In the first episode, listeners are introduced to Buddhist concepts of the "enlightened" and how these translate into surgery in 2021. Frameworks for work-life balance are introduced and discussed. Understanding and intentionally managing our "dimensions" can improve efficiency and create time to maintain wellness. Tips and tricks about time management, and both conceptual frameworks and tips to maximize time efficiency are discussed. Reading and References: Think Like a Monk, Essentialism, Peak Performance.
Welcome to Episode One of operating with Zen. In this episode, we're gonna give an introduction to the intentional process, and use time management as the first example of such an approach. So in medicine and surgery, as in other fields, we all want to enhance our efficiency, productivity, and create more times, great more time to do the things we enjoy doing. We all want to find meaning from what we do. But at the same time, particularly in medicine. At this juncture, we're combating burnout, stress, toxicity, whether that's in a hospital, in the clinic, in our training, and I'm going to make the argument to you that this can be done through an intentional approach to life, a thoughtful assessment of our career, our family, our leisure, etc. And I think one of the major inspirations for this is thinking of a monk like or mindful approach to these parts of our life. And I think one of the greatest examples is the Dalai Lama, right? Think about the Dalai Lama and things that popped to mind when you when you think of a monk, right, these are gracious people, they are thoughtful, they are peaceful, purposeful, they have self control, they are calm, they are focused on service, and they're focused on transcendence or a cause greater than themselves. And when you really think about it, this is what many of us are striving to find in surgery. These are the ideal qualities of a surgeon in 2021. No longer is it the ideologic strong, mean surgeon who's respected only for their skills, but not their demeanor. But now, surgeons, the ideal surgeon has all of those qualities puts all of those things together. They're great in the operating room, they take great care of people, they take great care of their colleagues. And they're revered for that much in the way that the Dalai Lama or a monk is revered for their skills. And these qualities come directly from Buddhist teachings, there's something called the power meters or which which translates into the completeness of perfection, which are really the Buddhist qualities of enlightened beings. And the exact parameters vary by tradition or teaching. But there's the same core essence. And as you think of these parameters, while these are described for Buddhist teachings and Buddhist qualities, these are really qualities of excellent surgeons and excellent doctors. The first is generosity, whether this is a material or self, ethical conduct, not harming oneself or others, acting with self discipline, virtue and morality, demonstrating patience, the tolerance of others and composure in tough situations, acting with honesty and truthfulness in all situations, proceeding with effort and diligence and hard work. Extreme control of concentration not being distracted, being determined to reach a goal, acting with wisdom or insights and knowledge. Using expertise. A skillful means to achieve a goal, acting with goodwill, which can include friendliness, but also loving kindness towards others. And the last is serenity, or equanimity and peacefulness with the world and those around you. And I think our teachings and our thoughts of who surgeons are and who they should be, has changed over time. And I think this is the kind of surgeon I want to be. And this changed my thinking on this. I think another really important lesson from Buddhism is that the Buddha believed that students shouldn't, should not practice necessarily what he taught in less it worked in the context of their own life. And I would say the same thing, as you go through the, through this podcast, we're going to talk about a lot of different topics, we're going to give insights in some areas, we're going to give recommendations or examples that may work for you or may not work for you. So ingest all of this, take it with a grain of salt, decide what's going to work best in your own life, and move forward with that. In that vein, I will present data and topics in a very scientific way, when there's data available, I will show you the data whether it's good or bad, I'll try and give you a commentary on that. When data is not available. We'll discuss hypotheses or rationale. I'll try to avoid anecdote. But in reality, this is a lot of what we do in surgical and surgical evidence, right? We present the data when available. If not, we're discussing hypotheses and rationale. I will focus some people are going to be very outcome driven. So we'll try and give outcomes when possible. But in a lot of a lot of them. Mindfulness in well being is not necessarily a hard outcome, right? This is not cancer specific survival as it may be in some of our surgical fields. But we're looking for perceptions of benefit and whether or not a benefit is achieved, if you feel better, and your colleagues feel better, and your patients feel better and your loved ones feel better, then we're moving in the right direction. That being said, I think we can improve efficiencies and we can improve outcomes. And we can make you more productive at work and in life by objective measures, by taking a thoughtful approach or an intentional approach to what you're doing. So the first discussion here is going