. This is not to say that you shouldn’t help patients with daily needs. But remember, if you are consistently acting as a nurse’s aide, you are not doing physician duties.
Nurses and medical assistants, not physicians, for instance, should be the ones to get patients water and pillows. And in some institutions where I’ve worked, nurses also fill out the discharge paperwork, a real time-saver that more hospitals should use.
● Use e-mail. Use e-mail whenever possible. This helps avoid endless telephone tag for non-urgent matters.
I use e-mail, for example, to give primary care physicians details about admissions and to send typed discharge summaries. I also use e-mail to send reminders and discharge summaries to subspecialists, to make sure that patients are being seen in the outpatient setting.
● Get charting down. For pity’s sake, write legibly. If you take the time to write “lanoxin” carefully, no one will call to ask about the levofloxin dose, so that’s one less page you’ll have to answer. And carry admission paperwork around with you, so you are not searching for it.
● Computers, part I. Drink the Kool-Aid. Computers are here to stay and your secret war against them is unwinnable. Learn how to type with any one of the many typing programs you can do at home, which is how my 9-year-old learned. And learn all the short cuts you can to speed up your charting.
● Computers, part II. Electronic health records are a great resource, but you an easily get sucked into finding too much information. Once you have found what you need, stop reading.
● Rightsize patient education. Patients need to be educated by us all. Studies have shown that educational material for patients needs to be at the fifth grade level, with simple instructions.
So 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.
● 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 be finished much faster.
Also, talk less, listen more and stop interrupting. Conversations can be completed faster if you take the time to hear what the person is saying, rather then preparing your response, thinking about something else or assuming you know what the person is going to say.
● Hone your patient exams. Pay attention to what you are doing. Listen to the lungs, not your pager. Ask the review of systems while examining the patient. To bring the exam to a close, ask if the patient or the family has any concerns or questions. When they respond, answer accordingly, and ask “Anything else?” Then stand up and shake hands. Tell them you are available if needed and that the nurse can page you if any issues arise.
And don’t interrupt your time with one patient to take phone calls or to speak with another patient’s family. Those interruptions not only waste time, but they also make the patient you’re examining feel unimportant.
● Keep a lid on 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.
● Take a break. Get a cup of tea, rest your brain and calm your senses for at least five minutes every two hours. Go to the bathroom if you need to. A refreshed physician is much more efficient than a frazzled one.
Marica Pook, MD, is a practicing locum tenens hospitalist in the Denver area and president of ExtraMD PC, a locums staffing company.
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