Physician time magic: regain control of your life

Life places unending and conflicting demands on virtually everyone’s time. Even though we all experience it, we not only cannot control it but we also repeatedly allow time demands to escalate until the burden of unfinished projects threatens to bury us. Although many physicians, especially obstetricians and gynecologists, frequently feel particularly overburdened with on-call hours, our profession and specialty are not necessarily unique or exceptional in this regard.

The catch phrase “24/7,” meaning being available 24 hours a day/7 days a week, did not actually originate with the medical community but has become 21st century shorthand for the pervasive sense of somehow needing to be available 168 hours per week every week. For residency directors, the phrase “24/7” currently translates into a pair of 80-hour work-week positions but threatens to become a trio of 60-hour work week positions. In Europe, the “24/7” demand may even soon require a quartet of 40-hour work-week positions.

Obviously, good time-management skills have become more necessary than ever. Before we bemoan the fairness of our professional time crunch dilemma, consider our patients. Parenthood, particularly motherhood, has always required a “24/7” time commitment, probably going back into the mists of time. In fact, our patients correctly perceive their time to be equally as valuable to them as is our time to us. That is why prolonged office waiting times, for example, rank at or near the bottom of every patient satisfaction survey.

A society obsessed with time

To say that American society is obsessed with time is a gross understatement. Consider just a few common everyday expressions related to time: free time, quality time, flex time, overtime, crunch time, waste of time, just in time, and out of time. Of all time-related phrases my personal favorite is “daylight saving time,” because it implies that we can somehow manipulate time to produce more of it. Needless to say, everyone periodically reaches a point at which he or she needs to yell “Time Out,” stop, and regroup. Recognition of time constraints is not a new concept. Five hundred years ago, 1 of mankind’s most productive geniuses, Leonardo da Vinci (1452-1519) felt plagued throughout his life by a sense of failure, incompletion, and time wasted.

Unfortunately, society’s obsession with time and the demands of the “24/7” mantra all too frequently produce stress , which is defined as physical, mental, or emotional strain, tension, and pressure. Occasionally, but probably more often than is actually recognized, the incessant demands of too little time produce distress, which differs from stress by being associated with great pain, anxiety, or sorrow accompanied by physical or mental suffering. Although stress, in moderation, keeps us alive and productive, there is definitely a point beyond which distress may set in and mess life up to the point of burnout or worse. Physiologically, chronic excessive stress actually kills brain cells. We will never know just how many people have become obsessed with time, or the lack thereof, to the point of physical and/or mental illness.

Time as the currency of the new millennium

Time has been described as the currency of the new millennium. Almost certainly time, or a perceived shortage of it, has always been important to busy, productive, and driven individuals of all ages in every civilization. It has been suggested that, as we begin the new millennium, we have more time available (at least discretionary time) than ever before. We also have more uses for it and demands on it than ever before. That being said, busy people, including physicians, universally expect to be able to use that “extra” available time to accomplish even more and more. And so the cycle of never having enough time continues to perpetuate itself.

It should seem almost intuitively obvious that the need for exceptional time-management skills is greater than ever. Unfortunately, exactly the opposite reaction frequently occurs. With so much time being devoted to accomplishing as much as possible, no time remains to slow down, pause, and analyze whether there is a better way to improve efficiency and actually have time left over. What a conundrum!

When faced with a medical conundrum, physicians turn to the literature. The literature on the subject of “Time Management” is surprisingly limited, which I find almost as intriguing as the subject itself. Books range in size from <100-page paperbacks to an occasional handbook 5 times that length. Some books focus more on better organizing skills, detailed planning techniques, or comprehensive list-making; others offer guidelines for actively managing time better. By book’s end, readers generally are left still trying to decide which suggestions best fit their own lifestyle. Instead they could be learning new time-management skills that foster a personal lifestyle that best allows them to pursue their stated life goals most effectively.

The time myth and reality

For any person who achieves the estimated life expectancy of 80 years, there is 1 absolute fact. You will have 29,220 days or 701,280 hours or 42,076,800 minutes to accomplish everything you need to do or hope to do in this life. Depending on how long you actually live, the amount of time available will adjust accordingly, but time is a metronome that indeed marches on: by the second, by the minute, by the hour, by the day, by the week, and by the year. The reality, of course, is that we all have only a fraction of that time available to use in a discretionary fashion.

The first truth about time is that you either use it or lose it. Depending on your age, a backward glance will always generate the same question: what happened to the last 10-20-30-40-50-60-70-80 years? Another question invariably is “have I accomplished all I wanted to do or could have done?” Regrets are pointless because only future time remains; however, avoiding past mistakes is fundamental to perfecting time-management skills.

The second truth about time is that there is never as much as we calculate there to be. First of all, approximately 25-35% of adult life is spent sleeping, assuming 6-8 hours average per day. Most exceptionally busy people claim to function on less sleep and often for sustained periods of time. Eventually, the body takes what it needs whether at night or during the day, in long stretches or brief snatches or even while awake but when too tired to function. Another 30-60% of adult life is probably spent working on 1 task or another, which based on the 80-hour work week model consumes 47.6% of the 168 available hours. Finally, daily tasks like eating, hygiene, errands, and commuting require a minimum of a few hours each day. For simplicity, an average of 7 hours sleeping, 11 hours working, and 4 hours for daily tasks adds up to 22 hours per day. This schedule leaves only 2 hours per day of true discretionary time. Is it now more apparent why life can feel so overwhelming, unbalanced, and out of control?

The ultimate goal of time-management skills is to expand discretionary time from a couple hours a day to any greater amount. Finding just an extra hour per day represents a 50% gain in discretionary time, not merely the 4% gain calculated with the use of a 24-hour denominator. Even an extra half hour adds 25% more discretionary time to the average day. Is it any wonder that better time-management skills can help everyone regain some control over his or her life, reduce stress levels, and provide greater balance and productivity?