to be about work life balance, and this is a really challenging term. The classic thinking work life balance, this is the scales where one goes up, the other goes down. And I really don't like that metaphor it implies, as work goes up, life outside of work has to come down and vice versa. First reason I don't like that is that that work life balance is much more complex than just up and down in those two dimensions. There's well described dimensions of wellness, right? There's emotional wellness, which deals with our coping mechanisms, our relationships, there's financial wellness, not only current financial situations, but future planning for retirement, social wellness, our sense of community and belonging to others, spiritual wellness, having to do not only with religion, but often not with religion more to do with what is our purpose, what is our meaning in life, occupational wellness, that touches on satisfaction and enrichment work. physical wellness with has to do with our physical activity, nutrition, sleep, our intellectual wellness, which addresses creative abilities, knowledge and skills, and lastly, our environment. Right? Do we work in spaces that support well being? Can we positively impact the physical space around us and the others around us, so you can see it an up and down simple dichotomous relationship or metaphor, it does not make a lot of sense to me. But one of the things that certainly makes sense is that there's going to be given take Thomas Sol, who is a economist said, there are no solutions, there are only trade offs. And he was referring to finances. But the metaphor holds true when you talk about anything where you have limited energy, money, mind, power, love, etc. We really only have a limited reservoir of those assets. And we do have to shuffle them around. But it's not a simple upper down. So the next term that comes to mind is work life integration. Does this make sense? Are we trying to integrate our work, and our, our life outside of work? And it seems a little mathematical to me too much puzzle, like it didn't doesn't make a lot of sense to me either. So I don't like that metaphor, as well. And so what are the alternatives, work life fifth work, life blend, work life, harmony, or synergy, we could flip the words around and make it work, family balance, or work family fit. But none of those make a lot of sense either. So it brings back to work life balance. And as I've thought more about this, and as I've gotten into yoga, and some others, other senses of physical well being, I actually do really like this term, but but the work life balance is not the dichotomous scale where one side goes up and the other side comes down. But think of this as a complex yoga pose, or even a simple yoga pose, like a tree, one leg up, the other leg tucked in. This is a complex balance, multiple forces acting on each other. And not only do you have to get the physical forces correct, and aligning your leg, muscles and your core, but you also need to be in the correct mental and emotional state to be able to hold that uncomfortable position, and bring those forces together and generate the outcome you're attempting. And I think that's the best metaphor for work life balance. So throughout this podcast, we'll make the argument that a thoughtful, intentional approach to life can allow you to achieve balance in all the dimensions you want. It can help you to be an excellent surgeon, and physician, and parent, and husband or my coworker, and colleague, and teacher and friend. And so we hope to maximize your efficiency and your output and your well being and to make you feel better about all of the things that you're doing. So we're going to use time as our first example of that. And I hope you find this interesting. So some of you who know me know that I was a physics major, and have a real love of physics and math. And one of the frameworks I've come up with to understand and improve my well being is that we need to know our dimensions and we think of the classic dimensions space and time ... And we'll start there. And one of the things I've come up with is that if you work in your dimensions and you master your dimensions, you can improve your outcome in them. And so the space and time can give us routine. But the other dimension we really need to think about is ourself, going inward instead of thinking outward about dimensions. And the self dimensions are physical, and the mental and emotional self, that I think can help us get purpose. And so we're going to start today with time, and we'll continue to build these things out. So one of the first concepts that's really important is that you cannot play chess unless you understand what the pieces do. And that's going to hold true for a variety of aspects of well being as we move forward. But with time, particularly, if you don't have time, insight or awareness, it becomes very challenging to manage your time. So I would say you cannot effectively manage your time if you don't stand, understand how well you're using it, whether you're using it well or using it poorly. And interestingly time can how you use your time can tell you a lot about yourself. And this particular exercise exercise comes from think like a monk, which is a great book by Jay Shetty. But it basically says you need to take stock of your identity and your values and what you do with your spare time to find your values and who you are. For instance, if you say you're a family person, but the first thing you do on a Saturday morning, is grab your golf clubs and spend six to eight hours away from your family, then your time management