The Real World (and Time Management)
Heather Jiménez, MD
YPS Education Chair
Residency is over, and now the “real world” begins. Looking back, how did you accomplish everything on your CV and check all the boxes to get a certificate during residency? Life was supposed to get simpler; so where is all your time going? Wether at work or home, it seems the greatest limiting factor in our fast-paced lives is time. Each person excels at managing this differently (or you would not be where you are today), but below are a few tips that might improve productivity and increase your satisfaction both on the job and with your family.
Utilize your resources.
The emergency department is staffed by numerous different people who can save you small segments of time repeatedly. Early in your career, you should observe your colleagues, converse with the staff, and feel out the department for ways to save time. Whether it is setting up for a pelvic exam, cleaning a wound, or splinting a limb, others can aid in your productivity. Your department may have a tech who can set up for a pelvic exam – or even better, recognize when one will be needed and have the patient in a gown, set up for the exam, and then serve as a chaperone when you enter the room the first time (thus saving you repeated trips). Your nurses may do digital blocks and/or numb and scrub a wound – thus after you have completed your initial exam, everything will be ready when you return to suture. Once the nurses are familiar with your preferences and techniques, you can provide quick direction so all your equipment is available (i.e., gloves, suture/staples, bandage, any ointment). You can then provide your discharge/care instructions while suturing. As a bonus, patient satisfaction will increase, as there will be limited time when they are not engaged in the throughput process of the ED, and their pain will be addressed almost immediately following your exam. Your department’s triage system can also be a lifesaver. Urine pregnancy tests, urinalyses and X-rays can be initiated here. Before you see a patient, their injured or painful joint/extremity can be filmed. By viewing the films prior to entering the room, you save yourself and the patient time. An ortho or casting tech can then be ready to splint after you do your exam while you are preparing discharge instructions. With all three of these examples, and any others you find in your emergency department, manage up – let the nursing supervisor know what an awesome job is being done and how helpful this is to you. It will stop any grumbling that “this is not how we do things here,” and often increase productivity in your staff as everyone loves to be recognized for a job well done.
Other staff can also be crucial to throughput in your department. Often, you will have a case manager who can assist with placement issues, home care arrangements, and early identification of who qualifies for admission. These godsends, in conjunction with social work, can save you multiple lengthy phone calls and much frustration. Social work can entertain a child while you speak with their parent, address domestic violence, assist with resource management/transportation, and a multitude of other concerns you might have. If necessary, they are a wonderful resource by serving as your liaison with law enforcement and child protective services. Again, frequent recognition of both social work and case management’s exemplary service will help ensure they remain in your department and will improve their job satisfaction.
Regardless of the exemplary care you will provide, some patients will be frustrated, dissatisfied or angry. The emergency department is a stressful place where a visit necessitates disruption of plans and events. Learn to recognize warning cues in these patients and families, identifying those who might need an extra few minutes in the encounter to diffuse a situation. This can save you many headaches and scenes as you are trying to mobilize them later – either to the floor or home. Also, know how to contact your administrator if needed. Verbal abuse or physical threats/assault are not acceptable, and often, there will be a third party in the hospital to intervene who can objectively listen to the complaint/concern. This then frees you to care for others more effectively.
As emergency departments become busier and the safety net gets stretched farther, know your “pop-off” valve. Diversion is an often-whispered word that causes groans and grimacing, but it is a reality. Know in advance the procedures for contacting your department and hospital administrators and how to arrange for department decompression if necessary. Patient safety must come first, and an overwhelmed department and hospital cannot provide adequate care. Unfortunately, your first single-covered shift is not the time to gain on-the-job training in this modality. Address this topic early, and also identify the qualifications for resuming regular ambulance traffic.
Plan ahead.
The emergency department is an unpredictable place, as no one plans their emergency. To ensure you are at your best throughout your shift, regardless of duration, plan your sustenance prior to arrival. Quick foods that will keep your energy level high throughout your shift are best. They can be consumed while briefly charting, do not spoil easily, and are often finger foods that you can grab on the run. Anything complex or complicated may sit uneaten while you run from person to person. There will always be days when the best-laid plans falter and you arrive ravenous or forgot your food at home. Talk with your secretary, techs or nurses early about organizing/arranging food delivery. You can even utilize this as a morale booster if you pick up the tab for all. Obviously this cannot be a daily occurrence, but in killing two birds with one stone you have kept your staff happy and fed yourself.
