Time management tips: Wrong answers only

In honor of April Fools’ Day, here are my top anti-hacks, welcoming pitfalls, and wrong-answer-only time management tips. Watch out though, some of them may hit a little too close to home.

1. Being constantly connected is paramount to your productivity. Therefore, you should check your email every 2 minutes or less. Random e-mail checks are a great way to fit tiny bits of productivity into every waking minute. Be sure to check it on your phone, computer, and tablet, use multiple different e-mail programs, and avoid having a system of folders or filters to organize and manage your inbox. Instead, just repeatedly mark emails as unread so that you can come back to them 5 minutes from now, reread them, realize you still are not in a good place to deal with them, and mark them as unread again. Repeat this cycle endlessly.
   
   
2. Don’t bother with productivity systems, to-do lists, timeboxing, or bullet journals. Those systems are for the weak. Instead, keep everything in your head. Your shopping list, family birthdays, tax details, work tasks, and any little thing that pops into your head should be kept at top of mind, so that you can deal with it when the time arises. Never mind that you can’t focus well on more complex tasks because you have all the open loops in your head. By keeping everything in your brain, you don’t have to worry about creating a task management system or adding things to your calendar. Instead, you can just keep it all in the little gray cells. If you absolutely must write something down, don’t put it in a centralized location where you will come back to it. Instead, put it on a random post-it note or an unused page of a notebook and spread the notes haphazardly around your office, desk, kitchen, and underwear drawer. By having a distributed arrangement of reminders, you are sure to find them at interesting moments.
   
   
3. As a busy person in high demand, you should spend most of your time just putting out fires and dealing with urgent things that pop up. Don’t worry about spending time on long-term planning, thinking through your personal and team vision, or looking at your strategy to see if it is effective or not. Instead, just keep working on the urgent tasks that are due tomorrow.
   
   
4. Double down on perfectionism. As a high-performing individual, it is important that absolutely everything you do is perfect. Do not distinguish between high-priority tasks and low-priority tasks. Even if going from a B- to an A+ level of work will not actually make a difference in the outcome just keep trying to make everything perfect. Even if it costs you countless hours, try to make everything perfect whether it needs to be or not.
   
   
5. If you make a mistake or find yourself ruminating on past mistakes, you should make sure you do not forgive yourself. Instead, that sense of shame can help keep you stay motivated and do better in the future. In fact, it’s a good idea to bring up past mistakes or failings in your mind regularly to remind yourself of them frequently, to make sure you perform better in the future.*
   
   
6. Ignore signs of depersonalization and burnout. These feelings are just a sign that you should push harder and do more, perhaps by cutting down on sleep, exercise, or seeing friends. Just because you have lost interest in work, feel exhausted all the time, and are no longer connected to your own sense of self and what is important to you, that is no excuse not to keep putting in all the hours at work. Instead, just keep chugging along within the current system. Surely someone will come and fix it for you before long. Don’t bother trying to fix it yourself as this is pointless, plus, isn’t it a little bit entitled to think that you deserve a rewarding career and a workplace that values you? You should also be extra sure to follow items 3 and 4 above even more assiduously.
   
   
7. Don’t take time to think through your goals and priorities for each year, week, or day. Instead, just jump into your tasks and bury yourself in them. Taking time to reflect and think about your personal mission, values, and goals is probably the type of thing that people who meditate do, but it’s not for you. Instead, just keep doing what you’re doing, whether you enjoy it or not.  
   
   
8. If you download one more app maybe that will fix things. The last 20 apps didn’t help, but maybe this one will be different. Download the app, transfer all your to-do items into it, and create a complex system of notifications and timetables for when things will get done. The more complex the system, the better. Don’t listen to the voice telling you that your phone is already a graveyard of planning apps, just try one more.
   
   
9. If you’re unsure of what to do in life and are feeling unsettled, unhappy, or burned out, just add more to your plate. Sign up for a few more committees, take on unpaid and unappreciated tasks at work, and make sure that you make homemade rather than store-bought treats for your kids’ school events (see item 4 above). Perhaps in order to feel a sense of personal meaning and accomplishment, you just need to try harder to climb the corporate ladder. Once you get to that next rung, surely then you will feel more successful. To get there, in the meantime, you should just ladle on more tasks, roles, titles, and responsibilities. If this has been your go-to tactic already and it hasn’t worked so far, perhaps you just need to try harder.
   
