Basically, there are two strategies of spending your day on the ward:
- Go with the flow and look what’s coming up.
- I have a well-structured plan. When unexpected things come up, I modify my plan.
I am a big fan of strategy number 2. Over the years I have learned that structuring your day gives enormous value to the patient, the nurses and myself. With the right plan, you can get more things done and don’t have to put out fires all day long. Here is my plan:
In this post I would like to share with you how you can plan your day proactively and an ideal schedule of your own. I have created an excel template, that you can download for free here.
So here is how to create a schedule for yourself and the day on the ward.
Got your template? You are going to need it, if you wanna get serious.
Step 1: Brainstorming.
Write down all activities that come up on a regular basis. For me this would look like this:
- Examining patients
- Going on rounds
- Looking at ECGs, X-rays
- Performing procedures
- Round on ICU patients
- Checking results of examinations
- Taking care of newly admitted patients (history, exam, initiate procedures etc.)
- EAT!
- Talking to nurses
- Explaining Results to Patients
- Discussing Patients with Consults
- Discussing Patients with my Boss
- Teaching Students
- Writing Reports
- Attending regular clinic conferences (radiology, pathology, microbiology etc. )
- Handover
Ok, so far, so good, now we want to put them in a logical order. Before we start, we want to keep general things in mind:
- Our concentration and brain activity declines over the course of the day. So things that require focused attention shouldn’t be done right before the lunch break but rather early.
- Try to batch similar activities of the same nature. For example activities that require a computer like checking lab values and CT scans should be batched.
So now, let’s organize our day.
Step 2: Start with fixed meetings.
Let’s start with the fixed, time-bound activities: Most doctors have fixed dates like
- handovers,
- morning conferences
- meetings with radiologists and pathologists
- ICU rounds.
Write these down first, they are a given.
Side note: After your shift ends, you can do your handover whenever you want. I actively schedule it, so I have a goal to work towards and get a chance to have dinner with my family.
Now our schedule looks like this:
Note that the fixed dates are surprisingly few. That means that up to a certain extent the rest of our day can be planned and structured by us.
Next you plan the meeting with your attending, because he will have clear intentions when to meet with you to talk through the patients.
I find it most effective to meet with her twice a day, so now my schedule looks like this:
Step 3: Fill in the blanks.
Now you start thinking of a logical order of the tasks.
Going on rounds will be a task that should be performed early during the day, but there may be tasks that have to be fulfilled before that. Taking care of urgent things will minimize interruptions during rounds.
Twice a day I would plan time with your attending. There is no need to talk things through with your attending until you have the main information needed to have a conversation about the patient.
So try to schedule these important meetings after you have acquired information. (rounds, lab values etc.)
Step 4: Colour.
I like to sort things by activity or location.
Green: Near the patient, on the ward itself.
Yellow means fixed dates (conferences etc)
Red: By myself, at the computer/with the patient’s chart.
Blue: With another person. (Attending/consult)
Done! Wasn’t hard, was it? Now you have schedule that allows you to perform many different tasksk in a logical order. Of course things are going to come up and you will have to change improvize, but that’s OK.
And now if something comes up, you can still argue with Henry A. Kissinger: “There cannot be a crisis next week. My schedule is already full.”
If you haven’t downloaded your free template yet, feel free to download it here.