How to Manage Interruptions and Limit Attention Residue: A Guide for Physicians

It’s not just your imagination. It’s more challenging than ever to maintain your mental focus at work.

💉 EHR alerts

💉 Phone notifications

💉 Interruptions from staff

💉 Attention sapping apps

💉 Email

All of these and more conspire to make focus more difficult than ever before.

These constant interruptions and the lingering effects of shifting attention, known as attention residue, can severely hamper not only your effectiveness and productivity, but also your own well-being.

Resolving the current state of disorder in healthcare will require systemic change, including a fundamental shift in the functionality of many EHRs.

But protecting your headspace is a critical skill that can help you stay above the fray.

In this article, we’ll explore strategies that you can use to retake control of your mental focus, manage interruptions, and minimize attention residue in your daily life and practice.

Understanding Attention Residue

Attention residue happens when you switch tasks, but a part of your mind remains stuck on the previous task.

The little breadcrumbs that remain can jumble up your thoughts and make it harder to focus. And once you’re interrupted, no matter whether the issue was urgent or trivial, it’s easy to switch over into another unrelated brain drain, such as checking your email or social media, rather than returning to the task at hand.

Realistically, interruptions are a part of life in most medical settings. Apart from a few innovative healthcare systems, the current state of affairs creates the perfect setup for attention residue.

Each interruption requires a mental reset, which can take a considerable amount of time and effort. Ultimately this leads not only to decreased productivity and lost focus, but also to increased stress.

This isn’t just theoretical. Research looking at Emergency Department physicians and nurses has found that interruptions from a broad range of sources can seriously degrade the ability to remain focused and aware. What’s more, the disruptions in this study occurred on average about 11 times every hour.

Strategies to Regain Mental Focus

Ideally, our healthcare system leaders will realize the importance of creating pathways that will minimize interruptions. This process is underway in a number of medical systems. But even under the best of circumstances, interruptions are going to happen. Here are a few ways that you can limit the mental drain.

Prioritize and Plan

This can be a difficult step for physicians, since we don’t always have control over the way the day might go. But simply outlining your top priorities can help by giving you a focus and a “north star” for the day,

Start your day by outlining your top priorities. Whenever possible, highlight high-impact tasks when your mental energy is at its peak. For many people, that is the first thing in the morning.

Use tools like the Eisenhower Matrix (also known as the Time-Priority Matrix) to distinguish between urgent and important tasks, and mitigate those less important time-wasters.

Time Blocking

Whenever possible, consider setting aside specific time blocks for different types of tasks. For example, set aside uninterrupted time to study for your boards, or for administrative work. If you have some control over your schedule at work, scheduling similar patient visits may be helpful, so that your mental flow is less likely to be interrupted.

Communicate your schedule and your plan to create these focused blocks of time to your team (or your family) to minimize unnecessary interruptions. Getting buy-in from your schedulers and administrative staff can help to make time blocking work for you.

Mindfulness and Meditation

Consider incorporating mindfulness practices into your daily routine. Techniques such as deep breathing, meditation, or yoga can help improve focus and reduce stress.

Meditation in particular has been found to be helpful in improving attention, focus, and memory and reducing stress. Just like medication or physical therapy, it’s important to be consistent. In one study, it took 8 weeks of regular practice before the impact of meditation was clear.

Taking a mindful pause before and after each patient, study, or procedure is a great way to mentally reset. In many cases, even this very  brief break can improve your efficiency.

Meditation might sound intimidating, but it’s really quite simple. This article shows you how you can easily get started. Don’t just think of meditation as something that you can investigate when you have the time. There is good evidence that engaging in a regular meditation practice can enhance your attention and mental efficiency.

Limit Multitasking

Multitasking used to be considered a superpower. But now we know that when people multitask, they often make more mistakes. And because of inefficiency, it may actually take longer to get tasks done than if each one was done separately. That’s especially likely if both tasks require mental energy, rather than rote memory.  

By focusing on one task at a time, you may improve the quality of your work, reduce the cognitive load, and actually save time.

If you have tasks that are time-consuming and not realistically amenable to completion in one sitting, break them down into smaller, more manageable steps. That way you can think of each step as a separate and achievable task. It can be helpful to write each of these sub-tasks out and check it off the list when it’s completed.

As you knock out these smaller to-dos, you’ll feel a sense of accomplishment. That can reduce the attention residue that builds up when you stress about unfinished work.

