You Can’t Get Your Time Back – But You Can Reclaim It

Time is precious, so precious that we cannot buy back the time lost. Each of us is given twenty-four hours a day. As full-time-physicians, most of you are spending the majority of your time doing work-related activities. The many hours you spent at work can create stress and burnout, as you realize that there is barely any time for you to recharge or do things outside of work.

Workflow matters. By carefully planning your day ahead, you have better efficiency, increased productivity, reduced stress and overwhelm. Yes, it is possible to plan and enhance your workflow as a physician, even when you do not have a predictable schedule, such as working in the emergency department.

Keeping things simple without oversimplifying helps with efficiency. The Eisenhower Matrix is a very useful tool for time management and prioritization. Consider your day’s tasks. Divide them up into a 2 x 2 matrix: first, the important and urgent quarter; second, the important and not urgent quarter; third, the not important and urgent quarter, and the fourth, the not important and not urgent quarter.

For the tasks in the first quarter, you do them. Do them right away. For example, when a patient passes out in your clinic, you drop what you are doing to tend to the potentially life-threatening situation. If you are rounding in the hospital, go see the critically ill patients first. When there is no life-threatening situation, the important and somewhat urgent tasks are next to do – seeing your scheduled patients, for example. Avoid doing another task while you are seeing patients, unless that task is more urgent. Many physicians agree with what is being discussed so far. Then comes the patient documentation. One may argue that patient documentation is important and not urgent, so should it be scheduled (at a later time)? I have discussed this in the past, and the answer may be different for inpatient and outpatient care.

For outpatient care, when patients have set appointments, completing care, one patient at a time, is the most efficient way to enhance your workflow. This means that you see the patient, complete the orders and the chart before moving on to the next patient. This makes sense, but many physicians choose to do some, if not most, of the charts after clinic hours because they do not want to be too behind to see the scheduled patients. I used to be the same way. At the end of the day, when you still have more than ten charts to complete, you are already exhausted, drained and less efficient. It is harder for you to focus and remember all the details. What would have taken you an extra five to seven minutes to complete is now taking you fifteen minutes.

The second quarter – important and not urgent – schedule those tasks. Many tasks for physicians fall into this category. For example, returning phone calls which nurses do not have the expertise to discuss. Or continuing education to keep your knowledge base and practice guidelines up to date. These are important things to do but not urgent. Schedule them. Set a time and put them on your calendar. One may also consider scheduled patients belonging to quarter two. After all, they are already scheduled. Whatever works for you, you get to decide. The ultimate goal is to achieve better time management and work efficiency. I do consider patient documentation as important and not urgent. Charting is a way to communicate with other clinicians, and to remind yourself what you planned the next time you see the patient again.

For the third quarter tasks – the not important and urgent tasks – delegate them. I am always an advocate for whatever you can delegate, delegate. Physicians do not have to do it all. Calling a patient about a normal result or a result that needs a simple instruction? Delegate. Screening phone calls and assigning the more complicated phone calls for physicians? Go for it. Writing a letter and filling out forms for patients? Delegate – you can check the completed forms to ensure the information is accurate.

The fourth quarter tasks are those which are not important and not urgent. Why are they there? Some of those tasks happen to be the ones which we spend time on more than you think if you are not aware of it. For example, interruptions which are not life-threatening. It may be an interruption about a patient call that the nurse could have taken care of. Or an interruption that is not related to work, such as a notification from your private email, the urge to scroll on social media, or your mind wandering off. Recognize their existence and eliminate them. The unconscious mind welcomes these unplanned interruptions and you may be distracted from doing tasks from quarter two.

Besides identifying tasks and categorizing them into the Eisenhower Matrix, finding the best workflow for yourself matters. This may be different for each physician and for different specialties. As mentioned above, for outpatient care, the most efficient way to care for patients is to complete everything about the patient, including charting, before seeing the next patient. For inpatients, your workflow may be different. This applies to me. When I am on the consultation service in the hospital, I see patients in different units. I find that the most efficient workflow for me is to prioritize the sickest patients while following their geographic location. Before doing the walking rounds, I review the patient charts first, and put in urgent orders as needed. Depending on how well I know those patients, I may go back to my charting room and do my notes after seeing ten to fifteen patients.

Workflow is better with setting time blocks to do certain tasks. Batching similar tasks in a set timeframe also helps. For example, you may want to set a five to ten minute block in the middle of your scheduled patients to review your inbox. You may decide to have a few of these blocks throughout the day, so you can delegate and handle the inbox tasks in a timely manner.

Always remember to take a break. No matter how determined you are to plough through, you are more efficient after taking a break. Even just for 5 minutes – get up, stretch, take some deep breaths.

It is possible for physicians to be more efficient by having a better workflow. Prioritize your tasks by using the Eisenhower matrix and determine what to do, to schedule, to delegate or to eliminate from your schedule. Delegate as much as possible. Be flexible with your workflow. Different work environment for a physician may require a different style of workflow. Set blocks and batch tasks. Take scheduled breaks (and avoid unscheduled breaks). At the end of the day, reflect on what worked and what you can improve. Every day is a new day for you to do better, to have better workflow and efficiency.