Time Management

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The blog Time  posed the question of our relationship with time–how much do we struggle swimming upstream compared to floating in the currents of time? The concept of “time management” broadens this question.

“Time management” refers to the tools we consciously use to control the amount of time allocated to tasks in order to increase efficiency. How do we use these tools while cultivating our relationship with time?

As an executive, I applied the time management approach of Getting Things Done  by David Allen coupled with the Seven Habits of Highly Effective People  by Steven Covey. Allen’s approach identifies the vague sense of unease we feel because of the scores of poorly defined tasks floating around in our heads– I need to change the batteries in the carbon monoxide detector; that report is due to tomorrow; the staircase in the backyard needs a railing; we are low on cereal; I wonder what that patient’s potassium was?

Many of these tasks create anxiety because they are unformed and not actionable. As a result, we know we should begin but don’t know how. As an example, if our task is to learn how to ski, we can’t proceed until we have defined a desirable outcome–ski the bunny hill during my February vacation- and an actionable next step– find John’s phone number so I can call and ask him which ski school he used.

Allen asks us to settle our churning minds by collecting all of our “stuff” (the pending tasks of our lives) and listing them in one place in order for us to define desirable outcomes and next actions. He then teaches a process to keep work flowing. His approach appealed to my “inner geek” because I was able to use the advanced functions of the Task List in Outlook to manage the activities of my life. I prided myself on having all of my work flowing through one and only one highly customized inbox

The time management approaches of Allen and others are useful tools for productivity but are less so when applied as a way of life. Indeed, time management tools enabled my illusion that I could outrun time and my infinite task list. I imagined that by running faster than time, I could outrun aging. Managing time is a delusion. We can’t manage time. Our planning does not impress time and it flows unceasingly with or without us. Yet action without planning is impulse.

Though we cannot manage time as a way of life, we can work on the kind of person we want to be as we use tools for efficiency and cultivate our relationship with time. I found Covey’s book particularly helpful in this regard. Covey goes beyond the usual time management lists, schedules, calendars and priorities by articulating the following 7 habits to improve our capacity to accomplish.: be proactive, begin with the end in mind, put first things first, think win-win, seek to understand–then to be understood, synergize (combine the strengths of people through teamwork ) and sharpen the saw (balance and renew your energy for a sustainable life-style).

Covey stresses that how we are in time–our character, relationships, attitudes and spirituality is critical for what we do in time..

Please use comments below to describe using time management approaches while cultivating your relationship with time.

Words We Use

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Our words direct thoughts and feelings. When interacting with patients our word choices shape our views.

During my formal medical training, I naturally desired to support and understand individuals struggling to adjust to a clinical diagnosis. As an eager medical student, I valued learning how another human being makes meaning from their medical condition. However, the training culture eroded my initial inclinations. I vividly recall instructions during an early clinical hospital rotation. “David, go workup the ‘lunger’ in room 208.” The “lunger”, a 38 year old father of 3 small children , was dying from chronic obstructive pulmonary disease associated with hereditary alpha 1 antitrypsin deficiency. The word “lunger” distanced me from the patient’s anguish and courage in this poignant human struggle.

During the first day of internship, the second year resident instructed me to write a note on the “CHFer” (an individual with congestive heart failure) in room 620. Introducing myself, I noticed the patient was too weak to lift a fork to his mouth to feed himself. Yet, the next day upon entering his room, I noted an open window, empty bed and dangling IV. The patient managed the strength to open the window jumping to his death. Later, I learned this CHFer was in his 40’s diagnosed with a rapidly progressive cardiomyopathy. As a motorcycle racer he jumped over large obstacles with his bike just 6 months prior to hospitalization. The last jump of his life represented the act of a once physically active man exercising his final choice. Categorizing him as the CHFer in room 620 completely obscures the meaning of a bedridden, dependent state for this individual.

I worked up appys, hip fractures, diabetics, acute bellies and numerous other “conditions”. Naming people by their clinical states, we condensed and ignored life experiences insulating ourselves from the patient’s “meaning making.”