Set Boundaries

It’s not surprising that research has found that interruptions increase the likelihood of errors, which may put your patients at risk.

What’s more, these unwanted intrusions also impact your own mental well-being, provoking measurably high levels of anxiety and annoyance.

Ideally, set clear boundaries with colleagues, staff, and patients regarding when you are available for interruptions.

When practical, limit social and nonessential chatter when you’re focused on something that requires deep thought or careful consideration. Reading studies, creating notes, reviewing charts, and developing treatment plans all fall into this category.

Use simple visual cues, like a closed door or a "Do Not Disturb Unless Urgent" sign. Distractions can’t all be eliminated, but taking these and other attention-preserving actions will likely build awareness and respect for your focused time.

It can also be helpful to set expectations with patients and staff that non-urgent in-box messages will only be addressed during or after certain hours of the day.

Conclusion

Maintaining mental focus requires practical, intentional strategies and consistent effort. By experimenting with some or all of the steps I’ve listed above, you will enhance your ability to concentrate, manage interruptions, and reduce attention residue.

Developing these practices will not only improve your productivity but also contribute to better patient care and support your own vital well-being.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

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Perfectionism, Procrastination, and Fear of Failure

An earlier version of this article originally appeared on Doximity.com in December 2022, where I served as an Op-Med Fellow from 2022-2023.

You probably didn’t become a physician without a healthy dose of perfectionism. From preschool through residency and beyond, many of us have survived, thrived, and been rewarded for our perfectionist tendencies. And when you didn’t hit the mark? You may have felt the sting of your parents’ and teachers’ disappointment. Eventually, you may have learned to define yourself by your perfectionism.

Perfectionism seems to be on the rise, especially among people born in the 1980s and later. Those on the outside may mean well when they assure us that perfectionism is an impossible goal, but the truth is that perfectionism is a prized attribute in our profession. Our patients appreciate it as well. After all, who wants a doctor who is willing to just scrape by?

Paradoxically, perfectionism can keep you from doing your best work. It can also hold you back from living your best life. In this article, I’ll talk about how perfectionism and self criticism often go hand in hand with procrastination. And I’ll give you a few actionable steps that can help you to overcome the self-imposed inertia that perfectionism often creates.

Perfectionism, Procrastination, and Imposter Syndrome

It’s not surprising that perfectionists often suffer from impostor syndrome. If you’re a perfectionist, you may fear that you are simply not good enough and that you will eventually be exposed for all to see. And in fearing that you are not going to meet the high standards you set for yourself, you may subconsciously find ways to procrastinate as a means of avoiding that discomfort.

When you fall prey to imposter syndrome, you may overlook or give up opportunities for growth that could lead you to a more rewarding and exciting professional path. Learning new skills, taking on a leadership role, and discovering a position that is more aligned with your values may all fall by the wayside.

And when you’re uncomfortable with embracing a beginner’s mindset, you may find yourself reluctant to take up hobbies or endeavors that might enrich your life and create new connections.

Perfectionism, Procrastination, and Fear of Success

Another factor holding perfectionist physicians back is, perhaps counter-intuitively, a fear of success. This often arises from fear of change and the unknown. The end result may be the same: procrastination and a failure to act in your own best interests.

Fear of failing to meet your highest standards often manifests in such mundane activities as uncompleted charts, unanswered messages, and unopened emails. This compounds the problem, and can create enormous stress, not to mention nasty messages from administration.

Breaking the Cycle of Procrastination

If you’re having a hard time getting started on a task, big or small, don’t beat yourself up. Chastising yourself for feeling overwhelmed and disorganized may only make the procrastination problem worse by confirming your fear of inadequacy and filling you with anxiety. And thus, the problem comes full circle.

To break the cycle of fear, frustration, and despair, it’s important to recognize that procrastination does not mean that you are incapable or irresponsible. And let’s establish right now that as a busy and caring physician, you are certainly not lazy.

So how can you harness your perfectionism? The key is to focus that superpower on providing excellent patient care. Sometimes that also means treatment plans, operative notes and imaging reports. These are things that truly make a difference, and that people are depending on you to complete. They don’t have to be works of art, but they need to be complete and correct.

Often it’s the non-clinical commitments, stacks of insurance paperwork, and lingering home projects that drain your mental energy. If no one’s life or livelihood depends on it being perfect, allow yourself a little grace. Realize that for many of your routine tasks, perfection is not worth the effort and may not even be possible. For many of these, good and done is good enough. Other times, it might be most efficient to simply delegate. And sometimes, when it’s appropriate, you just have to say no.

