How I Work Smarter: Al’ai Alvarez MD

One word that best describes how you work?

Compassion

Current mobile device

iPhone 12

Computer

MacBook Pro

What is something you are working on now?

Where do I begin? The pandemic has opened doors for virtual talks and conferences, so I’m just taking it week by week sometimes. I’m also doing a fellowship, the Stanford Byers Center for Biodesign Faculty Fellowship. I’m learning how to apply design thinking to well-being interventions in the ED, and hopefully collaborating with other high-performance teams. I am also co-directing a conference in May 2022 on High-Performance Resuscitation Teams.

How did you come up with this Idea/Project?

re: High-Performance Resuscitation Teams Conference, I have been attending the Mission Critical Teams Institute summits over the past several years. We wanted to create a conference focused on healthcare and high-performance teams. I’ve had the opportunity to center my areas of interests in Medical Education, Process Improvement (Quality and Clinical Operations), Recruitment (Diversity), and Well-being (Inclusion) through human-centered design. A natural area was focusing on team performance and professionalism under stress.

What’s your office workspace setup like?

I’m in the middle of 5 people-office space. I have a plant, some snacks, and a big monitor. I haven’t been there in months. My home office is somewhat similar.

What’s your best time-saving tip in the office or home?

Paper and pen writing of big deadlines in a week. I’ve tried calendaring after learning from Dr. Jennifer Kanapicki, though I have yet to develop the discipline to do this weekly. My coach offered an alternative, which is focusing on 3 big projects a week to focus my energy. This helps me put things in perspective, as opposed to having so many loose ends, and writing it down cognitively frees up memory space for me.

What’s your best time-saving tip regarding email management?

Quick run-through in the morning, and start deleting.

What apps do you use to keep yourself organized?

On Chrome: OneTab for all my tabs. Omnifocus for my to-do stuff. My calendar is a part of my life so my calendar is an extension of my brain. When2meet to find mutual availability for meetings plus My calendar with zoom links.

How do you stay up to date with resources?

Twitter. I know.

What’s your best time-saving tip in the ED?

Eyeball patients immediately so I have a sense of who’s sick and who’s not. Talk to the nurses. They know more about the patient most of the time. For the rest, I follow the mantra, “Quality care takes time,” and I am on the faster end of the dispositions in my group, as I’ve learned to be more comfortable with managing uncertainties.

ED charting: Macros or no macros?

No macros. I also don’t chart as much as I should. I write for the sake of documenting and not for billing. I’m OK with that. We can’t do it all.

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient?

    #selfcompassion. Can’t do everything perfectly. Show up. Learn to say no. The power of perspectives. In 1 week, 1 month, 1 year, 10 years will this really matter? This grounds me on how I tackle tasks and often the emotions surrounding deadlines.

  • What advice would you give other doctors who want to get started, or who are just starting out?

    Easier said than done, practicing self-compassion has allowed me to really develop a growth mindset. To start, simply doing a daily mindfulness practice of even 5-10 minutes. This trains my mind to slow things down when things become chaotic. This also trains me to be attuned to how my body reacts to stress, and therefore, tending to it whenever I notice these sensations (neck stiffening up, etc).

  • Is there anything else you’d like to add that might be interesting to readers?

    I may be doing a ton of stuff, and in the background, I’m doing a ton more and failing. For me, the more things I’m working on that I’m truly passionate about, the more I get done. I’m OK with failure, and whenever I do (and not if I do), these offer me a great opportunity to learn how to be better (or choose better opportunities). Last and also very important, I find the collaborations bring more meaning to my work.

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By |2022-01-18T09:55:16-08:00Jan 21, 2022|How I Work Smarter, Medical Education|

How I Work Smarter: Mark Ramzy, DO EMT-P

One word that best describes how you work?

Focused

Current mobile device

Samsung Galaxy S20

Computer

Samsung Notebook 9

What is something you are working on now?

Ultrasound Teaching Curriculum (both image review and interpretation) that can be made virtual and in very small group sessions with focused teaching and infographics.

How did you come up with this Idea/Project?

