Do you often feel overwhelmed, run late and stay later and later to finish never ending tasks? You are not alone.
As patients increasingly present with more complex and multiple problems, managing the 10-minute consultation is one of the most challenging demands facing GPs in modern practice. Here, we bring together recommended resources and tools to help you manage your time, which will in turn help reduce stress and control your workload.
You can also take the Mindtools quiz to find out how effective and productive you are.
Using a Time Management Technique
There are many tools and techniques to help you to manage your time. The Mindtools website is an excellent resource to teach you how to value your time, prioritise, organise and motivate yourself and maintain focus. The site also brings you useful tools to develop your decision making and problem solving skills.
The Pomodoro Technique is an effective time management technique developed by expert, Francesco Cirillo. This breaks down work into intervals separated by a short break.
Choose the task you would like to get done
Set a timer for 25 minutes and make a commitment to yourself that you will give the task your full undivided attention for 25 minutes
Work on the task until the timer rings . Immerse yourself in the task for the full 25 minutes. If you suddenly realize you have something else you need to do, write the task down on a sheet of paper.
Take a short break. Breathe, meditate, grab a cup of coffee, go for a short walk or do something else relaxing (i.e. not work-related). Your brain will thank you later.
Every four Pomorodo rounds take a longer break. Cirillo recommends 20 or 30 minutes to allow your brain time to assimilate the new information and rest.
Input Processing Technique
David Allen is author of the influential book Getting Things Done. In this book he advocates the Input Processing Technique as a useful approach to help manage the sheer volume of tasks we need to process in our working day. Allen has developed a useful flow chart which essentially works on the principle of: “Can it be done quickly? In which case do it. Do I need it? if not, get rid of it immediately. If it needs to be done but needs more time, file it and schedule a time to deal with it.” A similar approach is: DO IT, FILE IT, DELEGATE IT, OR DUMP IT!!
One Touch Technique
The one touch technique is a similar, well-used technique that teaches us to only touch things once. How many times do you find yourself going back over the same results or letters before eventually actioning them? Think of all that time wasted. Touch it once – if it can be dealt with there and then, DO IT, if it is going to take longer then file it until you have the time to deal with it properly. When you next look at it make sure it is dealt with at that time, rather than keep coming back to the same task again and again. This can be applied to home life, too. Respond to that party invitation or pay that bill immediately when you receive it.
Bit Literacy: Productivity in the age of information and email overload, by Mark Hurst
Procrastination - Eat the Frog!
Eat the frog – do your worst task first.
Procrastination is one of the most common pitfalls in managing our time effectively. Mark Twain famously said that if the first thing you do in the morning is eat a live frog, you can go through the rest of the day knowing the worst is behind you. Your frog is your worst task, do the worst first! It really works, imagine how good you will feel when that task, the one you are most likely to procrastinate on, is done and out of the way.
Brian Tracey two methods to avoid procrastination in this video, including Eat That Frog
Effective to do lists are invaluable in both time and organisation management and allow you to work smarter and reduce stress. Lists allow you to keep on top of your work if used properly, which keeps you reliable and protects your reputation. It is vital that your list is prioritised effectively.
If you have large items on your to do list then use an action plan instead. Break the task down to smaller actions each taking no more than 1-2 hours each.
Lists don’t have to just be on paper. Bullet journals are increasingly popular. Buy a beautiful notebook or a custom-made journal and divide it into sections according to your needs – i.e work, home, school, kids, hobbies and compile lists under each section. The bullet journal is often described as a ‘brain dump’.
See this Mindtools article for more help making an effective to do list. It includes a worksheet.
Toodledo is a useful app that helps you to organise your life and aims to increase your productivity.
Todoist lets you keep track of everything in one place.
Recognise your time thieves: This article by the Royal Medical Benevolent Fund lists distractions as one of the five mistakes doctors make in time management.