Below, I share some practical tips for tackling a handful of competing priorities and getting stuff done.

1. Medical documentation

We’ll address the elephant in the room first: your medical charts. As charts start to pile up and paperwork is left unfinished, your anxiety levels may rise, and you may find yourself in a spiral of regret and self-flagellation. If you have a system that works for you, kudos and keep it up.

But for the many physicians for whom the EHR and report generation are a major source of stress and procrastination anxiety, it’s important to get a handle on this beast as early as possible in your medical career. Just get the charts and notes done, either immediately during or after the visit (my preference) or at the end of the session.

The fewer times you have to return to a document, the more focused and efficient you will be.

Yes, the notes need to be succinct, truthful, and useful. And personally, I always found that including a brief personal observation reminded me of the issues that were meaningful to my patients when we met the next time. But your notes do not have to be perfectly crafted works of literature. Punctuation, spelling, even virtual voice transcription errors that don’t change the meaning of the sentence can often be safely overlooked.

Consider using “smart phrases” — text blocks that you use frequently that can be automated through your EHR system — as much as possible when appropriate. Look into using an AI assistant for history taking, if you can assure accuracy. The point is not to be sloppy or incomplete, but to include the pertinent details that assure great patient care and communication as efficiently as possible.

To avoid a horrendous backlog, create a block of time once or twice each day to get patient communication, testing review, insurance, and other paperwork done. This is known as task batching. Do it consistently every day (perhaps using the Pomodoro method), and even though you may not finish everything all at once, you’ll have a process for getting it done. Once you start seeing the results of your efforts, your feeling of self-efficacy will increase.

Let your staff know that you will be working on these tasks within these blocks of time. That way you can set expectations and encourage them to direct pertinent issues to you at a time that works best for you. Ultimately, this may create a clearer sense of work flow within the practice and enhance your teamwork.

2. Professional Commitments

When it comes to committees, research, and other professional commitments, take a good long look at what you’ve signed up for. Be sure that the work is meaningful and actionable for you.

Sometimes taking on more responsibilities is the right thing for your professional growth or your career trajectory. If so, it’s important to stay committed. Procrastinating on these commitments can have a seriously negative impact on your future opportunities.

Consider working with an accountability partner who is on the same committee or working on the same project. You can keep each other on task with quick check-ins by text. Simply committing to a plan can often get you halfway there.

But if you find that you just have a hard time saying no, then it’s time to reassess. As writer and time management guru Oliver Burkeman so aptly puts it, if we’re lucky, we only have Four Thousand Weeks. That means that time is a fixed resource. When you say yes to something, you are saying no to something else.

If your commitments exceed your capacity, you will never get everything done. Choose wisely. And remember that saying no doesn’t mean never or not at all. Is there a way to stay involved with something meaningful without diving all the way in?

3. Your Personal Life

Having a life outside of the clinic or hospital helps you to decompress, stretches your brain, and keeps you connected to the outside world. When it comes to family and close friends, your time and attention matter. And of course regular exercise is critical for just about every aspect of your health.

Unlike taking care of patients, the bar is fairly low. Usually no one is depending on you to be the best. Just being present and engaged is often enough. For your home projects, exercise, and other extracurriculars, consider using a Bullet Journal or other daily log.

Experiment with using a real notebook rather than an app. Not only does writing something down tend to create more solid memory retention, it’s easy for virtual to-do lists to disappear into the ether of the internet, never to be seen again. Most importantly, choose what works best for you, and be consistent.

To get started with something new, commit to just five to 10 minutes a few times a week, or set up an introductory lesson for something that interests you. You’ll be surprised how much you can do, and it may motivate you to keep going. If you’re not perfect, all the better. You’ll learn and grow and maybe even find new life passions.

Procrastination and Self Compassion

If you’re a chronic procrastinator, developing self-compassion is important. But being kind to yourself doesn’t mean you can ignore the pressing problems that procrastination has created. That will only add to your stress, and create more trouble in the long run.

When you put off completing charts or making calls, procrastinating can also hurt your patients and your practice. In the worst cases, medical care may be delayed and important notifications missed, with possibly serious ramifications for the people who depend on you.