We performed a needs assessment in ultrasound learning across different divisions and specialties (IM, Anesthesia, etc) within the hospital. This didn’t just include medical students and residents/fellows, but also included attendings and faculty members with a longitudinal component to teaching. Also planning to make infographics easily referenceable on shift for quick review.

What’s your office workspace setup like?

Well since I’m a fellow, I don’t quite have an office at work. My office (and also recording space) at home consists of a custom-built desktop computer that is essentially a replica of my laptop.

What’s your best time-saving tip in the office or home?

Chunk or group together your work, especially similar tasks. If you have articles or content to review across different slack work groups, try to do it all at the same time so that you can develop a flow to your focused work. Have similar rules for work and home. For example turn off your phone notifications when “chunking”, then when you dedicate time to yourself/family/friends, also turn off your phone and be as present as possible.

What’s your best time-saving tip regarding email management?

Don’t just get your inbox to zero, have an organized system to keep everything straight. Whether that is a folder, labels, or specific inboxes, make sure you can easily find information. Also, utilize the snooze button in GMail as it helps you prioritize emails that you need to respond to but are unable to right away if viewing on your phone.

What apps do you use to keep yourself organized?

  • OneNote AND Evernote (I think the former has drawing/writing features, allowing me to take handwritten notes and easily search them
  • Business Calendar
  • Feedly

How do you stay up to date with resources?

  • Push specific content to me (ie. Utilize email notification system on PubMed and Journals for articles on specific topics)
  • Make customized lists on Twitter following particular people and hashtags

What’s your best time-saving tip in the ED?

Count your steps and limit them when you can to ultimately see more patients and save time. Also in addition to nursing staff, make every possible effort to learn the names of the unit clerk, environmental services, and any other ancillary support staff in the ED.

ED charting: Macros or no macros?

Macros for sure. I re-read it every single time on every single patient and make sure it applies to the patient after slight modifications as needed.

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient?

    • Double-dip when working on a project. Writing an article? Turn it into a blog post as well! Spin it into a deep discussion with an expert to also make it into a podcast.
    • Find a way to make your work easily accessible on shift (with or without an internet connection), Evernote and OneNote are both great options for this.
  • What advice would you give other doctors who want to get started, or who are just starting out?

    • Treat your staff (and patients) BETTER than you would want to be treated. Actively work to know their names and develop a working relationship with them so everyone can better help take care of patients together as a team.
    • Don’t gossip or talk about others no matter how tempting it is to get pulled into the “drama”
    • Be that doctor, who staff are excited to see when you come on shift and say things like “Oh Thank God it’s you…”
  • Is there anything else you’d like to add that might be interesting to readers?

    • Make sure to have one or more hobbies outside of medicine that really push your creative boundaries. For me, it’s things like graphic design, infographics, baking cheesecakes, and artistically decorating. It’s an added bonus if others can benefit from your hobby too!

Who would you love for us to track down to answer these same questions?

  • Paul Young (@DogICUma)
  • Zaf Qasim (@ResusOne)
  • Zack Shinar (@ZackShinar)
  • Joshua Niforatos (@ReverendofDoubt)
  • Shreya Trivedi (@ShreyaTrivediMD)

Read other How I Work Smarter posts, sharing efficiency tips and life advice.

By |2021-11-11T07:33:34-08:00Nov 12, 2021|How I Work Smarter, Medical Education|

How I Work Smarter: Katie Holmes, DO FACEP

One word that best describes how you work?

Hustle

Current mobile device

iPhone 12 Pro

Computer

Macbook Air

What is something you are working on now?

Updated Curriculum for our EM Clerkship, VSAS, Conference Material, Intern Orientation planning, and more

How did you come up with this Idea/Project?

We are always trying to improve our curriculums to make them better based off of feedback from previous years!

What’s your office workspace setup like?

My kitchen counter or my office at the hospital.

What’s your best time-saving tip in the office or home?

Keep a To Do list and divide into “right now” and “ideas for later”.

What’s your best time-saving tip regarding email management?

