One word that best describes how you work?
Current mobile device
iPhone 11 — my whole life runs because of this phone!
MacBook Pro — thank goodness for the iCloud that syncs my calendars, notes, and texts
What is something you are working on now?
Just finished the Grounded in EM curriculum and am now creating a Grand Rounds for Evidence-Based Medicine for Sepsis.
One of my weaknesses is public speaking and also evidence-based medicine presentations. I like the concept of sepsis in general, so I picked this topic on purpose. It combined a topic I enjoy and an area of weakness, in the hopes that I’ll become a better clinician and educator because of it — I present it in September so we will see!
What’s your office workspace setup like?
HAHA. I live in a state of chaos with three kids and my husband, a newly-minted EMS fellow after finishing an EM residency. I typically work at the dining room table or on the kitchen counter, either once the kids are napping or asleep, or during quiet time. My husband has a study, which I often use as it has a door that closes (and locks!), but with the quarantine and 3 little kids not in school or daycare, there is always a lot of banging on the door for entry! Pre-COVID, I would often drop my kids off to daycare, so they have lunch and a nap on days I needed to get work done and go to a coffee shop around the corner, and then pick them up once nap time was done. I would get 2-3 hours of uninterrupted work time, and wouldn’t miss much of their day as they had lunch and then a nap. I honestly get more done when I’m working outside of the house, as I am not seeing other tasks that may need done or around distractions (laundry, dishes, dog walks, couch and TV time, etc).
What’s your best time-saving tip in the office or home?
I have several “notes” in the notepad function on my phone and laptop that I regularly update: To-Do lists, notes on resident progress, email drafts, grocery lists, kids needs, web-searches that I want to do. Since the program updates across my phone and laptop, I can jot down notes during the day when I’m on the move, dictate emails while I’m at my kid’s tutoring, etc. I can pick up the work right where I left off when I have more focused time on my laptop once my kids go to bed or I have some quiet time during the day.
What’s your best time-saving tip regarding email management?
I have three email addresses (one for personal, work, and clerkship/faculty). Within each, I have created filters for specific email addresses that auto-tags the emails. That way, I can quickly browse through and not be overwhelmed. I try to do my best to keep a zero-inbox, which for me is hard since I have a lot of FODSI (fear of deleting something important). Instead, I opt to have everything tagged so I can quickly archive when I feel like I have addressed the email.
What apps do you use to keep yourself organized?
I use the Notes function on my computer quite a bit! I have a shareable calendar with my husband and my parents to keep track of the logistical aspect of shifts, kids, after-school activities, etc. Basic, I know, but it works for me!
How do you stay up to date with resources?
I like to really make the most of my commute, so I’m a big fan of listening to Rebel EM and EMRAP on my drives into work. I get on Twitter a few times a week to see what is new there. I also really like JournalFeed and Pediatric EM Morsels for tidbits that go to my email, and will catch up on these every few days. I usually get my current events from my husband as this is an area that he likes to stay on top of, and I….don’t.
What’s your best time-saving tip in the ED?
- While working, I make a list of the room number, the patient/CC, and then two boxes. One box signifies I’ve completed the HPI, PE in their ED chart, and the second box means I’ve completed the EKG/MDM. I cross out the entire line once I’ve signed the note. This keeps me on top of my notes, as that tends to be the area where I can quickly become behind. It also entices the type-A in me to check off the unchecked boxes!
- The nurses are essential for patient throughput. I update my nurses on my plans for patients, and so they are moving the patient through their course actively, rather than reacting to orders in the computer. If you see a nurse starting an IV at the bedside, alert him or her that you need blood cultures, lactate, VBG, ammonia, etc, so that they don’t have to go back in afterward. Alert them of the meds/fluids you will be ordering if you’re all in the room together so that they can go to the med room rather than go to the computer to discover they have ordered. Do your best to batch your orders rather than trickling them in as this is extremely frustrating for them and slows your turn-around time! The nurses are an excellent resource for the vague/nebulous patient complaints, to get a different perspective for what the patient really wants or is concerned about.
- I also have perfected my clean catch urine sample spiel, which I recite while walking patients to the bathroom!
- I am especially more vigilant of specific tasks in the last 3 hours of the shift! Prioritize pelvic exams early in the patient course!
ED charting: Macros or no macros?
I do use macros, but I am deliberate about confirming that all the auto-populated areas are true! My biggest time savers are a pre-populated neuro exam, back exam, and extremity exam, as I do the same thing every time.