If the load feels overwhelming, realize that procrastination-born perfectionism can lead to important mental health conditions including depression, anxiety, and eating disorders. Get help from a mental health professional if you need it. And if you are questioning your efforts, your direction, or experiencing burnout, consider meeting with a physician coach.

Remember: your perfectionism is one of your superpowers as a physician. You have high standards, you solve tough problems, and you keep people safe. Leverage this, cherish it, but don’t let it take you down the road of procrastination.

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Getting Unstuck: How a Simple Mind Shift Can Move Your Life Forward

If you’re a physician, you’re probably juggling patient care, administrative tasks, and personal responsibilities like a boss. But when you feel the need for something beyond the daily routine, it can feel daunting.

Whether it’s getting up to speed with a new procedure, launching a research study, trying to get some time for self-care, or considering making a complete change of practice or location, it’s easy to feel like you’re stuck in an endless loop, unable to break free.

In my practice as a physician coach, I frequently encounter these common challenges. It can seem overwhelming from the inside looking out. But there is a way through, and it begins with understanding why you feel stuck.

In this article, I’ll explore common reasons that physicians feel immobilized, and I’ll offer you some strategies that will get you moving forward with purpose.

Break the Cycle of Repetition

Doing the same thing over and over, expecting different results, is not only the classic definition of insanity but it’s also a common trap. Whether it's procrastinating on completing notes, avoiding difficult conversations, or never saying no, these habits can perpetuate your feelings of frustration and stagnation.

Routine can be comforting, since you know what to expect, but it may also be a barrier to growth. When you’re caught up in an endless cycle of repetitive tasks, it’s easy to lose sight of what matters the most to you.

Strategy: Starting small can open up a crack that allows you to see a little more light. As simple as it sounds, begin by introducing small changes in your routine. This could mean taking a different route to work, setting aside just 10 minutes a day to walk or stretch, or incorporating new learning into your practice. Sometimes, the smallest adjustments can lead to significant shifts in perspective and outcomes.

Spring Free of the Inaction Trap

If you don’t take action, you will not get yourself unstuck. It’s that simple. But the fear of making the wrong decision often squashes the potential for change. That doesn’t mean it’s not important to think through your decisions. Be thoughtful and judicious, but don’t get stuck in an infinite cycle of analysis. Realize that taking action can mean taking the smallest of steps.

Strategy: Embrace the concept of ‘progress, not perfection.' Understand that inaction is a decision in itself, and it can be more harmful to your wellbeing and your future opportunities than making an imperfect decision. Start with very small, manageable actions that align with your goals and gradually increase the stakes as you build confidence.

Unaddressed Issues

Not dealing with problems as they arise means that they are given free rein to accumulate. Eventually these unresolved issues may begin to feel overwhelming. And as a consequence, this drag on your energy will make it harder to move forward. Whether it's patient care issues, administrative challenges, or personal matters, avoiding problems doesn't make them disappear.

Strategy: Commit to a proactive approach. Tackle important issues as they arise. You don’t need to solve every pressing problem on the fly. But by putting it in its place, it won’t be overlooked. That could mean delegating, scheduling committed time to address the issue, or even saying no. This not only prevents important issues from escalating but also builds a habit of facing challenges with purposeful action.

The Burden of Incomplete Tasks

Like unresolved issues, incomplete notes and tasks can be a significant source of mental load, leading to a feeling of being perpetually behind and unable to move forward. This is a very common issue for physicians, and one of the most important ones to get a handle on quickly. Your own well-being as well as your patients’ care depends on it.

Strategy: Get those notes done. Use templates, smart phrases, and any other resources available to you to make your notes concise, accurate, and useful. Prioritize and delegate the other tasks crowding your in-box. Addressing each task once and moving on, keeping your responses brief and succinct will help you get through your list. Consider adopting time management techniques, such as the Pomodoro Technique or time-blocking, to efficiently tackle your workload.

The Value Dilemma

Objectively, you probably know you’re valued. Despite the turmoil that many physicians face every day, your patients need you, and the work you do makes a difference.

But it’s easy to undervalue yourself, undermining your self-confidence. You’re not alone. Not believing in one’s own value is a common issue that affects how many doctors perceive their abilities and their worth. And as a result, you may miss opportunities, fail to stand up for yourself, put up with toxic working conditions, or take on projects that go against your won best interests.   

Strategy: Practice self-reflection and affirmation. Remind yourself of your achievements and the unique value you bring to your patients and the medical field. Journaling can be a very useful exercise. Keep a folder or a box with notes from patients and others who express appreciation and give yourself a few moments to revisit this when you’re feeling down.

