gus garmel how i work smarter

One word that best describes how you work?


Current mobile device




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.


  • 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.

Gus M. Garmel, MD, FACEP, FAAEM

Gus M. Garmel, MD, FACEP, FAAEM

Adjunct Professor of EM
Stanford University;
Inaugural Member/Distinguished Educator
CORD Academy for Scholarship in Education in EM