Start with the longest sitting email and work your way up, but always respond quickly to urgent emails, even if it’s to recognize you saw it.xt

What apps do you use to keep yourself organized?

iPhone To Do lists, Notepad shared with my team, Google Docs/Sheets

How do you stay up to date with resources?

Twitter, podcasts, subscribed emails

What’s your best time-saving tip in the ED?

Epic’s Work space, Updating ED Course frequently, Epic messaging, multitasking constantly

ED charting: Macros or no macros?

Minimalist Macros unless I have a complex patient, then it’s story time with M-Modal

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient?

    Always make time for the things you love. Travel hard. What you do matters. Don’t engage difficult people. Don’t take yourself too seriously… you just have to laugh it off sometimes. Take care of patients passionately. Encourage others around you always. Work can and should be enjoyable, if it’s not… you’re doing something wrong.

  • What advice would you give other doctors who want to get started, or who are just starting out?

We have the best job in the world, but you must truly love what you do to sustain a long and happy career in medicine.

  • Is there anything else you’d like to add that might be interesting to readers?

Surrounding yourself with motivated, helpful and kind people who are passionate about what they do is the best thing you can do in this demanding job! I don’t know what I would do without my people.

Who would you love for us to track down to answer these same questions?

  • Dr. Anant Patel, DO  @anantpatels

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By |2021-07-28T04:41:51-07:00Jul 28, 2021|How I Work Smarter, Medical Education|

How I Work Smarter: Gus M. Garmel, MD, FACEP, FAAEM

gus garmel how i work smarter

One word that best describes how you work?

Compassionately

Current mobile device

iPhone

Computer

MacMini

What is something you are working on now?

Multiple projects, presently Microaggressions & Civility in the Workplace, Communication and Success in EM, and Coaching/Mentoring in EM.

How did you come up with this Idea/Project?

These are important topics; not a lot of information is available about these topics related specifically to EM despite the need.

What’s your office workspace setup like?

Standing wrap-around adjustable desk with good lighting, multiple computer monitors, and sufficient space to work so that I can keep needed materials close and accessible in my work area. I have few distractions in my workspace, which allows me to focus best on the work I am doing.

What’s your best time-saving tip in the office or home?

Limit distractions and work on one thing at a time, which reduces inefficiencies and errors that often occur with multitasking.

What’s your best time-saving tip regarding email management?

I have several tips, although I have found that turning off email notifications and checking email infrequently (or on YOUR schedule when time allows) are perhaps the best recommendations I can share (again, this relates to multitasking inefficiencies, limiting distractions, and error prevention).

What apps do you use to keep yourself organized?

Ical, Notes, and email all help me stay organized. I also use SUPER-STICKY Post-It notes. They come in a variety of colors if you purchase them in bulk, which some people use to help with organization through color-coding (I don’t use this strategy, but it is a good one).

How do you stay up to date with resources?

Staying current and updated (medical and non-medical) is challenging and takes time. I have a few key websites bookmarked, and still get some materials through the mail on paper. I schedule time for keeping up. Some aggregated links direct me to articles of interest, and I receive TOCs directly from society journals (EM and non-EM). I make a conscious effort to keep up, and spend very little (or no) time on Facebook, Twitter, and other social media platforms.

What’s your best time-saving tip in the ED?

Always think DISPOSITION (every patient needs one). I teach that if you don’t have a good idea about a patient’s disposition, you should ask more targeted questions and do a better physical examination before leaving the room. I recommend planning for test results that can only be normal, abnormal, or indeterminate. Imagine what you would do for (and with) each patient if the test results are all negative (or normal). Have a plan for indeterminate results, for positive findings, or what to do if there is a worsening in the clinical course (including persisting pain, dizziness, vomiting, shortness of breath, etc.). I also think and teach to consider what information is necessary before it is appropriate to call a consultant that I or the patient needs anyway. Often consultants appreciate hearing about a patient “early” even before all the results return (especially if it is near the end of their day while they are still in the hospital).

ED charting: Macros or no macros?