isn't in alignment with your values. And so you need to think about those things. The other place that that metaphor holds really true is what are you doing at work? What are you doing as, quote unquote, official work? And what is your extra work? Meaning what are you putting in extra time for what are you staying late for, and if the extra work is contributing to your values and your reasons for being at work, that's excellent. If it's not negatively impacting your life, but if it's not adding any value to your pursuit of your goals and your interest, then maybe that extra work isn't worth doing. Interestingly, you can do the same argument and make the same do the same exercise with your money and finances. Right? If you're spending your discretionary funds on things that don't align with your core values, you may want to think about how you're spending that money. So the simplest thing to do when we try and understand how time influences our life and trying to be aware of time is to understand chronotype chronotype means what kind of person are you but the classic metaphor is larks versus owls. Are you a morning person? Are you a night person. Mozart was an owl he did most of his great work at night while Beethoven was a lark, he wrote mostly in the morning. Nothing wrong with either of them. Both were tremendous composers that changed the world of classical was we prefer to announce classical music. And we need to recognize our own normal cycles. And you can design your day according to your chronotype and your efficiencies. And I will tell you protect your most productive time. I am hands down a morning person. Before I started any of this and started being thoughtful about this. I always called 6am my Zen time, that was the time I would come in early. That was my best time to write, read to edit my colleagues papers, my brain was sharp, creative work comes easy for for me then. The other point of that of being a morning person is getting that work done early in the morning reduced my anxieties about the day because I knew I'd already accomplished some of the major tasks that I wanted to work on. And even on the weekend now, I still wake up early. Part of that is because my kids wake up early. But accomplishing something early on even on the weekend reduces my anxieties about day particularly I like to do physical activities on the weekend. So getting up early, working out, allows me to get the kind of self care I need to do out of the way. So now I'm not stressed about not paying attention or giving due time to my children, I've already taken care of myself, I've got my work out of the way and I could fully invest the rest of the weekend in my children and my family and the other things that are important to me. The flip side of knowing your chronotype is scheduled less demanding tasks at time when you are less alert. Right? So most of most surgeons are larks. And that's why we tend to naturally schedule our meetings in the afternoon. We get our heavy work done in the morning we're operating we're seeing patients and our administrative meetings which tend to require sometimes a little bit less cognitive focus happened later in the day. However, if you are the opposite, you're a night person. There's absolutely nothing wrong with scheduling some of your meetings and less strenuous activities in the early in the day as your body and your brain are warming up and schedule your really strenuous work for later in the day. As you're getting ready to wind down and go to bed, the other part of this is don't fight fatigue, when you recognize that you're out of your chronotype, right, so for me as the day wears on or early in the evening, use that time for recovery, and to generate creative ideas instead of trying to slog through work that of being inefficient at the second really important kind of time consideration is the 10,000 hour rule, right? This was the story of success, the Malcolm Gladwell outliers book. And this was worked by K. Anders Ericsson, a PhD behavioral scientist, who showed that deliberate practice in actually violin experts distinguished distinguish the experts from the others, and they went to a classic musical training school. And they actually found that everybody in school spent about 10,000 hours playing the violin, but the experts did it in a deliberate way. It wasn't just the hours they put in, but the type of work they put in during those hours, and gives us you know, the quote, you know, practice doesn't make perfect, but it's really perfect practice, that makes perfect. So you really do need to put your time in and you do need to put it in deliberately. You need to work hard at it. But you also need to do that in a way that's efficient and allows you to kind of get to that 10,000 hours in a more efficient way. There's another really important concept, and this is the growth equation. And if you're interested in reading more about this, I would suggest peak performance is a great book by Brad Stolberg and Steve Magnus. The growth equation postulates that stress plus rest equals growth. And the from the exercise science literature, this is called periodization. And it's basically the concept that any anybody who's worked out understands, right, you isolate a capability or work right, let's say we want to work on our biceps or so we go do curls, we provide stress, the stress is the curl, we are then going to rest and recover, whether that's in between sets or days off. And then we're going to repeat the process adding additional stress. So stress plus rest equals growth. And that metaphor holds true whether it's physical work like