The Hidden Cost of Open Loops

You finished seeing your last patient 90 minutes ago. Multiple notes are waiting for you to be completed. The inbox is still marked with 20 new items to review. Your computer has multiple tabs open. You are staring at all these, trying hard to decide what to tackle next. Many thoughts are coming up, and the main thought is, “What am I still here?” You are working hard, yet somehow, you are not done with your work. The problem is not laziness – in fact, you are working non-stop. The problem is not poor work ethic or lack of intelligence. The problem is too many open loops which are draining you mentally.

What are “open loops”? An open loop is anything that is incomplete, unresolved, undecided or mentally hanging over you. For patients, it may be a test that has not resulted. For physicians, some common open loops are open EMR charts, inbox messages, unfinished documentation, pending orders, tabs left open “for later”, tasks being remembered mentally, or any unmade decisions. Your brain treats unfinished tasks as active threats which require attention. The more open loops there are, the more tension they create for your mind.

How do open loops destroy efficiency? There are three components: attention fragmentation, effects of overwhelm and busyness. Every unfinished task requires mental energy. The more unfinished tasks there are, the more mental energy you are using. Even when you are focused on one chart, your brain is tracking other unfinished notes, inbox messages, patient callbacks and tomorrow’s schedule. The result is reduced concentration. When you are not fully concentrated, you are slower to complete a task. You are more prone to mistakes and have to redo your work.

When there are multiple open loops, it is natural to feel overwhelmed. When you feel overwhelmed, it is difficult to prioritize, which leads to more indecision. The more undecided tasks there are, the more you get into mental fatigue, which leads to slower work. That translates to more after-hours work. Overwhelm is not just an emotional experience. It directly affects what you do and how you do things. It directly impairs executive functioning and efficiency.

Physicians often mistake constant motion for productivity. You have probably experienced days when you are non-stop working, yet little has been accomplished. Clicking back and forth between tabs, Revisiting and re-reading inbox messages, starting tasks without finishing them, or constant context switching all take time. However, they are hindering productivity. The brain pays a price every time the attention is shifted.

Why are so many physicians stuck in this pattern? High-responsibility environments, such as in the outpatient clinic or in the hospital, naturally generate open loops. Many physicians rely on memory to do certain tasks. They rely on mental tracking and reactive workflows to get through the day. One common challenge is that many physicians have the fear of missing something, so they keep everything in mind, and constantly remind themselves what those things are. The problem is that trying to mentally hold everything creates more cognitive overload, which creates more feelings of overwhelm, stuck, hard to concentrate. The cycle repeats itself.

The solution to regain efficiency is to intentionally close the open loops. The goal is not to work harder – most physicians are already working very hard, some are even operating in the overdrive mode. The goal is to stop forcing your brain to carry unnecessary cognitive weight. Externalize tasks. Use your brain to think and not as a storage space. Write the tasks down, use checklists, create simple capture systems and reduce reliance on memory. Create simple systems. Always keep things simple without over-simplifying. Simplicity over perfection. For example, choose an inbox processing workflow, a task triage system (a nurse to screen patient calls), assign dedicated blocks for certain tasks such as phone calls and inbox tasks. Systems reduce decision fatigue. Close loops consistently. Finish tasks fully when possible. Make decisions intentionally instead of repeatedly revisiting them. You cannot move forward to something else if you are stuck in indecision. Reduce visual clutter – have fewer tabs open, fewer mental reminders and fewer unfinished notes.

When you decrease open loops, you have more mental capacity to work. You have improved focus, which promotes faster completion of your charts and other tasks. There is less overwhelm. You think more clearly. You get to have more presence with your patients and at home. You are minimizing or even eliminating work in the evenings and on the weekends. The emotional shift makes practicing medicine feel lighter again.

For many physicians, the current workflow is overloading the brain. Efficiency improves when mental load decreases. Closing loops intentionally creates clarity, focus and freedom. If you are tired of finishing clinic only to start your second shift at home, physician coaching can help you create sustainable systems that allow you to leave work on time and enjoy medicine again. It is possible for you to leave work on time and enjoy life outside of medicine again.