   
10. Lower your expectations of yourself, of others, and of life in general. Just kill the spark of originality and humanity that makes you unique. Embrace the fact that you are just a cog in a machine, and probably not a very important cog at that. Embracing this mentality will help you more fully embody your role as a cog, rather than trying to be an individual with your own hopes, dreams, and values.

We have probably all fallen prey to some of these pitfalls in the past. If you find yourself resonating with any of them, let’s talk. Coaching can be a great way to get more clarity about your thoughts and desires and to create a strategy to make change. My goal is to help partner with individuals to catalyze growth and renewal in their lives. You can find out more here.

“Putting things off is the biggest waste of life: it snatches away each day as it comes and denies us the present by promising the future. The greatest obstacle to living is expectancy, which hangs upon tomorrow and loses today. You are arranging what lies in Fortune’s control and abandoning what lies in yours. What are you looking at? To what goal are you straining?
The whole future lies in uncertainty:
live immediately.”

Seneca – On the Shortness of Life

*In fact, studies show that students who were able to self-forgive after procrastinating on one exam were better able to procrastinate less for future exams (Wohl et al Personality and Individual Differences 48 (2010) 803-808).

How to get off the rumble strips and love your journey

Do you ever find yourself overwhelmed or constantly at your wit’s end with all that you have to do? This can feel like driving a car bumping along the “rumble strips,” those grooves in the payment designed to slow vehicles down and alert them to danger ahead. This phrase came to me from a coaching client, Gabrielle (not her real name), a successful surgeon, researcher, educator, and mom of two. She had just spent 7 hours in the Operating Room before logging onto a zoom coaching call with me. She described a scenario that is all too common among physicians and other professionals, the problem of: Too Much On My Plate.  

She had a busy OR and clinic schedule at baseline and had then volunteered to take on an extra OR day, plus all the preparation time that entailed, in addition to an evening course, and all the individual meetings and teaching responsibilities of academic life. She shook her head then looked up at me, “I think I’m on the rumble strips. I know I did this to myself,” she said, “and I want to figure out why I ended up in this situation again.”

If you ever feel like a car bumping along on the rumble strips, pay attention to this warning as something is trying to tell you to course correct. Staying in a state of chronic overwhelm can lead to “mental slowness, forgetfulness, confusion… or impaired ability to problem solve.” If you can relate to Gabrielle, keep reading. Here are some short and long-term strategies to help you get back on the road.

Short-term strategies

First, assess what you need to do to just get through the day and the week. Today, try to at least allocate 15 minutes of planning time. A few minutes to pull your head up from the grindstone and look at what is going on will allow you to assess, prioritize, and strategize to at least make it through the short term.

Second, take stock of what is causing the stress and overwhelm. The 80:20 rule often applies here. What are the 20% of things that are causing 80% of the stress? If you can identify the main sources of stress, then you can hone in on ways to de-stress, minimize, complete, or step away from them. If it is something that is not required for your job or is not that important to you, see if there is a way you can take it off your plate or cancel it. If it is not something you want to cancel, think about how you could delegate parts of it, or create what, in business, is called a minimum viable product (MVP). Do enough that it is a functioning product, but put off adding bells and whistles until you have gotten through the short-term overwhelm.

Third, find ways to get through the next week. If that means ordering out, creating MVP dinners, or skipping optional meetings for the week, do what it takes to get the biggest things done to create more mental freedom and planning time.

When you are in ‘survival mode’ it is hard to think creatively or strategically. Once you get off the rumble strips, then you can take time to do some bigger-picture planning. This is where you can really make changes to prevent getting into the same situation again.

Longer-term strategies

First, ask yourself: Are you driving? Or is the car swerving around because no one has their hands on the wheel? When we end up in the TMOMP rumble strips, we sometimes start to feel like victims. We feel like there are so many things we have to do or are forced to do. The first step is to remember that you are the one driving. Anything on your schedule or to-do list is there by your choice, which means you get to choose whether to keep it on there in the long term, or whether to phase it off. Those committees you are on? Yep, you applied for them or accepted the invitation to serve. The extra OR day you volunteered for? That was a choice. In academia, it is easy to feel like we are out of control when, in fact, the only way to get more control of our time and our days is to remember that we are the ones driving.

Second, are you carrying too much baggage? If you are teaching, researching, working clinically, mentoring, volunteering, writing, driving kids to four different sports and activities, and also trying to exercise, eat healthily, and hand-sew your matching Halloween costumes, there is a good chance things are going to start falling off your metaphorical roof-rack. It is time to take stock and prioritize.