bicep curls, or whether it's mental work and mental exercises. Or I would even say skill sets skill training, like surgery, capability, stress, rest, repeat. One of the important processes of that is it works best when you've got full energy and full efficiency. And Palmer Ronis a good colleague and friend in urology, and he uses a metaphor of a battery, right, you can only give your best work when your battery is fully charged, aren't correct or recognize when your battery needs to be recharged. And don't attempt stressful strenuous work. When your battery's empty, at that time kind of coast, do your less strenuous work, let yourself recover. And then you can give them more efficient stress to provide the most growth and, and efficiency and outcome. Now interestingly, you know, you can think of this to where, you know, it's really hard to get a better battery. But by manipulating the system or the external forces, you can certainly make your battery work better. But most importantly, recognize when your energy levels are low, whether that's up to your external forces, and making sure you're recharging and giving yourself a chance to work most efficiently. So there's good and there's bad and there's ugly with stress. And stress is certainly our stimulus for growth and adaptation. When we think of an anabolic state that's driven by testosterone and DHT, a testosterone provides lean muscle growth, bone health, enhanced cognition and cardiovascular health. A da ga, which is a neurosteroid has been shown to reduce anxiety, depression, heart disease, neuro degeneration. But we know that too much stress or stress for too long can actually result in deterioration. This is called the exhaustion phase or chronic stress and it's a catabolic state, where we're breaking down our body breaking down our mind, and this is really driven by chronic cortisol release. It's associated with lingering inflammation and impaired immune response, depression. And it's one of the putative mechanisms for why we see worse health care outcomes in racial minorities in the United States. Chronic stress chronic cortisol, chronically bad health outcomes. And in addition to just our physical stress and physical growth, there's also mental health and mental growth. And so there's something called system to learning. And the concept is basically we have two systems of learning. And this was put forward by the Nobel Prize Laureate conovan was a psychologist. And in system one, this is automatic with quick thinking, neural connections. This is our instinct and intuition. System two is more thoughtful and analytical. This is ad for effortful mental activity. Think about a young child. We've all seen young children crawl, walk, and they stumble as they walk. And then you know, within a few months to a year, they're running around the house pretty quickly. That is a transition from system to just thoughtful and analytical into automatic quick thinking instinctual activity, and the process that facilitates that is myelination. Right as these neural connections are built, myelination happens that facilitates a quicker circuit that allows the process to move from system to system one. Interestingly, most of that myelination occurs at night during sleep occurs during restful periods. So it talks about why mental stress and rest is also incredibly important and growth. On the flip side of that, without rest, when we're overly stressed, we can see mental breakdown, think about plane crashes, right? Usually technical malfunction, often bad, while that weather, often poor communication. But almost always, there's a tired pilot, or some kind of mental impairment that is leading to these breakdowns. And so one of the other really important concepts of Time management is what I call micro and macro breaks, small breaks and larger breaks. So micro breaks or breaks throughout your day. And there's actually a tremendous literature that shows that maximal productivity in a variety of vocations, is gained through 50 to 90 minutes of work, followed by seven to 20 minutes of scheduled rest. And that cycle is repeated. This has been shown in agricultural workers, artists assembly line work, including the automobile industry and meat processing, athletes, financial consultants who are mostly at their desk, and particularly in high cognitive fields like engineering and software. And Google was one of the first places to pioneer mandatory breaks. And they found in the concept is these repeated known breaks allow for physical cognitive and emotional recovery, allowing for quote unquote, peak performance. Peak Performance leads to peak productivity, and working consecutively for longer time, while at less than peak leads to inefficiency, breakdown of productivity, and an unwell workforce. So I would tell you all try to work for no more than two hours without a break. And I've incorporated this into my operating schedule where I try and give everybody a break, to step away from the patient. Even if it's for two minutes, 30 seconds, give yourself a little bit of a break every 60 to 120 minutes, recharge, reconnect, think about what you're doing and come back into the field. And in surgery, there's this stigma and this dogma that we can never walk away from a patient. And I would say that that is not true. In fact, your patients would likely be much happier that you're efficient and in tune, and giving them the best possible outcome by recharging and refreshing every so often, to making sure you can deliver them the safest best surgery possible. I'm not sure I need to say this, but I will obviously don't walk away from a