banishing busy

Medical professionals are busy people and exist in a constant state of “being busy.” How do we resolve chronic “busy-ness”? How do we manage our time effectively? In her recent talk at the CORD Academic Assembly 2020, Dr. Christina Shenvi, EM Physician and Associate Residency Director at UNC, provided 5 key actions to help us be productive, complete our work effectively, and strive for work-life balance. Dr. Shenvi recorded her lecture again to be shared with the ALiEM Faculty Incubator. This series of posts breaks down her talk into 3 sections in order to summarize her key points and to help us “Banish Busy” from our lives. This first post will address the importance of value-based scheduling and how to avoid self-sabotage.



  • 0:48 Why does this matter? Maximize our time by being strategic and efficient
  • 2:00 How can we reduce clutter and reduce distraction?
  • 3:01 Activity A: Brain Dump! Write down all your distractions!
  • Key point #1: Practice value-based scheduling
  • 3:46 How do we determine which actions are worthy of our attention?
  • 4:27 What are our Big Values? How can we align our time to them?
  • 8:48 Activity B: Write down your “Big Hairy Audacious Goals” and Important values
  • Key point #2: Avoid self-sabotage
  • 9:09 Why do we self-sabotage?
  • 10:01: Why do we procrastinate?
  • 10:53 What is self-worth theory and how do we protect our self-worth?
  • 12:42 Why are we programmed to withhold effort and make excuses?
  • 15:46 What is defensive pessimism and why do we use it?
  • 16:54 Why do we procrastinate?

Before we begin: remove distractors

The only way to increase productivity is to be strategic about what we do and efficient in how we do it. A jumbled, muddied, and disorganized mind prevents productivity.

  • “Mind trash” are key distractors that take attention away from our important and relevant work.
  • “Brain Dump:” When working on something of importance and “mind trash” floats to the surface, write it down but do not take action on this “trash;” remain focused on more important tasks. The goal is to move from avoidance to action but also from overwhelmed to control.

Activity A: Brain Dump

If any “mind trash” floats to your mind while listening to these videos, write them down on a separate piece of paper (or preferred digital medium) and come back to them later!

There are 5 key actions that we can take to help us take control of our time. In this section, we address the first of these actions and start to discuss the second key action.

Value-based scheduling (Attention∝Worth)

Big values are the values that truly matter to each of us. These “big values” should be the metric we utilize to evaluate if we are spending our time wisely. These values should form our “big hairy audacious goal” (BHAG) [1].

  • This approach provides clarity and maintains momentum towards accomplishing these goals.
  • BHAGs should be specific and not abstract, including exact numbers and dates of completion.
  • BHAG can pertain to multiple arenas of our life including personal and professional goals.

Once we have identified our BHAG, small changes and accomplishments will all accumulate and progress towards a BHAG. A BHAG should NOT be the role we want to be in but should represent our vision. Overall, time spent and effort used should reflect our big values!

banishing busy

Activity B: What are your BHAGs?

Take a moment to reflect and then write down our “big values” and important goals. Identify your BHAGs! Don’t worry about getting it ‘wrong’. These do not need to be lofty, transcendent goals. Just write down what is important to you in the way you would explain it to a 10-year old. Keep it simple and honest!

Avoid self-sabotage:

Since time management is chiefly intertwined with emotion management, the inability to manage negative moods often leads to procrastination [2]. This association is based on the self-worth theory (SWT). Self-worth is a critical dimension of human functioning. The theory explains many aspects of how we both assess and protect our self-worth and the effects that has on our time management:

  • The theory states that individuals will protect their self-worth at all costs.
  • When there is a fear of failure, an individual will sever the tie between ability and performance by decreasing effort.
  • This is a maladaptive behavior that we use to protect our self-worth in case of failure.

This concept is called self-worth protection (SWP) strategies [3-6].

