Getting it Done

June 30, 2019
by Mark David Siegel

Hi everyone, 

One of my favorite college professors was the famed historian, Eric Foner, an expert on 19th Century America, particularly Reconstruction. I’m still reading his books, 35 years after I last took his class. 

I learned much more than history in Professor Foner’s class. When I was in college in the early 80s, Apartheid still reigned in South Africa, and many Columbia students were pushing the university to divest from its South African investments. The students held protests in front of the college president’s office, arguing that the university’s investments perpetuated racial oppression. Professor Foner helped us see the connection between the struggle to end Apartheid and older struggles in our country to end slavery and Jim Crow. To this day, the lessons I learned then inform how I view ongoing work to combat racism

Professor Foner also pushed me to become a critical thinker. At 20, I was habitually inclined to accept the wisdom of experts, as if I were still memorizing facts from high school textbooks. During one visit to his office, he challenged me to look out for intellectual biases and to identify faulty reasoning in the work I read. His teaching remains a powerful rebuke to anyone who doubts the value of a humanities education. The skills I learned studying American History apply perfectly to reading the medical literature and to reasoning through complex clinical cases.

Professor Foner was a tough grader. He rarely gave As, and it took me nearly a year with him to produce work that was polished and thoughtful enough to merit a high grade. His blend of high standards and encouragement still influence how I teach.   

Finally, Professor Foner taught me a valuable practice, which I really want to highlight today. Without fail, he always graded papers and exams the same day they were submitted- an impressive feat in a class of 30+ students. However bright the students were, it must have been dreadfully dull to read so many undergraduate essays at once. But his rationale was clear. He was a prolific author, and to focus on writing, he had to get these unavoidable but important tasks off his desk. He had to get them done. 

We face our own brand of tedium in medicine. W10 forms. UI forms. Disability forms. Work hour documentation. MedHub evaluations. Epic inboxes. Medicine reconciliation. Clinic notes. It’s painful to even think about them. Yes, they’re important, but piles of work can sap our spirits. But letting the pile grow just prolongs the torture. And your patients, colleagues, and program are depending on you.

A number of surprisingly interesting books and articles have been written on procrastination and getting work finished, and I’ve included several links below. Sometimes procrastination is actually useful, particularly for creative work. When you’re writing a paper, planning an experiment, or preparing a talk, for example, it’s helpful to let ideas marinate in your brain for a while. The output will be richer and more interesting than work you rush to complete (unless you wait until the very last minute, which is never smart).

But marinating doesn’t work for mundane tasks. Instead of improving with time, the tasks just accumulate, like dishes in the sink or loads of laundry on the couch. So how can we get them done? I’ve thought a lot about this subject and here’s what I’ve gleaned:

  • Don’t let work accumulate. The only thing worse than a pile of work is a mountain of work. The longer you wait, the higher the pile. It takes a few minutes to do one MedHub evaluation; it takes hours to do thirty.
  • Finish work when it’s fresh. The longer you wait, the harder the work becomes. When I finish notes right after clinic, I’m usually done in an hour. When I wait, it takes forever. When I write notes immediately, I can remember my findings, thoughts, and decisions. When I wait, I waste time reconstructing what I forgot. 
  • Work in batches. Multi-tasking is a myth. It takes longer to get anything done when you’re toggling between emails, texts, Instagram, desk work, phone calls, and computer work. Do one thing at a time.
  • Know yourself. Some people work best in the morning; some are better at night. Some people work best in long stretches, others in small chunks. Find the best system for you.
  • Set reasonable goals. If you’ve gotten behind, or you’re feeling overwhelmed, don’t despair. Divide your work into parts. If you have twenty MedHub evaluations to complete and you can’t do them all at once, do five-a-day, and you’ll be done in four days. The same goes for studying. Are you overwhelmed by the number of MKSAP questions you need to answer? No worries. Plan a schedule and do a few every day. Before you know it, you’ll have hundreds done.
  • Be gentle with yourself. It’s easy to get mad at yourself when the work piles up and the longer it sits there, the worse you feel and the less motivated you’ll be. Give yourself a break. We all get overwhelmed sometimes. Think of how good you’ll feel when the pile shrinks. Just getting started will relieve the stress.  
  • Identify the emotional obstacles. Just the thought of calling for medical pre-authorization fills me with dread. Contemplating work is worse than the work itself. It’s good to recognize the emotional obstacles to getting started, particularly for work with little intrinsic reward. Try an extrinsic reward. Eat a cookie
  • Make a list. Lists convert work from infinite to finite, and they provide tangible evidence of progress as you check off boxes, draw lines through the tasks, or just delete them. 
  • Take a break. When your energy wanes, do something else. Go for a run. Read. Hang out. Watch Netflix. Do nothing. You’ll be more efficient when you get back. 
  • Set time aside for the important things. Part of what makes it hard to finish tasks is the time you spend wishing you were doing something else. These wishes are legitimate. There are lots of things you’d rather be doing, like hanging out with friends and family, or working on a project you’re passionate about. We need to preserve time for the activities we cherish. That’s why we set time aside at work each day for teaching conferences. If we didn’t do that, the same work would just expand to fill the vacuum, and we’d waste time wishing we were doing something else.  
  • See the value. It’s easy to forget why these tasks are important, but they are. You don’t want your patient’s electricity to get shut off and you don’t want to accidentally prescribe meds that were supposed to be stopped. Your colleagues value your peer evaluations just as you value theirs. You can learn a ton studying MKSAP, and a complete medical record is essential to good patient care. If work is truly useless, we should look for ways to get rid of it. But many tasks will always be unavoidable and indispensable. Let the value motivate you. 

The truth is I’ve struggled with procrastination my whole life, though I think I’m getting better at navigating workloads. As we start this academic year, let’s do our best to stay on task. Let’s complete our MedHub evaluations as soon as possible, let’s finish our charting right away, and let’s keep our inboxes empty. We may not reach perfection the way my college professor did, but it’s a worthy goal. When we finish our work, we’ll feel great, we’ll make important contributions, and we’ll free up brain space to create our own particular brand of brilliance. Let’s get it done.

Enjoy your Sunday, everyone.   

Mark 

PS: I’m leaving for Quebec tomorrow for a food vacation with the family. Have a Happy Fourth of July and see you next week. 

MDS 

PPS: For your reading pleasure: 

MDS.

Submitted by Mark David Siegel on July 01, 2019