bleeding field or a patient who's in Extremis, or in a tough situation. And take full advantage of your partners, or your fellows or your residents who can keep someone safe while you recharge. And the converse, give them a chance to recharge, and make sure they're in tune so they can learn and assist in the best ways possible. But when things are going well and you can schedule a break, it is perfectly acceptable to recharge and give that patient the best outcome possible. This can also be done in your clinics and your clinic schedule. This can be done with academic work. This can be done with administrative work. So build these micro breaks into your day. So how do you take these micro Burke breaks? Well, first of all, schedule them right. If you're not in the operating room, and you have the freedom schedule to do it every 45 to 90 minutes, you know you're taking a break. I would also say you can take unplanned micro breaks, particularly when you hit an impasse with the most easily recognizable as writer's block. Right. You're writing a paper, you're working on a grant and all of a sudden your brain is not working. The worst thing you could do is sit there and stare at the keyboard or the screen, take a break, take five minutes, go for a walk, read a book, change your mindset. And that will often help you come back and be much more efficient. So what are the Quick, quick and easy examples of micro breaks, you can listen to music, you can read, if you're going to read to read something unrelated, that just helps your mind shift back and forth. Take a shower. menial tasks are great things like doing the dishes run a vacuum cleaner. It just allows your mind to unplug from what you were doing. And kind of shift focus and come back to it. Outdoor walks are great. There's a whole bunch of literature that shows a six minute outdoor Walk walk can actually improve creativity, productivity, a two minute walk every hour has been shown to reduce mortality in some studies. Get out in nature, if the weather's if the weather's nice, it increases, quote unquote positive feelings, it's actually been shown to reduce interleukin six levels that resulted with inflammation and stress. If you can't get out in nature, hang a big picture in your office that shows a nature scene. I've got a couple in my office and I think they really do help unplug or help you kind of get back to the feelings you were when you were in that setting. Sleeping or naps are great. Actually, I'm not a big napper or sleeper. But there certainly is a whole bunch of literature and science to support this. NASA encourages 25 minute naps for its astronauts. And if NASA is encouraging it, there's no reason surgeons or doctors can't do that. And there's actually literature that show that a short nap under 25 minutes will outperform coffee drinkers. However, flipside of that you're not for too long, over 30 minutes. And that can be counterproductive. That's something called sleep inertia. We'll talk about that in the podcast on sleep, health and sleep hygiene. And the last way to last really nice way to take a microbe a break is to socialize. This is called quote unquote social recovery. Go, go see your colleagues, go see your friends, call somebody on the phone, just unplugging and doing something social helps ground us helps, helps put us in a better mindset. And in some of the athletic literature where they put athletes in social settings, you actually see improved testosterone to cortisol levels, with just short social breaks. The last part, the second part of breaks, our macro breaks, longer breaks. These are. These basically say that longer, harder periods of work record require more time to effectively recover. So the first way you can think about doing that is scheduling yourself off longer time in a day, especially when you're doing something strenuous. Jeff Weiner who is the LinkedIn CEO scheduled two hours a day blank on his schedule. Now that often gets filled with things. But it's two hours blank, we know he has time to recover and think and process what's going on. The other way to take macro breaks is to strategically align your off days and your vacations after periods of hard work. Particularly, you know, oh man, I'm going to be killing myself in the operating room for the next couple of weeks. Or I've got a vacation coming up at the end of the month. Let me really fill my schedule because I know I'm going to be able to recover from that. Other times to think about this grant deadlines, paper deadlines, meetings, and consider even extended breaks take weeks or months off. The best example of this was Patrick C. Walsh, the chairman emeritus at Hopkins, he would take off the entire month of August every year. He didn't see patients he didn't operate on patients, he reviewed surgical videos. He reoriented himself, he thought about what was important in medicine and surgery, particularly in prostate cancer at that time. And it allowed him to reorient and be much more efficient in the 11 months when he was in the hospital. The other way to do this is consider taking sabbaticals right, you can travel you can pursue another degree elsewhere. These are ways to kind of adjust macro Bay breaks. And I think one of the really important things with a macro break and you can include this in micro breaks off is that when you are off, you really need to disconnect from work. That's the most important thing. You need to rely and trust that your colleagues can cover for your patients. They're gonna take good care of them. That's why your colleague, and you need to disengage from your ego from that little voice inside