What’s the best advice you’ve ever received about work, life, or being efficient?
One of my senior residents told me once: “The goal is to get out on time, with your notes done, and make decisions your mom would be proud of” — I loved that! I love practicing medicine, but I also love leaving work behind to spend time with my family. Rather than finding a balance that suggests equal weight, I consider all my various roles as a massive juggling act, re-focusing on the task that is my hand, and then on to the next. And I wouldn’t have it any other way!
What advice would you give other doctors who want to get started, or who are just starting out?
In the beginning, it is typical to have self-doubt, but that WILL go away! You trained for this, and you ARE good at this. It takes a little while to get your bearings in a new role, so give yourself a little time and a lot of grace.
Is there anything else you’d like to add that might be interesting to readers?
As cliche as it is, find something outside of work that you LIKE. You don’t even have to be good at it, just enjoy doing it! It will replete you on days on which you feel like you don’t have anything left.
Who would you love for us to track down to answer these same questions?
- Laryssa Patti
- Brian Barbas
- Eric Blazer
Read other How I Work Smarter posts.
A 32-year-old male presents for evaluation of fever and mild dry cough. His vital signs are stable and within normal limits, he is in no respiratory distress, and he looks otherwise comfortable. He is a physician at a nearby emergency department and he notifies you that he just learned that he was just exposed to a Coronavirus positive patient. He had not been wearing personal protective equipment at that time. Your diagnosis? High risk for coronavirus-19 (COVID-19) Your management? If looking well, home quarantine. If possible, he’ll be doing remote work.
In 2014-15, we hosted a “How I Work Smarter” (HIWS) series, led by Dr. Ben Azan, focusing on the individual strategies of high-performing, successful emergency physicians. After the conclusion of the series, Ben went one step further and recruited a team which included Drs. Marilyn Innes, Brent Thoma, myself, Alex Van Duyvendyk, Zafrina Poonja, and Teresa Chan to conduct a thematic analysis, which was just published in Cureus [open access full text].1 Although the content is from 2014-15 and many of the featured contributors have moved institutions with different roles, the themes and tips remain salient and informative in today’s era of digital and cognitive overload in the clinical and non-clinical environments.(more…)
We are continuing our series with Dr. Dara Kass (@). In addition to being director of Undergraduate Medical Education at NYU/Bellevue in New York City, Dr. Kass has recently unveiled a new initiative: FemInEM. Along with Dr. Jenny Beck-Esmay (@) and several superstar section editors, Dr. Kass has debuted a site focused on professional development for women in Emergency Medicine. But FemInEM is more than just a blog: it seeks to bring open access principles to the traditional model of membership based professional women’s networks like Academy for Women in Academic Emergency Medicine (AWAEM) and American Association of Women Emergency Physicians (AAWEP). FemInEM will be a hub for mentorship, growth, leadership, wellness, and more, all specially geared to women in Emergency Medicine. How does Dr. Kass go about managing this ambitious initiative, full time work, medical students and family? She shares her insights into working efficiently.
I am Dr. Azita Hamedani, Founding EM Department Chair at University of Wisconsin: How I Work Smarter
Today we have the privilege of hearing from Dr. Azita G. Hamedani MD, MPH, MBA, founding chair of the Department of Emergency Medicine at the University of Wisconsin School of Medicine and Public Health (UWSMPH). Under her leadership, the department has grown exponentially, growing from 6 to 36 residents, from 14 to 45 faculty while experiencing a 100% increase in patient volume. For showing exemplary skills in leadership, clinical quality, operations and healthcare finance she has been awarded – amongst other awards – both ACEP’s Outstanding ED Medical Director of the Year Award and the Association of Women in Academic Emergency Medicine Early Career Award. But beyond numbers and awards Dr. Hamedani is known for fostering the academic spirit at UWSMPH, elevating the department renowned to a national level. Below, she shares her tips on efficiency and getting things done.
After a long break, we are back with a heavy hitter: Dr. Reuben Strayer (@). He is the author of EMUpdates.com, a treasure trove of emergency medicine wisdom. Highlights include a set of genuinely useful checklists, many airway pearls, an approach to opioid misuse in the ED, and much much more. Dr. Strayer regularly speaks at national and international conferences with a focus on airway management, ketamine, and clinical quality. Beyond his contributions to medical education, Dr. Strayer is regarded by his peers as an exceptional clinician. It is this editor’s opinion that this stems in part from a truly thoughtful and methodical approach which permeates Dr. Strayer’s approach to life. He generously shared his insights into how he works smarter.