Review your calendar monthly, weekly and daily to ensure you are aware of all responsibilities and obligations. Identify conflicts as early as possible to allow for the greatest chance to remedy a situation. If you have a family, they should participate in the weekly and monthly planning so you can remain an active participant in their lives, too. Plan vacations early, working around school holidays (if you have children) and ask for this time off well in advance. If you do not have children, ask your colleagues about the school holidays, and steer clear of those dates. Chances improve that your vacation will go forward as planned, and your co-workers will appreciate the coverage while they are on vacation with their families. If you want to attend continuing medical education events, discuss this with both your colleagues and scheduler. There likely is a system in place to ensure the whole group does not try to attend the same conference, leaving the department short on coverage. Ask early how the holiday schedule is created and shifts are divided. Knowledge of what is expected, as well as awareness that EDs are open 24/7 will save you from disappointment. Relay your schedule to loved ones so alternative plans can be created in advance ensuring a good celebration. By planning in advance, you can ensure your scheduling requests are submitted in a timely fashion and give yourself the best chance of attending your desired function or event. This will also help maintain your productivity at work, as there is one less stressor on your mind.
As a side note, just as emergencies happen to your patients, colleagues and co-workers also experience unexpected events. Even during your first weeks, you can lead by example and demonstrate your willingness to help others. Covering unexpected injuries, illness, deaths, etc., will establish you as part of the team. It will also be beneficial if an event occurs limiting your ability to work.
Even if you have left the world of academia, over time, you will likely be ask to serve on hospital or department committees, take a leadership role in EMS, or assume community outreach responsibilities. Before joining or agreeing, identify exactly what is expected of you. Often, these obligations include lectures or meetings. Designate/block out ample time in advance to fulfill these tasks. Just like in residency, creating a lecture takes time. You want to represent yourself and your department well, so plan to have the lecture done well in advance. Small steps over weeks will occupy much less time than 1-2 days of limited productivity just prior to your presentation.
In addition, make yourself a part of your community. Volunteer at community functions, attend the local high school games, and become a positive, recognized role model in the town in which you are living (see below about spreading yourself thin). By immersing yourself in the town (especially a small town), you develop pre-established report with your patients, saving yourself time during the visit.
Learn to say NO.
Early in your career, you may be tempted to spread your wings and agree to complete any task asked of you. This could range from serving on committees within your hospital to volunteer work with local community resources. Unless you are truly interested in the task, feel free to say no. Over the first six months to a year at your new job, you will be trying to study for boards, learn the lay of the land, and adjust to your “real world” experience. This can be a trying time and for most, it will be the first true taste of responsibility in patient care with a great upward climb of systems and knowledge base. Trying to couple this with numerous extra obligations will stretch you thin. Instead of just declining, you might try a counter-offer or give a reason why the task or commitment is not doable at present. Obviously, if interested, feel free to say yes!
Separate home and work.
After four long years of medical school and at least three of post-graduate training, there are many people in your life who have supported you emotionally, financially and physically. Whether they are your spouse and children, your parents, or your friends, they have been witness to your meshing of work and home life. As you advance to the next stages of your professional development, make a concerted effort to separate the two. This will help you manage your time wisely in both worlds. Obviously, this will vary from person to person; but think about how many times you relay a stressful medical situation to your nonmedical spouse. They can provide emotional support, but it will become taxing on them if it is a daily occurrence. You will have no “safe zone” when you get home as you have enmeshed your two worlds. When you go out with friends, recognize the topic of conversation, and unless entirely composed of medical colleagues, make an effort to steer clear of medical jargon/patient care discussions. In reverse, don’t bring any stress from home to work with you. Allow your full focus to be on the patients while there.
Recognize emotionally challenging situations both at home and work. If you have a patient death that really touches you or you have had a very challenging day at work, learn to identify these situations and have a plan in place to decompress prior to entering the world of “home.” The opposite is also true. Sick family members or deaths within your family can affect your ability to provide the best care possible. Recognize this, and work with your group to ensure adequate coverage of your shifts while you cope/grieve. Remember your loved ones’ birthdays, anniversaries and other special dates. Program these into your calendar with alarms/reminders so you can mail the cards in time, arrange for floral delivery, or have an extra few minutes for phone calls. Remembering to mail a card or make a phone call in advance can potentially save you countless reminders later that will detract from your relationship with that person – or if your spouse – your happiness at home!
Take a vacation. Regardless of whether it is a staycation, trip of a lifetime, or just a few days to refresh, your mind and body will thank you. You will be much more productive when you return. Recognize when you are feeling any effects of overworking, and ensure you have time to unwind and do something for yourself.
After at least seven years of additional education and training, you are finally joining your high school and college friends in the real world. Make the most of this transition by utilizing your time wisely and striving for excellence in all you do. Your career will thrive, your home-life will excel, and your sense of personal well-being will be great. As mentioned before, this is not a complete list or meant for everyone, but if any of these areas are a source of strife, consider the ideas mentioned to better yourself.