Seek feedback from peers and mentors when you need it and consider engaging with a coach to build self-confidence and set achievable and meaningful goals.

Conforming to Expectations

Playing to other people's narratives is a common trap that can lead you down a path that doesn't align with your values or aspirations, leaving you feeling stuck in an unfulfilling or ill-fitting role. This is another theme that plays out for so many physicians. It often begins with family expectations, and it may eventually become a way of life.

Strategy: Define your own success. Take time to reflect on what success means to you, independent of anyone else’s expectations. Setting personal and professional goals based on your values and aspirations will ensure that your actions align with who you are and how you want to live your life.

Moving Forward

Feeling stuck doesn’t have to be a way of life. By understanding the underlying reasons and adopting targeted strategies, you can navigate your way out of the quicksand of stagnation.

Take the time to understand your value and remind yourself of the resilience that got you this far. Think of change as a catalyst. Create and then begin to implement a plan to take action, one step after another. Remind yourself that fulfillment is a process that can lead to unexpected growth and opportunities.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Bike Shedding for Physicians: Avoiding Trivial Time Wasters

Your time is precious. You have a demanding and consuming professional life. In all likelihood, you're juggling multiple priorities at any given time. Sometimes it’s the most trivial issues that seem to claim the most attention. But as a physician, it's important to be able to focus on the things that really matter, and to avoid getting dragged down into the weeds.

It’s useful to consider the phenomenon known as bike shedding. The term was coined by C. Northcote Parkinson, a British management expert and naval historian, in the 1950s. In introducing the idea of bike shedding, he described a committee meeting that is called to discuss a specific financial agenda. On the agenda is:

• a nuclear power plant costing tens of millions of dollars

• a bike shed for the plant costing a few hundred dollars

• a coffee budget amounting to about twenty-five bucks

The nuclear power plant is way out of anyone’s comfort zone, and no one wants to look ignorant or ask too many questions. So they quickly approve the budget and proceed to focus on the more familiar topic of the bike shed. After extensive discussion, argument, and finally compromise and agreement, they complete the deliberations over the bike shed with a feeling of satisfaction. They round out the meeting with an hour-long debate over the coffee budget, a topic on which they all have a strong opinion.

In a nutshell, bike shedding is a term used to describe the tendency to spend disproportionate amounts of time and energy on relatively minor issues, while neglecting more important but complex concerns. If you’ve spent any time in committee meetings, you can probably relate to this phenomenon. Issues such as EHR functionality and staff management can sometimes also fall into this category.

But bike shedding can also happen in your personal life. For example, you might spend hours researching the perfect running shoes, instead of focusing on your training plan. Or you might spend days agonizing over the color scheme of your living room, while putting aside more important but troublesome family issues at home.

It’s natural to want to escape from stressful decisions by focusing on things that don’t really matter. And the importance of taking time to rest and refresh cannot be overstated. But spending that precious time perseverating over things that are not meaningful can be counterproductive. The bigger problems are still looming. What’s worse, these are the issues that tend to build up steam the longer they are ignored. Eventually you may find that you are compelled to take action, whether you feel ready or not.

Here are a few tips for avoiding bike shedding in your personal and professional lives:

• Identify your priorities. What's most important to you? Once you know your priorities, you can make decisions more easily and avoid getting bogged down in trivial matters and unnecessary conflicts.

• Delegate. If you can delegate tasks, do it. Delegation is important both at home and at work. This will free up your time so you can focus on the things that matter most.

• Remember the big picture. When you're feeling overwhelmed, take a step back. What are your long-term professional goals? What do you want to achieve in your personal life? How can you break that down into achievable steps? Keeping your goals in mind will help you to stay focused on the important things.

• Set boundaries. It's important to set boundaries so that you spend your time purposefully. This could mean saying no to extra work commitments with little upside so that you can make time for yourself and your loved ones. Or it could mean giving up your spot on the neighborhood committee that causes you stress and lost sleep, when you’d really rather be gardening.

It’s natural to default to bike shedding. It’s a way of avoiding stress and putting off difficult questions. But it's something that you can learn to recognize, navigate, and redirect. If you find yourself getting caught up in bike shedding, try to take a step back and ask yourself if it's really worth your time and energy. If not, let it go and move on.

By following the tips above and then building your own strategies, you will protect your time and energy and focus on the things that matter most.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.