Interrupted, Again — Finding Calm in the Constant Chaos of Medicine

The status board was showing that a patient arrived. I started to get his note organized. While I was focusing on writing that patient’s orders, the nurse walked in. Naturally, I looked up. Before I could react or say something, she asked for orders for another patient who needed therapeutic phlebotomy. Alright. I stopped what I was doing, because I did not want that patient to be delayed to start the phlebotomy procedure. At the same time, I thought to myself, I was pretty sure I put in the phlebotomy orders. We were just in the second week of implementing the new electronic medical record system. EMR tech support was sitting next to me, and we reviewed my orders – the orders were there and they looked good. Then the nurse returned and asked to clarify the parameters for the phlebotomy. For the nurses who know me well, they know I always include the parameters of when to proceed and when to hold phlebotomy. I certainly put it in – goal ferritin less than 100.

The nurse proceeded to question, since the last ferritin was less than 100, why therapeutic phlebotomy was needed that day. I appreciated the curiosity and double checking things, and I proceeded to explain that the patient had a ferritin at goal because he had been getting maintenance phlebotomy. Just like a patient with hypertension on medication. When the blood pressure is at goal, you do not stop taking the medicine; you continue to take it to maintain the patient at goal.

That incident was easily ten minutes of my time. Interruptions are an integral part of medicine, no matter what specialty you are in. Some get more, some get less. Expect interruptions while you try to avoid them. Although most interruptions are unpredictable, there are things you can do to “run away” from them. For example, sit at a corner if possible, facing away from other people. Or wear headphones. “Do not disturb” status is also a helpful way to minimize interruptions.

When you are interrupted, notice the emotions you are experiencing. You may feel annoyed, frustrated or helpless. Manage your emotions. Take a second to pause. Focus on what the next best thing to do. Remind yourself that you are capable. You do not have to feel happy or excited. It makes a difference if you go from feeling those unpleasant emotions to feeling more neutral about your situation.

Decide which task is more important or urgent, and do that first. If both tasks have similar urgency, I suggest finishing what you are doing first. If you decide to complete what you are doing first, politely inform the other person that you are finishing the last bit or your last thought, and will attend to them right away. In other words, it is important to be clear on what is more important or urgent to do, so you can make a split second decision, without doubting yourself. Once you finish the task on hand, you can give your full attention to the other person or the other task.

After the interruption, take a moment (when you have a moment) to reflect. Ask yourself if similar interruptions can be minimized – is there a pattern? Are there opportunities to streamline, automate or create protocols? It is also a good time to set boundaries, or to examine if the boundaries set are upheld. Is there an opportunity to set certain time blocks for questions or interruptions from your staff members? Are you taking advantage of the “do not disturb” status on the office instant messenger?

Interruptions are always going to be part of clinical medicine. There are unexpected incidents which happen anytime. Always expect the unexpected. Manage your emotions – pause if you need to. Do one thing at a time. Decide what is more urgent to do first. Use every opportunity to learn and grow, to streamline and automate. Although most people do not like interruptions, you will find them more manageable.