How many times have you thought or said that throughout your medical training? You know, where it feels like one interruption or unexpected delay will cause the whole house of cards to collapse. But it’s not just medical culture, hurry and hustle are ubiquitous in our modern, Western culture. We see it in our movies, books, and internet sensations from 2012 (“ain’t nobody got time for that!”). But the funny thing about the rush for too little time is that we all spend every minute, – whether intentional or unintentional – on something. So, since we can’t create more time in our day (which even if we could, would it actually change anything?), and as a resident you don’t have as much freedom to craft the schedule of your work day, I think the margins of your day (i.e. before and after work) are the best place to reclaim some control. It just takes a plan and some expectation management.
Before we dive into our margins let’s recognize what you are experiencing everyday. Imagine your time spent awake every day as a straight line on a page. Since most residents spend 10+ hours at work, in the middle of the line and taking up the majority of it a large block labeled, “Stress at Work”. No matter your specialty, everyone will experience some amount of stress at work on a day-to-day basis which I break down into four categories: hurry, conflicts, tasks, & risk of doing harm.
So, we all have to climb up this block of stress and move through our workday which requires energy. And for me, I noticed that when I had no intention behind the margins of my day, there was a greater energy expenditure even just ramping up to work. Then after work I was easily distracted by screen time, eating, or something else to disconnect from the stress rather than process it. And honestly, spending my time like this did not bring my best to work. It was all reactionary to survive and led to an overstressed, overworked, & unbalanced clinician reaping the fruit of my unintentional system. Something needed to change. But where to start?
Well, we gotta know where we’ve been to change where we’re going. So, I got some baseline data. I spent time tracking how I spent larger blocks of time (i.e. time spent at home, at work, and commuting) to discover how much time I had in my margins. My results were that I typically had 3 – 5 hours in my daily margins – depending on the rotation.
After I stopped crying from the realization that I only had a few hours in the day under my control, I moved on to logging what I was doing with that time. Not surprisingly, there was no consistency or intention. If I was on a busy inpatient month, my morning routine was rolling out of bed, making sure I was somewhat put together and hygienic, and off to work. On less demanding rotations, I occasionally read my Bible or exercised, but most of the time I felt the need to sleep in and “recover from last month.”
Then my evenings were similarly without discipline. The actual time I arrived home waxed and waned with notes to complete or to-do lists to check off, and so many times I would find myself on my phone. I would do the typical, “I’m gonna check my email real quick,” and then get sucked into social media to find out an hour has gone by without knowing it.
After collecting all this data, I could finally sit down and ask myself – what do I want to do? How do I want to spend these precious minutes? This introspection led me to develop my most successful framework for daily life in medical training – what I call my morning and evening triads.
It’s a simple idea and many people are doing elements of it daily, but I think putting some language and intention behind it helps residents reclaim their margins. It simply asks:
What 1-3 things are essential to your mornings and evenings? Then whatever your answer – do it everyday.
I can hear some of the responses, “That’s it? Really?” Yes, really. It’s that simple and reminds me of a quote from Osler’s A Way of Life, “so simple indeed is it that some of you may turn away disappointed as was Naaman the Syrian when told to go wash in Jordan and be clean.”
Here is why I have settled on this framework.
We’re going back to one of our big questions: How do you want to spend time in residency?
Specifically – how do you want to spend your margins? What is essential to your daily life?