SWP strategy #1: Self-sabotage and ready excuses or alibis

When we fail, there is a direct relationship between effort and shame. If we have put in high levels of effort and fail, we experience high levels of shame. Having excuses for our failures decreases our feelings of shame significantly. Along with excuses, putting in lower effort will lead to the lowest levels of shame. While low effort may increase guilt, “Shame eats guilt for breakfast.” Guilt will be tolerated to extinguish feelings of shame. Failure with low effort and built-in excuses protects self-worth. Pitfall: If success occurs, there can be inappropriate inflation of our own perceived abilities.

banishing busy

SWP strategy #2: Defensive pessimism

This concept is the idea of creating self-fulfilling prophecies of failure for ourselves. “This talk is going to be terrible” or “I’m going to fail this test.” This effectively lowers our self-expectations and protects ourselves from shame. Another concept, reflectivity, allows us to combat defensive pessimism. Reflectivity is considering the worst result versus the more likely consequences of a poor performance and creating perspective.

Why we procrastinate:

When thinking about procrastination, it is helpful to think of the energy needed to start a project. The “activation energy” requires overcoming fear of failure, self-preservation strategies and the avoidance of negative emotions. If we avoid starting a project, we avoid the possibility of failure. Furthermore, we use procrastination as a self-worth protection mechanism, which also raises the activation barrier to starting a project [7, 8]. Finally, we frequently procrastinate to avoid the negative emotions associated with a task. If we anticipate feeling boredom, anxiety, insecurity, or self-doubt when performing a task or working on a project, then we tend to procrastinate.

Procrastinators who avoid maximum effort do so for various reasons:

  1. To avoid the negative emotions
  2. To protect of self-worth
  3. To protect the feelings of those less successful such as protecting family members that are less successful
  4. To avoid mockery or unwanted attention such as ‘nerd’ or ‘geek’ or ‘gunner’ or ‘workaholic’
  5. To rebel against authority
  6. To gain revenge in a passive-aggressive nature

Coming soon in Part 2:

How often do we get in our own way when starting or finishing a project? In part 2, Dr. Shenvi discusses seven ways to help keep us from being our worst enemy by avoiding self-sabotage.

References/Recommended readings:

  1. Collins, J, Porras, J. Built to last: successful habits of visionary companies. New York: Harper Business Essentials. 2004.
  2. Lieberman C. Why You Procrastinate (It Has Nothing to Do With Self-Control). New York Times.. Published March 2019.
  3. Cano, F., Martin, A.J., Ginns, P. et al. Students’ self-worth protection and approaches to learning in higher education: predictors and consequences. High Educ 76, 163–181 (2018).
  4. Covington M. The Self-Worth Theory of Achievement Motivation: Findings and Implications. Elem Sch J. 1984;85(1):5-20. doi:10.1086/461388
  5. Covington M. Goal Theory, Motivation, and School Achievement: An Integrative Review. Annu Rev Psychol. 2000;51(1):171-200. doi:10.1146/annurev.psych.51.1.171
  6. Voge N. Nic Voge: Self Worth Theory: The Key to Understanding & Overcoming Procrastination. Presented at TEDxPrincetonU. Nov 2017
  7. Covington M, Omelich C. Effort: The double-edged sword in school achievement. J Educ Psychol. 1979;71(2):169-182. doi:10.1037/0022-0663.71.2.169
  8. Burka J, Yuen L. Mind Games Procrastinators Play. Psych Today. Jan 1982;16:32.
Brian Barbas, MD

Brian Barbas, MD

Assistant Professor & Clerkship Director
Department of Emergency Medicine
Loyola University Chicago – Stritch School of Medicine
Brian Barbas, MD

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Laryssa Patti, MD

Laryssa Patti, MD

Assistant Professor
Emergency Medicine Clerkship Director
Department of Emergency Medicine
Rutgers - Robert Wood Johnson Medical School
Meenal Sharkey, MD

Meenal Sharkey, MD

Medical Student Clerkship Director and Core Faculty
Assistant Program Director
Department of Emergency Medicine
Doctors Hospital, Columbus, OH
Meenal Sharkey, MD

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Eric Blazar, MD

Eric Blazar, MD

Clinical Assistant Professor
Department of Emergency Medicine
Rowan University
Inspira Medical Center
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Christina Shenvi, MD PhD
Associate Professor
University of North Carolina
Christina Shenvi, MD PhD


Emergency Medicine and Geriatrics trained, Educator, Professional nerd, mother of 4, excited about #educationaltheory, #MedEd, #EM, #Geriatrics, #FOAMed.
Christina Shenvi, MD PhD

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