Each day, we make decisions — often by routine and default — on where we will devote our personal resources.
Just as any countries or businesses choose how to use their resources — natural resources, human resources or money — to achieve their goals of providing services to the citizens or customers, we too have limited resources and must prioritize how we will use them.
What are the most precious of your resources?
In my work as a family physician, I am committed to supporting the wellbeing of over 2,300 patients.
I have a limited number of appointments each day, but the care of my patients requires administrative activities beyond that face-to-face time: the writing of referral letters, completion of forms, review of lab results and the appropriate management of both normal and abnormal investigations. These behind-the-scenes administrative duties may require 20 per cent of my time during the week — averaging several hours each day of the week including weekends. So of course, time is a priority resource I must carefully apportion each day.
At the end of a full day of seeing patients — up to 40 in one day, each bringing multiple separate concerns that require a detailed history, examination, diagnostic formulation and management, my brain can feel fried from decision fatigue.
The physician's mind is active throughout each patient encounter, working through differential diagnoses — weeding through the constellation of possible explanations for the presenting symptoms, reformulating further detailed questions and planning a course of management to rule in or rule out each possibility.
To launch into the administrative tasks at the end of the day's visits is psychologically daunting considering that interspersed throughout the clinical day, physicians are interrupted with urgent messages and results that require immediate attention. Decision fatigue arises from spent mental energy.
Another personal resource we all need to budget each day is our energy. Most physicians use their lunch breaks to keep up with the accumulating tasks appearing in the EMR (electronic medical record; the computer program that virtually every family doctor is required to use to meet the current College of Physicians and Surgeons standards of patient care).
However, just as our brains move through various stages of sleep each night, during the day, our brains cycle through 90- to 120-minute ultradian rhythms. With long periods of driving, monotonous work or intense concentration, we need to change gears and participate in other activities. We need coffee, lunch, social and meditation breaks in order to recharge and return to our previous activity with renewed energy, efficiency and enthusiasm.
My practice is to book off sufficient time during the midday break to get to the local pool for a second swim — 20 or 30 minutes of high intensity aerobic exercise getting my heart rate up to 140.
My first swim each day is at 6:10 a.m.; 80 lengths, or 2,000 metres, in the community pool. The second swim is half of that in time and distance — usually 1,000 metres. From May to September, the Central Park Outdoor Pool is open. The drive is just long enough to eat a turkey breast sandwich enroute to the pool and an apple on the way back to the clinic. I return with more mental and physical energy than I would get from a Starbucks coffee or a nap (if that were possible in a medical office).
Physicians committed to serving their patients can get stuck on the treadmill of putting more value on our work than the rest of our lives. In my old school training, we were encultured to accept long hours and sacrificing sleep and personal priorities to care for our patients. Younger doctors generally have a healthier approach to balance their lives, many eschewing full-time family practice to part-time hours or other forms of work.
Your most precious personal resource
A final personal resource that few prioritize or even attend to is in fact your attention. Ideally, what we ought to be paying attention to is our intentions. These are the priorities aligned with our deepest core values. These may involve familial, community, ethical and spiritual aspects of life. These are the few precious things that bring the greatest meaning.
The world competes for your attention. Facebook, Instagram, email and text messages; ads and commercials; gossip and mindless chit chat divert our minds from what matters most. For the student, looming projects and exams take priority, distracting us from the necessities of self-care. For parents especially mothers of young children, the countless details of their daily routines and weekly activities are forefront, leaving little bandwidth for self-care.
Work is the greatest time, energy and attention vampire; it will consume all that you allow. Many retire at the end of nearly a lifetime of work not having lived the rest of their lives. The quantum Zeno effect, also called the attention density effect, simply stated tells us that what we focus upon we amplify. Donald Hebb's neuroplasticity catch phrase, "Neurons that fire together wire together" tells us that what we practice repeatedly we reinforce, establishing habits of action and habits of thought. Through each day, our attention is side tracked by urgent, unimportant tasks.
We need to stop whatever we are doing and shift our attention, time and energy from someone else's priorities. We don't routinely pause and ask if this urgent task is truly important and deserves more than a moment of our attention. We more frequently neglect the nonurgent important priorities of our lives - our relationships, our passions and other sources of joy. These ever-important spheres of our lives sooner or later become urgent priorities often too late when we are spent of time, energy and attention. We can obviously turn off notifications and make a deliberate intention to get off our dopamine-fueled addiction to social media and other electronic communications. How can we better manage where we commit our attention?
First comes intention, beginning each day asking, "At the end of each day — and each life — what matters most?," "What will I focus upon today?," "What are the essentials of my day?," "How will I make this day complete?," and "How will I make this day matter?"
Not one of us can wait until the task at hand is complete as another will inevitably follow like the blocks in an endless Tetris game. You can't wait until the job is over or when the crisis of the moment passes. You can't wait until you have free time.
You will never be freed until you take control of your time, attention and energy.
Commit to mindful moments during the natural breaks of day — mid-morning, mid-afternoon and meal breaks; water breaks; washroom breaks; and those moments when you yawn or feel distracted.
Use these moments to check your compass. What have I been attending to? What has been my focus? Is it aligned with my values? Does it move me closer to my greatest life goals?
Don't live on autopilot. You will find yourself at the end of life's journey far from your intended destination. Turn off the default focus function of your attention. Make it a regular practice to manually adjust to a wide beam of attention and look at the big picture before you zoom back into your laser focus. Budget the allocation of this most precious personal resource, empowering your attention with deep intention.
Dr. Davidicus Wong is a Burnaby family physician and has written for the NOW since 1991.
