Unless you have been living under a rock, you undoubtedly have used a resource or participated in an event led by Chris Nickson. Chris is an emergency physician and intensivist, who has humbly amassed an impressive list of accomplishments in the community of FOAM, including co-creating Life in the Fast Lane, SMACC, iTeachEM, and The RAGE podcast to name a few. In fact, he wins the prize for the person tagged the most number of times by other How I Work Smarter contributors. Everyone certainly wants to know how he is able to get things done so efficiently. Here are Chris’ words of wisdom.

  • Chris_Nickson_SMACC_headshotName: Chris Nickson FACEM FCICM
  • Location: The Alfred ICU, Melbourne, Australia
  • Current job(s): Education Fellow at The Alfred ICU, also co-creator of LITFL, SMACC, iTeachEM, The RAGE podcast and INTENSIVE
  • One word that best describes how you work: Opportunistically
  • Current mobile device: Not willing to say…! An upgrade to iPhone 6+ is (hopefully) imminent :-)
  • Current computer: MacBook Pro 17″​

What’s your office workspace setup like?

My laptop is my office. It is a behemoth. I have moved inter-state frequently over the past few years so my 17 inch MacBook Pro has doubled as a portable desktop. Which is lucky, as I have recently been evicted from my former pseudo-office at home (again) and a new baby has moved in…

I find sitting in an office at work to be an open invitation for interruption (not always a bad thing!). So, for me at least, work requiring intense concentration or at least an absence of interruptions must be done elsewhere (e.g. the library or at home when everyone else is asleep).

In summary, I tend to do whatever I have to do, wherever I have to do it.

LITFL at uluru sm

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

1. If it doesn’t need to be done, don’t do it! (unless you really, really want to).

  • As others have said, saying “No” and learning how to do it, is tremendously important. I would love to do it all if I could and I hate saying “No” to people as not helping simply feels wrong. Also, it can be difficult to decide which opportunities to prioritise. Each of us needs to have clear concept of what we are about so that we can sift out the opportunities that work for us, and that we will work for. Fortunately, most opportunities seem to come knocking again one way or another. Unfortunately, many of us only learn how to say “No” after it is already too late. In saying ‘no’ I try to be thankful for the opportunity, make sure I explicitly say ‘no’ (don’t leave room for your arm to be twisted!) and try to offer an alternate solution… such as someone even better than me who has time on her hands :-)

2. Maximise the output from any work that you do, and make it accessible.

  • If you have to give a talk, why not use that same research and distillation of thought to write an article or blogpost as well? Many of the blogposts I write come from ideas that have been simmering throughout on-the-floor discussions, readings, patient interactions or teaching sessions for days or weeks prior. The actual writing is often a relatively brief finale to a lot of prior thought. In turn I continually reuse and reinvent work that I have done before – which is made easier by being instantly accessible on the internet. I have turned talks into blogposts, and blogposts into talks. The trick is to add value with every transformation – an update, a different voice, a different point of view or a restructured approach to the topic. This enables me to come up with teaching sessions on the fly, often gives me a head start on new projects and means that people can easily access the work that I have done. It also results in the illusion that I have more time than I really have and never sleep!

In general, though don’t take advice from me… Weingart has it all worked out [blog post and podcast].

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

My tips (echoing many others before me):

  • I do not use the inbox as a ‘to do’ list – I do one of 3 things:
    • delete or archive the email then do nothing
    • delete or archive the email then respond/ act immediately
    • delete or archive the email then and add to an ‘action plan’ (sounds cooler than ‘to do’ list)
  • I use Gmail and no longer bother with tags – I just archive and do full-text searches later if needed.
  • I try to check emails only at designated times of the day
  • I use Boomerang – as previously suggested by Matt Dawson – it is good for making it look like you are not awake at 3 in the morning.

Of course, I’m only human, so I stuff up this up a lot of the time – it works well when I stick to it!

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

I think efficient use of time, whether in the ED or in the ICU, depends on ensuring your team works effectively. Communicate plans, delegate tasks, and anticipate problems before they arise. Know yourself, your team, and the environment. Avoid interruptions whenever possible (multi-tasking is a myth). In particular, try to be a ‘enabler’ of others, someone who enables higher levels of performance in those around them than they could achieve by themselves… With a bit of luck, they will do the bulk of the work for you!

For those trying to thrive in a busy ED, this 2004 overview by Campbell and Sinclair is a classic.

ED charting: Macros or no macros?

Huh?… Is paper a macro?

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

I am, of course, an avowed Oslerphile. Charles S. Bryan wrote a unique book called ‘Osler: Inspirations from a Great Physician’. This book is not a biography but a collection of lessons distilled from Sir William Osler’s life and works remastered into something resembling a personal development guide. It includes innumerable pieces of wisdom such as this, from Osler’s “A Way Of Life”:

I stood on the bridge of one of the great liners, ploughing the ocean at 25 knots. “She is alive” said my companion, “in every plate; a huge monster with brain and nerves, an immense stomach, a wonderful heart and lungs, and a splendid system of locomotion.” Just at that moment a signal sounded, and all over the ship the water tight compartments were closed. “Our chief factor of safety” said the Captain. “In spite of the Titanic” I said. “Yes” he replied, “in spite of the Titanic.” Now each one of you is a much more marvellous organization than the great liner, and bound on a longer voyage. What I urge is that you so learn to control the machinery as to live with “day-tight compartments” as the most certain way to ensure safety on the voyage. Get on the bridge, and see that at least the great bulkheads are in working order. Touch a button and hear, at every level of your life, the iron doors shutting out the Past, the dead yesterdays. Touch another and shut off, with a metal curtain, the Future, the unborn tomorrows. Then you are safe, safe for today!”

By striving to work in ‘daytight compartments’ we can ensure that the work at hand is done well, and avoid worrying about the past or the future. However, planning for the future should also be ‘all in a day’s work’… On occasion, I actually come close to achieving this Oslerian ideal.

Finally, Peter Safar’s ‘Laws for the Navigation of Life’ are also a constant source of inspiration. For instance:

Law 8. If it’s worth doing, it’s got to be done now!

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

  1. John Bailitz
  2. Karel Habig
  3. Rick Body
Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at https://t.co/50EapJORCa Bio: https://t.co/7v7cgJqNEn
Michelle Lin, MD