Stress-free primary care?

When I graduated from medical school in 2005, my friend Liz gave me a label maker and a book called Getting Things Done (GTD). I assumed it was a gag gift, though I knew Liz to be a fan of GTD and its author, David Allen, a productivity swami. I thought it was interesting, so I read it.

And then I labeled everything.

Over the last few years, I have practiced a watered-down version of the GTD process, which advocates "stress free productivity" through effective management of the information that comes to us faster and faster. When the mind is unburdened of the task of remembering all the things there are to do, it is possible to be present for whatever task is at hand.

Through residency, this was tough. The task at hand generally involved some high-stakes activity performed in the setting of sleep deprivation and incompetence-by-design. Delivering babies, for example: you become competent by doing it, they come in the middle of the night, and it's a big deal if you screw it up. There was little about residency that allowed for stress free productivity. I did what I could, but there were limits. Mostly, I just crashed through.

I've been out of residency less than a year, and have been a full time family doctor for a little over six months. I work five full days in clinic, seeing about eighteen patients a day for multiple concerns, acute and chronic. I also manage dozens of lab and study results every day, and respond to patient phone calls and email.

My goal: go in every morning relaxed and prepared for whatever comes my way and leave at the end of the day having acted on every piece of information that came my way. That doesn't meet I've cured everybody, cure is pretty rare in medicine.

But hope that by day's end I will have responded to every item that demanded my attention in a appropriate way:

• Every patient visit ends with a mutually agreed plan;
• Every patient call that came in got an answer, a plan;
• I reviewed every lab or study result and made a plan;
• I updated patient charts to clearly describe the plan to everyone who might need to know.
• I set up reminders to myself so I don't worry that I'll forget about important parts of the plan.
  

When I accomplish all those things, there is an empty in-box in front of me, ready to receive whatever might arrive next.

More importantly, my head is not cluttered with all the things I "should" be doing or trying to remember all the things that might be coming in. Unburdened, I feel much more able to be fully present for patients during the twenty minutes I get with them. We have a lot to do in those brief visits and they expect my full attention. When I'm on my game, they get it.

Maybe I'll write more about this later. It seems like a good topic to explore further (running a visit, how the day flows, setting reminders, updating care plans, teamwork and communication, cross-covering for colleagues...)

But it's time to get started with the day, so off I go.