Macros, but only after I see the patient and with attention to modifying the EMR as necessary. I am meticulous about adding detail and removing anything that is incorrect from the Macro. I never use Macros in my free-text HPI.

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient?

    FOCUS – that’s key. Make every minute (or moment) count. Whenever possible, try to “finish” one task before starting another, which keeps your “to do” list as short as possible and prevents errors and inefficiencies related to multitasking or task switching.

  • What advice would you give other doctors who want to get started, or who are just starting out?

My best and most frequent advice to all physicians (especially new physicians) is to work hard (and smart), be a team player at all times, show compassion and demonstrate empathy as often as possible (always is best), and strive to improve your communication and professionalism skills. Clinical knowledge is expected. Your efficiency will improve with experience and with practice. Be kind to as many people as you can as often as you can. These are important strategies for professional success, patient satisfaction, and personal wellness.

  • Is there anything else you’d like to add that might be interesting to readers?

Enjoy your career in EM, which will be challenging yet extremely rewarding. Strive to achieve Joy and Meaning in Medicine by working with purpose. Use people’s names frequently and correctly (patients, staff, consultants, colleagues), and express genuine interest in them as people and professionals. Learning something personal about your patients and colleagues (in and outside of EM) is a sign of respect. Expressing gratitude and saying “thank you” with sincerity are always beneficial.

Who would you love for us to track down to answer these same questions?

Anyone who has demonstrated consistent long-term success in EM, and is able to share his or her successes, failures, and strategies in a clear manner.

Read other How I Work Smarter posts, sharing efficiency tips and life advice.

How I Work Smarter: Christopher Lloyd, DO

One word that best describes how you work?

Opportunistically

Current mobile device

iPhone 12 Pro

Computer

iPhone Xr

What is something you are working on now?

Qualitative analysis on resident perceptions of feedback

How did you come up with this Idea/Project?

As a program we are continuing to look at how feedback is being delivered to residents, when it is happening, how it is received/implemented, etc. This project grew from a desire to explore the resident perspective on these topics so as to understand better where we are effective with our feedback techniques and practices and where we can find areas to improve.

What’s your office workspace setup like?

Currently I’m sitting on my back patio while my three kids are across the yard in their hammock cocoons. I’ve never been much of a desk person, and I always am more comfortable and productive when I vary my environment. Kitchen table, living room by the window, backyard, or, preferentially, a local coffee shop – although that’s less frequent recently #thanksCOVID. Really the only constant to my workspace is my computer and a cup of coffee. Occasionally just a notepad and the cup of coffee. Always the coffee though.

What’s your best time-saving tip in the office or home?

Don’t wait until your sitting down for intentional work to start a to do list! You’ll spend the first 30 minutes of what could be some productive time thinking about what you should be doing. Find a method that works for you to collect your tasks (I’ve used a bunch…topic for another day) and have a plan for when you start to work. I mentioned working opportunistically above. There is no set schedule in our house. Both my wife and I are emergency physicians. I usually look at the week ahead and pick out where my blocks of work are going to be and then look at my task manager and pick out what/where I want to accomplish anything. Its rare that I sit down with an hour or two to work and don’t already have a plan. Second part of that is matching task management with energy levels. Say its 9am after two straight 5pm – whenever shifts (you know the one….the shift that technically has an end time but you never leave at that time). I know that after two nights of crummy sleep that I shouldn’t be trying to do any deep focused work so I’ll plan on doing lighter tasks that are quick and require less concentration. Save the stuff that takes more time and focus for days that you know you’ll be working with a full cup:) I tend to label these with either squirrel or zombie (Some call this the ‘mind is mush’ mindset) tags on my task manager so I can get a quick filter of either one depending on how I’m feeling.

What’s your best time-saving tip regarding email management?

Check it twice a day at the most. This is hard, and I fail regularly, but email is the single biggest time sink we have and the more time you spend out of email the better. The argument I hear is ‘what if it’s something important from my chair/medical director/PD?!’ Here’s the thing…if you only check it twice a day you set that expectation for others. Thankfully those people in my life know that if something is mission critical/needs addressed now they’ll call/text. Set aside this time once or twice a day, reply to the stuff that only takes 2 min or less, and add the other stuff to your task manager. I’m an inbox zero person, but I know that’s not for everyone.