that says I'm the only one who can do this certain thing. I'm the only one who can take care of these patients. That's not exactly true. And if you are the only person guess what if there really is an emergency or problem, somebody's going to pick up the phone and get in touch with you. And when you take those macro breaks the other things is physically and mentally engage in activities that you find relaxing and restorative. That's what's going to help you get back to who you are and be maximally efficient. The last thing I'm just going to touch on briefly here is single versus multitasking as we think about time management. We'll talk more about brain power. Our how our brain works in another podcast. But really multitasking is not as great as its as it as it seems. First of all, only 2% of the population can actually effectively multitask. Most people serial task, they shift rapidly between multiple processes. This has been shown by a number of research studies, I think one of the really good ones is a functional MRI study by koechlin it author and, and others that really showed it's almost impossible to perform two things at a high level simultaneously. And that the brain shifts back between those two tasks. In studies of multitaskers 40%, of productive time was consumed by multitasking. So if you look at what was produced at the end of two hours, and people who are single tasking versus multitasking, multitaskers actually had 40%, less production. And interestingly, attention and memory tasks are worse in people who medium multitask flip between their email and Twitter and Facebook, do much worse on standardized attention and memory tests. And the really interesting point here is that multitasking engages dopamine pathways. These are the same centers in our brain that are known as the addiction pathways. These are high reward centers. And so multitaskers is particularly those who multitask through electronics are compelled to engage in more multitasking as part of this dopamine pathway. In also prevents serotonin release, and serotonin is one of the hormones that helps with contentment, and relaxation. So therefore, multitasking is exhausting. And if you do contemplate a thoughtful single tasking, you will actually feel better at the end of the day. The last part of Time management is choosing how we share. The last part of Time management is choosing how we spend our time and choosing how we spend that time effectively. Once again, I'm going to highlight another book, this is essentialism by Greg McCown. And he puts better the concept of less, but better. And how do we choose the right tasks put our energy in one direction that is maximally impactful, instead of a million smaller directions with less impact. And we want to use the freedom of our time, because it gives us creative freedom. But we want to be disciplined in the way we approach. We approach our life we approach well being understanding that we're going to have to make trade offs. And if we do not purposely or intentionally choose where to focus our energy, others are going to make that choice for us. So remember, we can all have priorities and list out those priorities. But you really can only have one priority, right? That's the definition of the word it is the single most important thing. So what is the most important thing? And how do you prioritize the rest of your life based on that single one thing. And so we often fall into this paradox, paradox of success with which flows through multiple phases, particularly in medicine, particularly in academic medicine, right? When we first get started, we've got clarity of purpose, we know what we're going to do. And we succeed, we have early successes, successes, because that's who we are, right? We've worked hard to get through medicine or in our residency. And here we are as a young faculty member or in practice, and we're succeeding. So we get a reputation as a go getter. And all of a sudden opportunities have expanded. Now, that same effort is being diffused over multiple demands, we get spread thinner and thinner. And all of a sudden, we're not. We don't understand why we're not as productive as we were. Well, it's because we've undermined the clarity that we started with. And we're becoming distracted from where we really want to make a contribution. So you see, this is actually a model that a lot of us were taught, right? When we started off, say yes to everything, figure out what's important. But one of the problems that we also see is that poor leadership can facilitate this paradox, right? You take advantage of the go getters, well, that's my go to person over there, I need help. Let me call let me call on Joe, or Sally, or whoever it may be, and use them over and over and over again, because they get things done. But that actually prevents effective progression, and real, high levels of contribution. Good leaders can therefore eliminate meaningless and give people space and time really importantly, to be productive. So one of the things I try and do now in the middle of my career where I'm have some leadership roles and also sit at the in the middle of many committees in organizations. Try to avoid useless email chains, purposeless projects and unproductive meetings. If you really don't have a clear goal for why Your meeting? Or why you're sending that email? Or why you're handing out that task. Don't do it. If you're being assigned a project that doesn't make a lot of sense, or being called into unproductive meetings, politely find your way out of it, or call into question, Hey, why are we doing this? And maybe you're just not