Imagine, replacing the standard clinical term “work up” with a request to please “understand” the patient in room 208 who is short of breath with end stage chronic pulmonary disease. The improved training culture would embed the medical evaluation within the context of values and meanings for the patient.

Soon, I internalized the pervasive training culture. Shaped by words, I began elevating clinical problems above “subjective experiences.” Years of clinical practice and personal losses provided the humility for me to appreciate the flaws in this viewpoint. Witnessing the courage of patients and families struggling with loss, fear, confusion and vulnerability, while grappling with my own traumatic health crisis, helped me understand the importance of creating a healing environment and experience with patients.

For many of us, who’ve experienced early clinical training within the traditional medical culture, paying consistent attention to clinical needs arises more naturally than attending to the emotional and experiential concerns of patients.

Please use “comments” below to provide examples of words you use or hear that enhance or diminish the experiences of the individuals we support

Healers and Ritual

 

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Picture the following doctor and patient interactions from my time as a practicing physician.

Patient A: “Every few weeks, I get a momentary stabbing pain right here on my chest. It feels like an electric shock.”

Dr. A: Already knowing the symptom does not represent anything serious, I listen to the heart and lungs, palpate the abdomen and check knee reflexes.

Patient B: “Sometimes my stools are little and hard. You know, just like a rabbit’s. I have noticed this for 20 years and it has not changed.”

Dr. A:  Already knowing that the symptom does not represent anything serious, I listen to the heart and lungs, palpate the abdomen and check knee reflexes

Patient C: “Ever since my wife died 3 months ago I have trouble sleeping. I am worried that I have a serious medical problem.”

Dr. A: Already knowing that the insomnia stems from grief, I listen to the heart and lungs, palpate the abdomen and check knee reflexes.

After years of being drawn to listen to the heart and lungs, palpate the abdomen and check knee reflexes I felt engaged in an ancient dance. In most cases, these assessments contributed little to my knowledge about a patient’s physical condition. Going through the routine, I felt a subterranean kinship with witch doctors and shamans.

At one point in my career, I felt compelled to learn about ancient healers. I discovered they all had something in common: ritual. Rituals mark the transformations occurring with significant transitions such as birth, death, birthdays, confirmations, bar mitzvah, etc. Listening to the heart and lungs and palpating the abdomen represented an important ritual in applying human touch to transform worry into acceptance.

In a remarkable 18 minute TED talk video entitled “A Doctors Touch,” author and infectious disease specialist Abraham Verghese describes the power of the human hand to touch, comfort and diagnose. (Click here to view). Verghese paints a vivid picture of the everyday health care ritual of patients baring their souls to physicians and then disrobing.

Please use comments below to describe your thoughts about the relationship of healing, ritual and touch

 

Healing Lineage

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The healing lineage of physicians traces back thousands of years spanning cultures. We explain the present; we predict the future; we change the future. We forge relationships in order “to cure sometimes, to relieve often, to comfort always.”

When I was a young physician, Dr. Moses Barron, posthumously taught me about healing. I never met Dr. Barron, but received his teachings via a tattered, folded note carried for 40 years in Max’s wallet. As part of an initial history and physical examination, I asked Max the usual question: “have you had any medical problems over the years?” Max said nothing as he reached for his billfold retrieving a handwritten note dated (before my birth) and signed by Moses Barron: “You have nervous bowel. It will flare up whenever you are under stress.” Sure enough, Max suffered symptoms of irritable bowel syndrome, yet never sought treatment, subsequent to Dr. Barron’s inscription. Dr Barron explained the present (you have irritable bowel), predicted the future (you will have symptoms whenever you are under stress) and changed the future (Max did not seek medical help for his symptoms).

Dr. Barron taught me “little things” contribute to healing in ways that we may never observe.

Years later, I learned Frederick Banting, during his 1925 Nobel Prize acceptance speech for discovering insulin, attributed his findings to an article written in 1920 by Dr. Baron.

Please use comments below to describe how “little things” contribute to healing through relationships, explaining the present, predicting the future and changing the future.