What apps do you use to keep yourself organized?

I use Todoist for task management. That’s really it.

How do you stay up to date with resources?

Feedly is a RSS feed that I use to capture articles. I try to keep up to date with EMRAP and EMA because I know the residents are in that space regularly and I want to be able to speak to the topics that is on the forefront of their minds.

What’s your best time-saving tip in the ED?

Unless someone requires a life saving intervention never get more than 2 charts behind. What will take me a minute or two to dictate now will take 2-3 times that after my shift or later on and it adds up fast. Also dragon dictation. If my dragon is broken you will find me curled up in the fetal position under the desk.

ED charting: Macros or no macros?

Macros for physical exam – but make sure its your typical physical exam so you don’t need to change it often. Other wise dragon dictation for everything else. Not a fan of macros for medical decision making documentation. Too many times its obvious that its a macro and as such starts to diminish the credibility of the note.

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient?

    Work life balance implies that you have to give up one side to balance the other. I preach and practice work life integration.

  • What advice would you give other doctors who want to get started, or who are just starting out?

Sit down with patients and listen to them. You’ll save more time here than at your desk charting. Find what’s important to you and intentionally make time for that. Wellness is different for everyone.

Read other How I Work Smarter posts, sharing efficiency tips and life advice.

How I Work Smarter: Miguel Reyes, MD

One word that best describes how you work?

Comfortable

Current mobile device

iPhone 12 Pro

Computer

Macbook Air

What is something you are working on now?

Wound Care article, REBEL EM CME content, Journal Reviews

How did you come up with this Idea/Project?

It was an opportunity that presented itself during the fellowship. It’s a collaborative effort with other faculty members to pull together this large review article, its a lot of work and effort but I think it’ll be worth it. As for the REBEL content, I’ve been working with Salim for a little bit and this chance came up so I decided I wanted to help upload the content to be made into CME.

What’s your office workspace setup like?

Well, it used to be the Kitchen Counter (NYC apartment doesn’t offer much space) but recently got a little desk and chair in our bedroom so I sometimes use that.

 

 

What’s your best time-saving tip in the office or home?

Close all distractions and put away your phone. When working on a project consider it your “deep work” time and focus your energy on that.

What’s your best time-saving tip regarding email management?

Check it only twice a day. Once in the morning and the other time in the afternoon.

What apps do you use to keep yourself organized?

Strides – My habit tracker for things I want to improve on, studying EM topics

Todoist – Great app for being able to break down large daunting projects into smaller manageable tasks while keeping it all organized. Since downloading this app I’ve become significantly more productive.

How do you stay up to date with resources?

Feedly – News aggregator website. I simply link all the FOAM sites I really like to it so when a new article comes out I’m interested in I can read it there.

What’s your best time-saving tip in the ED?

When you dispo the patient, finish the chart, and every time you stand up from your seat try to do at least 3 tasks before sitting back down.

ED charting: Macros or no macros?

Macros, otherwise I’d be charting for ages and there isn’t enough Great British Bake Off to numb that kind of pain

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient?

    Discipline equals freedom – Sounds trite but its transformed my outlook. The more disciplined I’ve become with social media and focused work time has allowed me to be more present with my family and loved ones for the time that really matters.

    Dr. Bove one of our staff at St. Joes gave us what I thought was great efficiency advice. If you wanna be good and have a good flow in the department every time you stand from your seat to do a task, do as many as possible before sitting back down.

  • What advice would you give other doctors who want to get started, or who are just starting out?

Don’t rush the outcome. The fun in this is not the destination but the journey in getting there so try to enjoy all the twists and turns along the way.

Who would you love for us to track down to answer these same questions?

  • Marco Propersi, DO

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By |2021-05-31T15:34:38-07:00Jun 2, 2021|How I Work Smarter, Medical Education|

How I Work Smarter: Laryssa Patti, MD

One word that best describes how you work?

