I Tracked My Time for a Day as a Doctor: Here Are the Results
Take the highest performing 1% of school kids, put them through 10 years of grueling training, brutal exams, and rigorous standards to bring them up to the highest level of clinical excellence, and then equip them with the tools for the job. Windows XP and fax.
Anyone who works in a clinical field will have laughed when they saw that headline. I’m going to cover what a typical day looks like for me as a junior hospital ward doctor. I’m very precious about my time.
Two very different relationships with time
When you’re self-employed, every minute counts. Anything you do has a direct opportunity cost. As a doctor or in any resource provision job, you’re there during those hours regardless of what happens. Your job is to assess, investigate, and initiate a management plan for those patients. Once you’ve done that, you can’t do someone harder. The job’s just done.
I’m making this video because if you’re an online coach or self-employed, you’ll probably resonate with a lot of this. The biggest mistake people make when moving into their own business is that they inherit a lot of the old broken habits from an office job environment and miss out on the massive opportunity for total autonomy.
You are capable of so much more than you think. What follows is a normal day with normal staffing on a geriatrics ward.
Morning: handover, printing, and getting to the ward
I cycle into work in the morning, get changed into scrubs, and go to the on-call handover room where the night team hand over any outstanding tasks. I then go to my ward and update the Microsoft Word document in a shared file that has the jobs for the patients on our ward.
I try to print it. The printer is broken. I go to a different ward, log into a new computer (which takes time to build a user profile), print it there, bring it back, and head to the nurse handover.
Ward round and patient care
The ward round varies depending on the consultant leading it. Some frontload the notes, then whip round to see the patients. Others go as they go using a computer on wheels. Today was a frontloaded ward round.
I write up all the notes on the system. Before we start, I’m asked to do a couple of blood tests the phlebotomist failed and put in a couple of cannulas for IV drugs. Then we start the actual ward round: seeing patients, checking them over, making sure they’re improving, making any course corrections to their management plans, and setting them up for going home.
After this, I review a patient with an itchy red eye. I examine him, write up the notes, and call the ophthalmology registrar who advises on specific eye drops. I document the conversation and then head for lunch.
Afternoon: the administrative reality
After lunch I see the remaining patients on my own and write down the jobs for them on my handover sheet. Then the jobs for the day begin:
- Paperwork at the bereavement office for a patient who died overnight
- 8 minutes of pre-recorded messages, then 5 minutes speaking to the haematology registrar for specialist advice
- 15 minutes printing a mini mental state exam document, then 10 minutes going through it with the patient
- Searching five different wards for an MRI request form that isn’t in the cupboards, drawers, or on the internet
- Reviewing a patient who is being sick, giving anti-sickness tablets
- Half an hour updating prescriptions and drug charts. Luckily we’re using digital prescriptions, which is a huge timesaver.
- Writing discharge letters summarizing each patient’s admission for their GP
- Annual leave Tetris across four spreadsheets in the shared drive
End of day
A few phone calls with patients’ family members to update them on what’s happening. A battle with the printer to send referral documents. Final checks, update the jobs list for the next day. Evening handover to let the night team know what needs doing. Then cycle home.
As you can see, the majority of the time is spent doing clerical stuff and not actually physically with a patient.
Within that, I’m bottlenecked mostly by the systems: the version of Windows I’m using, waiting for computers to load, finding the right form, waiting to get through to someone on the phone.
The real cost of micro-delays
Little interruptions or software delays cause you to leave attention residue on the previous task and it takes much longer to get back into what you were doing, with some data suggesting it takes up to 18 minutes to re-enter flow after an interruption.
In large organizations, it’s very difficult to track this stuff and hard to see the true impact. The fundamental problem is the size of the organization and funding relative to that. If a system is underfunded, rather than rebuild from the ground up, it’s cheaper in the short term to Frankenstein little new bits and bolt-ons until the eventual outcome is a huge messy system that is much harder to change. Then management consultants come in at £9,000 a day and make pretty slideshows about vision and narrative and no real change happens.
Luckily, you are much more nimble if you’re self-employed and you can address these at the root.
Three observations worth applying elsewhere
The things I find most interesting about this day:
- The ratio of time with a patient versus time filling in documentation. This has changed a lot over the last 20 years.
- Task management between teams. Startups use dedicated tools to minimize friction and duplication of effort. Our version is a pen-and-paper printout of a Microsoft Word document duplicated in a shared file every day.
- Switching time versus batching similar tasks. A ward round takes longer if you try to do everything at once rather than batching all documentation in one go, then all the jobs later. That minimizes attention residue. Moments when you’re made to wait, like pre-recorded messages on internal phone calls, quickly add up to millions of man-hours across an organization. Eliminating them is a massive low-hanging fruit.
What task-switching does to thinking
We can see the impact that interruptions, noise, and task-switching have on the brain. They make thinking stupid. Stupid here is defined not as the opposite of intelligence, but as Farnam Street defines it: overlooking or dismissing conspicuously crucial information because of sensory overload.
That’s how my day looked when I tracked my time as a doctor. If you’re interested in more on this, have a look at the productivity playlist.