It’s easy to get distracted and waste time, both in the consultation and when facing other tasks. In the consultation look at where you could save time – for example, do you print off leaflets when you could give the patient the link to look up themselves? Do you find yourself filling the consultation if the patient’s problem has been dealt with within the first few minutes, spend time looking for equipment, refilling your printer or become distracted by social media or the internet?
Look at identifying and reducing your time thieves – take the Facebook app off your phone and only check on your computer, delegate the stocking of your room prior to surgeries, have a pre-printed sheet of useful internet links for patients etc.
A useful exercise is to time how long it actually takes you to leave the building from doing your last piece of work or seeing your last patient. You may be surprised at how long it takes due to those time thieves, what can you change to get home sooner?
Recognise when you are naturally quicker and slower in the day and tailor your work around this, for example don’t do blood results and letters at the end of the day if this is when you are at your slowest, are there other ways you can organise your day to do tasks when you are more productive?
Techniques to manage the consultation
Dr Deen Mirza, founder of Better Doctor, comments: “Few outside our profession can understand the feeling of panic we experience when we are 20–30 minutes behind (or more) in our appointments. The stress generated is disproportional to the actual harm caused to patients. Managing the consultation time is probably one of the key flash points in the day. This will be a significant factor in reducing overall stress.”
Deen has written four books which are available on Amazon: a three part series on ‘How To Consult Efficiently’ and another on managing difficult patients with unreasonable demands (the FRAYED consultation model). He also runs popular one-day time management courses for doctors.
'While I'm Here Doctor' and Long Problem Lists
If you are running behind, try saying: ‘Thank you for being so patient’ instead of ‘sorry to have kept you waiting’ and notice the difference in your patient’s reaction.
Below are some tried and tested useful phrases to help you manage the consultation:
“I think that’s a problem we’ll have to leave for another time”
“Gosh it sounds like there’s a lot going on here, will you come back and see me again next week”
“I don’t think I can possibly do that problem justice squeezing it in at the end of today’s consult” etc etc etc
“So we can plan our time – is that all we need to cover today?/ is there anything else you were hoping to cover?”
“Sadly as we only have eight minutes time together we need to be realistic about what is safely manageable, what would you like to cover today and what would you like me to arrange for you to have another appointment for.”
“I am going to leave that there, we have so much to explore, now let’s book you in for more time with me.”
“Unfortunately we are now in the next patient’s appointment time, let me arrange for you to have more time to sort this out for you”
This approach allows the patient to realise that their time is up and hopefully allows the impact of running late on other patients to be thought about.
The 'Heart Sink' Patient
David Rainham talks about strategies to manage these patients in his book The Stress of Medicine, produced for the NHS Practitioner health programme.
He describes 20% of the patients causing 80% of the stress and gives a number of suggestions for managing them:
Set ground rules for frequency and length of visits. Consider a longer appointment that will allow you to really listen to the patient and identify their underlying worries.
Recognise the feelings these patients elicit in you – be that anger, frustration, resentment, inadequacy etc
Use ‘metatalk’ with useful phrases such as ‘I’m finding it difficult to help you’; ‘What can we do to work better together on this problem?’; ‘what changes have you had to make as a result of your symptoms?’ and ‘That’s great that you are doing so well in managing your condition’. This encourages ongoing self responsibility and self care, helps focus on action and have a greater sense of control and responsibility. ‘I can see that these symptoms are very distressing to you but thankfully there does not seem to be any sign of serious illness’.
Time saving apps, tools and resources
Value your time: do you have jobs or tasks that are time consuming and not enjoyable? For example, do you hate gardening or cleaning? Calculate how much these jobs are costing you to do at your current hourly earnings, it is likely that it will be much more cost effective for you to pay to delegate these tasks, thereby freeing your time to spend on the things that bring joy to your life.
Work out your goals: identifying your personal and professional goals – short, medium and long term – helps underpin and drive your time management and aids planning and prioritising your workload and tasks. This is a useful guide.
Set your goals and make them happen: GP-S coaching and mentoring service is free to all GPs locally and can help you do just this.
Please register to view all of our informative resources within the GP Phoenix Programme.