Interruptions of your workflow are common in your work as a doctor. Most of them are legitimate, after all we get paid for solving medical problems.
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But if we manage to channel these interruptions in time slots that work for us, your concentration and your work will improve tremendously.
While office workers can lock their door, doctors have to be accessible 24/7 to take care of possible emergencies. Most of the interruptions aren’t emergencies. Typical issues include the following:
- A nurse asks for a dose of a medication.
- A consulting doctor wants background information about your patient.
- A patient or his relative wants information.
So how can we handle these?
Be proactive. Monitor the interruptions for a couple of days. After 3-4 days you can categorize the groups of people and their requests in 4-5 categories. Nurses, patients, consulting specialties, relatives, phone calls of all kinds. Since most of them are predictive you can proactively address their issues at a point of time you determine.
1. Requests by nurses:
Before I start my morning round I meet with responsible nurses and ask them for problems I have to solve rightaway: IV lines, look at critically ill patients, etc.
I decide, whether they are more urgent than my ward round, or can be postponed until afterwards. Some tasks can be delegated to students. Later during my rounds I will only be contacted because of emergencies.
But: don’t confuse these short mini-meetings with rounds!! They do not have the goal to talk about how many centiliter of saline the patient will receive today or how to dose this or that drug. These questions require concentration, laboratory values and especially time and cannot be answered in between doors.
2. Consulting doctors:
Any doctor doing a consult on your patient needs background information. That’s a given. They want the history, exam result, pathology and radiology results before they look at the patient. In most hospitals you fill out a request form (paper or computer) when you request a consult. Put in as much information in that, even if it takes ten minutes. Sooner or later you will have to provide this information, and this way you get to choose the point of time. Have a detailed consult request and all the necessary reports ready. When he comes by, he can start with the work without you having to interrupt your workflow.
3. Patient knocks on the door because he wants to know test results:
You can anticipate these interruptions: Tell the patient before you send him to an examination (CT scan etc) when HE can expect a result. If they do come by, I usually take a minute to tell them that ward rounds is the right point of time to address these issues. This is not mean or lazy. It’s the only way to satisfy every patient’s needs and to get all the work done. If you talk to every patient once in the morning and once in the evening, you will soon neglect other responsibilities. However, in most cases I end up giving them the information they want, if it doesn’t consume too much time. But in all this, try not to be judgmental or angry, because we can’t expect the patient to know our workflow and office hours.
4. A relative wants information about your patient
These talks are difficult to plan, because visitors come and leave as they like. So, as soon as I see a relative, I usually walk up to them and give them a short update, if time allows. That shouldn’t take more than 2 minutes (if we have talked before). Most of them are happy with that.
The longer I work in hospitals the more I am convinced that the relatives contribute greatly to our success with patients. Hence, my threshold to interrupt a task for a talk with a relative is low. When I really can’t discontinue a task, I tell them to wait in the patient’s room, so they can spend the waiting time with their relative. Give them a rough waiting time, so they can decide, whether they want to wait.
5. Phone calls:
Phone calls are responsible for most unnecessary interruptions. My approach is this one:
1.Give a student your phone.
2. Tell them to answer the following: “He is with a patient right know. Are you calling because of a lifethreatening emergency? Can I take a message?” This is good training for the student, because he acutally has to think whether to bother you with information (lifesaving vs. absolutely needless).
By anticipating and eliminating interruptions you will gain a lot of time and focus.
Question: How do you handle interruptions of your workflow? Leave a comment!
