You Don’t Have To Be A Headless Chicken To Keep Ahead Of Your Inbox

There’s a time to scramble, and a time to sit down and get deliberate.

When I first started working in a non-academic, community based practice, my medical director advised me to handle “tasks” on the fly: between each patient seen in the clinic, take care of 2 things, like a med refill, patient callback, or lab result.

For the first several years before EMR, this worked well enough — I didn’t have huge piles of paper to contend with — but there were still times I walked to the car at 7 PM.

As a primary care physician, the mass of incoming tasks, in order of bulk, was

1. lab results
2. appointment requests
3. medication refill requests
4. patient callbacks

In order of urgency of outgoing tasks, however, the list was more like this:

1. patient callbacks (especially for come-in-now problems)
2. grossly abnormal lab follow-ups
3. specialist call-ups (for appointments, or ambiguous notes)

Either way, the mass of data and time to be processed was huge, and never ending.

There’s A Time To Bump, And A Time To Grind

Even in the first few years of EMR, I continued to deal with these tasks in between patient rooms, but it was taking a toll on my staff. See a previous post for an explanation why.

Furthermore, it became clear that there were 2 sets of urgencies: 1) things that were sheer volume based (bale this boat regularly or drown), and 2) things that were time based (few in number, but each needing 20+ minutes to complete).

Your own workflow is much the same, regardless of specialty. Some tasks will be simple and numerous, and others will be moderately complicated.

Your first impulse will be to apply the “whiz it out” method to everything, but it only works for the simple stuff. The complex tasks, it can worsen by shifting tremendous burdens to your support staff.

“Batch Processing” To The Rescue

Timothy Ferris elucidated this concept in his book, The 4-Hour Workweek. As I’ve noted in my other medical blog and podcast, busy medical professionals can learn an awful lot about time management from busy, financially driven entrepreneurs.

Batch processing means that you group similar tasks together, then deal with them all at once. The business analogy is that eternal time waster, email: doing one task, answering a few emails, doing another task, answering a few more emails, and so on. Business folk can have hundreds of emails a day, not unlike physicians having hundreds of labs and prescription refills to review each day.

Instead of mentally shuttling from task 1 to prescription refill, then out to task 2, then back to refilling, then out to task 3, and so on, you just get into refill mode and blast through all your refills. And eliminate all the little back and forth transitions between the different types of tasks.

This seems to work best on items of moderate complexity, like lab results, or chronic medication refills. Sometimes you can just look at a lab or refill request and quickly address it, but often you’ll have to think about the patient’s other chronic conditions, and when they were last seen or tested. This consideration involves a certain mindset, which may be very different from the patient care mindset you’ll use 3 minutes hence.

Shift mental gears less often, and you’ll move quicker and be less fatigued at day’s end.

And again, by batching similar tasks, you avoid passing needless scut to your staff, just because you’re in “bump” mode, and you hit upon a “grind” task. (Ferris characterizes this as not increasing the entropy of the universe — working leaner overall, instead of just passing the buck.)

Make Batching A Regular Part Of Your Day

Set aside a couple brief chunks of time — say, the first 15 minutes of your lunch break, and the last 20 minutes at the end of your day — to batch process your medium complex tasks. (Take the first 1-2 minutes to quickly review your “pile,” to set aside any quickie or critical tasks that may have snuck in.) Then grind your way through, uninterrupted.

You can always handle the quick and numerous tasks as they come in — you will have to, to avoid death by a thousand cuts. But batching gives you another tool to attack your workload, one that puts more of your focus where it’s needed for patient benefit, saves you time and mental fatigue, and decreases staff stress.

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