understanding the purpose and the goal. And you can see it time and time again, individuals, companies, institutions can fail because they're pursuing more without discipline. And so we really need to think what is that one thing that we want to do well, and then move on to the next thing once we've accomplished that. And so we really need to think about time and choice and how we choose the time we spend. And this once again, comes from Greg McKinnon's book of Essentialism. When you surrender, the ability to choose something, or someone else is going to step in and choose for you. And you may not have control of what all of your options are, but you always have the control how to choose among those options. And when you do less, but you think more, you can produce better outcomes, whether that's as an individual, or an institution, and vilfredo. Pareto was notable for putting forward the 8020 rule, or 20% of our efforts produce 80% of our results. And my favorite quote from him is if you're Noah, and your Ark is about to sink, look for the elephants first, because you can throw over a bunch of cats, dogs, squirrels, and everything else that is a small animal and your Ark will keep sinking. But if you can find one elephant to get overboard, you're in much better shape. So if you resolve a tiny fraction of your problems, you can create major solutions. And then the last part I want to make about time and choice is that if you're too busy to think you're too busy, period, make time to read make time to process what you're doing. Think about Patrick Walsh taking off every August, think about macro breaks that I talked about before. And one of the easy ways to do this and build it into your day is to create a journal, we'll talk more about gratitude journaling, setting up goals for the next day in other podcasts. But coming up with a routine where you use a journal and you effectively create your time for the next day. Or effectively note what was successful today may help you tomorrow. Be more efficient and choose your time best. And the last thing I would say is sometimes you need to be isolated. Right? Isaac Newton, Pablo Picasso, Keith Richards are all famous for doing their best work in complete isolation. A granted Keith Richards had a lot of drugs and booze with him. But it's okay to be alone. It's okay to create that time where you can be creative and you can be effective. So I'll leave you just with some tips and tricks for efficiently working through your day to kind of summarize here. First, identify the best times of day for your work. What is your chronotype coordinate your schedule to maximize your efficiency? night hours are okay night clinics are okay. Plan your day to be efficient. Plan for less demanding tasks and your off hours. Optimize your to do lists. And we didn't talk about to do lists specifically, but align your to do list first with your deadlines and when are things do but then align your to do list with your goals and values. I write on the upper right corner of my to do list on a legal pad. What are my What is my priority? And what are the other goals I want to accomplish. And when I'm having a hard time deciding which box to check off. Next, I look at those goals. I look at that priority. And I decide which is essential and what I need to do next. The other important thing to recognize about to do list is they are never going to disappear. So you can check off as many boxes as you want to today, you're still going to have more boxes to check tomorrow. So devote your time give your time efficiently and when you're becoming inefficient. Back away recharging, come back and do it again, efficiently. The same metaphor can be used for clinical responsibilities that as many patients as you take care of today, it will still be patients to take care of tomorrow. The other advice I give is compartmentalised during work. I do this explicitly. Now, the first thing is I turn off, I've turned off all of my notifications. You do not need to know about every email, tweet or new story that comes to your phone. And in fact, much of that is counterproductive. If there truly is an emergency someone's going to pick up the phone and call you or come knock on your door. The second part of compartmentalization is set up distinct amounts of time for certain tasks. I know I've got a deadline for a paper coming up. I'm going to come in for the first hour of the day, I'm going to work on this paper. Then for the next 30 minutes. I'm going to go through my epic inbox that I'm going to call patience. Whatever I get done in 30 minutes, that's what I'm getting done. Then I may take a break, check email and answer the phone for 15 minutes and 15 minutes alone. Go Back to my paper or go back to epic and I end my workday when it's supposed to end. Remembering. First of all, if you finish the work today, there's still going to be more work to do tomorrow. But it keeps you efficient. It keeps you fresh. And it sets an intention about what else you need to do in your life. And the last part of that is built in your brakes, both micro and macro throughout the day, go for walks, drink coffee, go outside. If you can't go outside, get lost in the picture in your office, go check in on the residents, call a friend. And that brings us to the end of this episode. I hope you enjoyed it. Hope you found it useful. I hope you found some tips and tricks for how to be aware and manage your time. In the next episode, we're going to incorporate time in space. Knowing our dimensions and how to generate routines that make us effective and efficient. I look forward to talking to you then.