Modern medicine makes all physicians “multi-taskers.” All have days filled with multiple patient care needs, escalating productivity expectations, and relentless demands for their time and attention. With the advent of the electronic medical record most physicians, including residents, spend a sizable portion of their daily effort on data entry and the mandatory filling of “fields” within the programs. The EMR also offers a communication venue for providers, nurses, and even patients to contact the physician with the expectation of a prompt response. Most residents are also accessible via e-mail, text, and other electronic media. Pagers and cell-phones have allowed direct access to the physician for any nurse, fellow physician, or administrator with the expectation of an immediate reply. Finally, many physicians including residents are subject to multiple institutional meetings, which are routinely scheduled to the convenience of administrators, not the physicians.
It is not uncommon for a neurosurgery resident to be in the operating room 4-5 days a week. While the operating room sometimes offers a blessed respite from the multi-tasking, it does not entirely shield the resident from outside responsibilities. Most residents are besieged with calls and texts throughout their time “scrubbed-in.” This affords the added stress of finding personnel to field the calls, and the anxiety of potentially missing important messages. Often, time spent in the O.R. simply compresses a massive docket of tasks into a smaller fraction of the day to complete them.
One of our residents was recently “written-up” for “uncooperative behavior” due to the fact that he did not respond to repeated calls placed by a floor nurse in want of a sleeping pill order. The resident in question was enmeshed in an emergent and protracted operation (severely broken spine) with his attending neurosurgeon. It being the middle of the night, no other team member was available to answer the page. The task fell upon the circulator nurse who became so exasperated by the volume of calls that she turned the alarm off on the cell phone.
The neurosurgery resident faces a mix of outpatient and inpatient demands. In a single day, the advanced resident may perform several elective and urgent procedures, see outpatients in a clinic, round on critically ill inpatients several times, and field urgent and emergent consults. No wonder the typical resident feels as if they are in constant Brownian motion; almost randomly bouncing from one task to another. Long, unbroken hours of hard work seems to be sustainable for most residents, but all begin to fray when they are “blitzed” with multiple tasks and demands at the same time.
For discussion with the residents….
-When do you feel the most “multi-tasked?”
-What emotional responses do you have to multi-tasking?
-What physiological responses do you have with multi-tasking (e.g. tightness in chest, moist palms, perspiration, palpitations, etc.)?
-When does multi-tasking become impossible? Can you tell when you are reaching your limit?
-What affects your coping limit?
-How can electronics be employed to help with multi-tasking? Are they ever a hindrance?
-When are you best at multi-tasking?
-Who on your team is best at multi-tasking? What are his or her secrets?
-What are your “best practices” for multitasking?
-Where do you notice yourself multitasking out of habit, even when the context does not require you to do so?
-Do you miss multi-tasking when you have only one thing to accomplish at a time?
-How do you prioritize your tasks?
-What percentage of your task lists do you accomplish on the average day?
-How often does someone offer help with your task-list?
-What do you do when someone offers help? How do you feel?
-How often do you help others with their task lists?