After a long break, we are back with a heavy hitter: Dr. Reuben Strayer (@emupdates). He is the author of, 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.

  • Name: Reuben StrayerReuben Strayer Sml
  • Location: New York City
  • Current job: Emergency Physician at Elmhurst Hospital (Mount Sinai) and Bellevue Hospital (NYU)
  • One word that best describes how you work: Chocolate- especially with peanut butter. Also, chocolate chip cookies.
  • Current mobile device: iphone 6 and a galaxy s4/android
  • Current computer: imac retina 5k, macbook pro retina


How I Set Up my Workspace Smarter


I spend a lot of time at my desk, and recently had the opportunity to reinvent my workspace because I retired my old desk after many years. It doesn’t matter how great your chair is, if you sit in it for a long time, your bum will hurt. So I took the plunge and got a standing desk, a desk that goes up and down with the push of a button. Now, after some period of sitting, I get sick of sitting and stand, and it feels great to stand. I sway left, right, do a little tiptoe action, right at my desk, it’s awesome. After a while I get sick of standing and sit down again, which also feels great. Standing desk is a win.

I had a problem getting a keyboard tray under the new desk, and a keyboard tray is essential, because when the keyboard is on the desk you have no desk, and you need the desk for a bowl of noodles. Anyway I hacked a solution to the keyboard tray problem and now have a soft-touch das keyboard under the desk with trackpad on the left, mouse on the right, perfect.

I live in southern Manhattan and make physician’s wages so it’s a very small apartment; I make up for this by owning a ton of computer monitor real estate. You don’t realize how much time you waste closing windows and hiding applications until you set up two huge monitors. I use one as my primary workspace, and the other as a sort of palette, with commonly used app windows and folders I’m always working with, always in direct view.

The monitors (and the laptop, and the microphone, and the desk light) are all mounted on arms, which is essential to bring everything toward you when you’re deep in project mode, and then to push everything back when it’s time for noodles. I eat a lot of noodles prepared in Szechuan and Xi’an style, and they sling oil all over the place, gotta move those monitors out of the way.


How I Work Smarter

Inbox management

  • A lot of folks recommend email triage into various lists, folders, calendars, and task management apps to effect inbox zero. This does not work for me because I feel just as oppressed by all the lists and folders as I do by a bloated inbox. I have found that what facilitates productivity for me is not just minimizing the mail in my inbox, but minimizing the number of inboxes, so my gmail inbox is my shrine, it is my one and only task list, it is everything. Threaded email functions beautifully in this way–it is automatically dated, easily tagged and filed, and infinitely searchable. The power of sending an email to yourself to add information to a thread is way under-appreciated, and you can instantly attach pictures, files, calendar events, whatever.
  • To take it to the next level, get boomerang. Boomerang allows you to push a thread out of your inbox, to return whenever you want, or, if you’re composing an email, to send it whenever you want instead of right now. So when I get an email that is best dealt with on my next shift at hospital A, I boomerang that email to return to my inbox 15 minutes before the start of my next shift at hospital A. If I need to remind myself to bring another bottle of crushed habanero pepper to stick in my locker at hospital B, I compose an email to myself, and set it to send 10 minutes before I would leave my house to go to my next shift at hospital B. You can push this kind (or any kind) of email to your phone by SMS using the email to SMS hack. If Jeremy Faust emails me about something, I want to reply and get it out of my inbox, but I don’t want to enter into an email back and forth, so I’ll compose my reply and send it in 4 hours; I call this avoiding unwanted synchrony. Boomerang has a special function where you can return to inbox if no reply, so if I send an email to my boss asking him if it’s acceptable for me to stipulate that for every CT requested by a trauma surgery consultant, he or she contribute $1 to the American Cancer Society, I can give my boss, for example, 1 week to reply, and if he doesn’t, the message bounces back to my inbox, so important issues never fall off my radar.

Procrastination management

  • There is a powerful psychology that prevents all but the most productive among us from getting stuff done, and it’s best explained in this raptitude blog post. In short: just start it. Right now. You don’t have to finish it, you don’t have to even make much progress, just start it. Work on it for 10 minutes. Starting is everything, once you start, the rest is easy. And tomorrow, again, you’ll feel that dread of starting it, you’ll look for other things to do instead of starting it–it’s exactly that feeling which alerts you that you are falling into a psychological trap. Counter that feeling by telling yourself you’re just going to work on it for 10 minutes and then you’ll check facebook. Next thing you know the task is done.

Interruption management

  • I am compulsive about inbox zero and am quite susceptible to that variable rewards email surge of dopamine, so I use inbox pause, by the same guys who make boomerang, I take no money from them but am happy to if they’re reading this. You press a button, email stops coming into your inbox. Press it again, it starts again. I set it to allow email in at the top of every hour, turns that dopamine thing to my advantage. Set your phone to do not disturb, 64% of iphone users do not know about this amazing feature.

Obligation management

  • Only take on projects that excite you. If someone asks you to do something you’re not interested in, say no but offer instead some related thing you could do that excites you. An obligation way into the future is too easy to say yes to, always ask yourself if you would be excited if it were due in two weeks, because soon it will be.

How I Incentivize Myself Smarter

I dip chocolate into peanut butter. There is no incentive like chocolate, and nothing goes better with chocolate than peanut butter. Just break off a square or two of chocolate (if you just finished a big project, three or four squares) and plunge them into a jar of peanut butter. If you’ve used most of the peanut butter in the jar, you won’t be able to scoop up the peanut butter with the chocolate without getting peanut butter all over your hand, so use a knife. If all your knives are dirty, you can also use a fork–the bend in the fork actually works really well to spread peanut butter on the chocolate.

How I Stir Peanut Butter Smarter

The best peanut butter requires stirring, and there is no better peanut butter stirrer than the Witmer Company Peanut Butter Mixer. Bonus pearl: store unstirred peanut butter upside down. When you’re ready to open it up and stir, it’s easier with the oil on the bottom.

How I Work in the ED Smarter

See how to think like an emergency physician.

Benjamin Azan, MD

Benjamin Azan, MD

Emergency Physician
Lincoln Medical Center
Founder/Editor of
Benjamin Azan, MD


ED attending in NYC, #FOAMed enthusiast, #MedEd, founder of
Benjamin Azan, MD

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