The most important skill for doctors regardless of your specialty is this one: Decide which crisis you deal with first. Many tasks will appear very urgent, and some actually are. However, you can only effectively focus on one thing at a time. Multitasking is a myth. So here is an example: 

Welcome to your shift: You start at 3PM and here is what you’ll expect:

• Three nurses will tell you to look at their patients RIGHT AWAY.
• Two relatives have waited more than 2 hours to talk to a doctor. They are awaiting you.
• Also your attending physician is waiting in your office to talk through his patients with you.

Now you have to triage your task list. Here is how I make this decision:

Most important: Acknowledge that you can only focus on one thing at a time, so ALL except for one task will have to wait.

1. Talk to the nurses and ask why they believe their patient has to be seen again.

   Is a patient actually in danger? After all he was rounded on by another physician this morning:

   A changed mental status or, deteriorated vital signs, or a bad feeling of an experienced nurse will cause me to go there right away. Either way I will definitely go and see the patient in the next hour.

2. Deal with the relatives.

   I truly believe patients profit more from a good relationship between the doctor and the relative than from 50% of the medication we prescribe.
   Letting somebody wait more than two hours is unacceptable.

   Many times a focused doctor-relative talk will be less than five minutes. Most relatives just want to have a quick update. Either way, I would definitely apologize to them that they had to wait so long, even though it wasn’t my fault.

   If it is evident that this talk will take more than 5 minutes I would ask them whether they would prefer to wait for another hour or whether we could talk on the phone later that day.

3. Next the attending has to be dealt with.

   Even though he is your boss he is last in line in this scenario, mainly for three reasons:

   A: He knows the medical institution best and should be understanding there are urgent things to deal with first.

   B: If there is a medical emergency a good attending will expect you to take care of that right away. Or better – offer his help. On the long run he will recognise that the way you handle things work out and make patients, nurses and relatives happy.

   C: Angry bosses will always have a reason to yell about something because they just like to yell. So, why bother trying to make him happy. If you have the choice whether he yells at you for not taking care of a patient or for letting him wait I choose the latter.

4. Ask the right questions to find out what led to this chaos:

   That is the most important step to manage this crisis is preventing these situations from happening again.

• Was everything of this really unpredictable?
• What happened in the shift before?
• Why were three patients suddenly unstable? Wasn’t this foreseeable? Was anybody contacted before you started your shift to look at them?
• When was the last time you contacted the relatives of your patients?

Question: What task would you have dealt with first? Leave a comment below!