Organized chaos (that’s 2 words)

Current mobile device

iPhone XS

Computer

2020 13″ Macbook Air + iPad with keyboard as a second monitort

What is something you are working on now?

Incorporating FOAM into our EM clerkship

How did you come up with this Idea/Project?

COVID decided for me — we’re working on a way to keep students engaged even though we’re still semi-distance learning. Additionally, I want to send my students into residency knowing that FOAM exists but needs to be assessed in the same way we think about peer reviewed literature.

What’s your office workspace setup like?

I have an office at our medical school that is a big flat surface in a square room with an internet connection. All of the art on the walls is of landscapes, no diplomas! It is off the beaten path (and also around the corner from the hospital Starbucks), which makes it a great place to get work done.

Since COVID, I’ve been doing the majority of my non-clinical work at home with essentially the same set up, but including a cat.

What’s your best time-saving tip in the office or home?

Everything goes into my Google calendar. If I need 30 minutes to read articles for our department journal club or food shopping, it goes in my calendar. It keeps me honest and on top of my to-do list. I try to protect a certain morning/afternoon a week (this year it’s Tuesday afternoon) for my own projects and writing and will defend that time from other obligations. I am still learning that I probably need 1.25-1.5x more time than I think to achieve any goal, though.

What’s your best time-saving tip regarding email management?

I am an inbox zero person. The 5 digit unread email number of one of my good friends gives me palpitations. My Gmail automatically sorts emails into buckets (e.g., advertisements, bills) so that my actual inbox is only emails that need immediate attention. If I can give a response immediately, I will. If I need more time to research an answer, I’ll reply as much, and stick it on my calendar to come back to. I’ve also really leaned into “snoozing” emails in both Gmail and Outlook. Things like the didactic conference schedule for this week or the agenda for a meeting later this week will get snoozed until 30 minutes before that time. Similarly, I schedule a lot of emails to be sent (like the medical student schedule that we send out weekly) so that I can put in a little bit of effort upfront and then trust Outlook to send that to faculty at a certain time.

What apps do you use to keep yourself organized?

Gmail, Tasks, and Google Calendar primarily. And also the notes app on my phone for random things that I don’t want to forget that come to me while driving or in the middle of the night.

How do you stay up to date with resources?

I subscribe to a few journal aggregators that send me weekly summaries of new articles and, of course, the EM:RAP and Twitter FOAM universe that sends me back to primary sources.

What’s your best time-saving tip in the ED?

Enter orders and write/dictate at least HPI/PMH after every patient. Every time I try to stack a bunch of patients (even low acuity ones) I end up getting interrupted and realize that I’m more behind than I thought.

ED charting: Macros or no macros?

Macros, with cautions. I have some standard physical exam and discharge instructions, but only use them for specific patients.

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient?

    Say no to things after your first year out. Once you know what you like, ask yourself: is the time/effort required to participate in [admissions committee/ interdepartmental project / extracurricular project] worth what you get out of it? If the answer is no, don’t do it. If the thing that you get out of it is rest/relaxation that is a valid reason.

  • What advice would you give other doctors who want to get started, or who are just starting out?

Say yes to things your first year out. This helps you meet people and learn about different niches that you can fill. But you can’t do this forever (see answer above).

  • Is there anything else you’d like to add that might be interesting to readers?

Accept that things will not go according to plan and forgive yourself. One of the best things that I did in the last month was blow off a long meeting in that I had nothing much to add besides being a member of the quorum in order to go on a walk and watch a movie with my husband. I came back to work re-energized and was much more productive the next day. Totally worth it.

In the same vein, I’m a new mom and still struggling to find a balance between being home and present, clinical work, and non-clinical work, and am continuing to remind myself that as much as my son is growing, I am growing too! (Some days work out better than others).

Who would you love for us to track down to answer these same questions?

  • Eric Blazar (@eblazar)
  • Sugeet Jagpal (@ysugeety)

Read other How I Work Smarter posts, sharing efficiency tips and life advice.

By |2021-05-17T06:44:59-07:00May 19, 2021|How I Work Smarter, Medical Education|
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