A quick exercise to help identify your priorities comes from the Japanese concept of ikigai, which refers to what gives you a sense of purpose. The things that will give you the most meaning and value occur at the overlap of: what you love, what you are good at, what the world needs, and (ideally) what you can get paid for. Draw that four-leaf Venn diagram on a piece of paper, and then write everything that you do on it in the relevant spot. There will likely be many things you do that you love and are not paid for, and some things that you do not love and are paid for. Hopefully, there will also be some in the center, overlapping with all four requirements. Items that end up outside all four circles, or only overlap with one, are great candidates to decline, delegate, or not renew. 

Third, are you driving too fast? In high-performing, competitive careers, it is easy to feel like the Red Queen from Lewis Carroll’s Through the Looking Glass, who says:

“Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!”

Lewis carroll – through the looking glass

Because the world, it seems, is moving so quickly, we have to run just to stand still. But once you have created a little breathing room to plan and strategize, look at whether you have bought into this lie and tried to run without a break. We do not drive our cars without stopping to refuel and for regular checkups, yet we tend to do just that to ourselves.

Finally, are you on the right road? If you are constantly feeling stressed and overwhelmed, or like you are swerving back and forth without a clear path, then maybe it is time to pull off the road and check the map. Reassessing, soul-searching, and planning are the difficult work that it takes to understand deeper levels of why you find yourself on the rumble strips: Is it out of a need to prove your self-worth? Out of a need to look competent? A desire to help people? A deep sense of empathy? A need to prove people wrong who said you would never make it? A sense of obligation? A fear of irrelevancy or failure? A need to leave a mark or legacy? Clarifying what matters to you is the first step to strategically making the difficult choices about which road to be on.

Gabrielle and I talked through why she had found herself over-committed that week. She made plans for how to cope with the rest of the difficult week and decided that to keep herself on the road in the future, she would adopt some specific strategies. Before signing up for extra shifts, she would check the whole week’s schedule to see how that shift would fit in with the week and month overall. She would pause and notice when she was jumping in to try to help too early and would allow time for others to step up. She would use the experience on the rumble strips as a reminder that when your schedule is already full, it only takes a few additional things to wipe out all your extra capacity and to go from full to overwhelmed. She planned to build in and protect more buffer time so that she had capacity when urgent needs came up, making her schedule more resilient.

Whether you are on the rumble strips, unsure of which way to go, or need to make a U-turn, you can use these practical strategies to help get back to loving your own beautiful journey.

This post was first published on the Harvard Macy Institute blog, and was cross-posted here with permission.

Setting New Year’s resolutions that quietly fall by the wayside within the month is so common as to be cliché this time of year. What if this year could be different? What if at the end of 2023 you thought differently, acted differently, and accomplished more of what mattered to you? Up to 40% of what we do is driven by our habits. Building habits is how we can make changes that will stick. 

The key is instead of setting new year’s resolutions, to plan new year’s habits. Aristotle said, “we are what we repeatedly do. Excellence, then, is not an act but a habit.” The key to creating real change is choosing the right habits. Daily steps will get you further in the next year than isolated big leaps. 

Instead of New Year New You, try New Year New Habits. Here are a series of future-focused questions and reflections to help you identify and implement habits that will help make this year different. 

Step 1: Set a specific goal: What is a single, specific goal that you would like to achieve by the end of 2023? Be as specific as possible. “Get in shape” or “be healthier,” while good ideas are not specific enough to create actionable goals around. Instead, consider what it means to you to get in shape. Does that mean being someone who goes to the gym 3 times a week? Does that mean to be able to run a 10k? Does it mean being someone who walks 3 miles five times a week? Consider what it truly means for you and create as crystal clear a goal as you can. Also, consider what this goal will mean for you? What makes this important? What makes it urgent or timely right now? How will accomplishing it change how you live, how you feel, or your sense of accomplishment? 

Step 2: What habits would you need to start or continue in order to reach your goal? It doesn’t have to be the same thing every day, and it could be a habit that grows. For example, I may decide I need the habit of going to the gym and doing 30 minutes of exercise 3 times a week in January and increasing to 45 minutes in February. Set habit goals that will be achievable but that also excite you.  

Habits are powerful because they reduce the willpower we need to do difficult things. You don’t have to fret each morning over whether you will brush your teeth and if you have the energy to do it, because it is a habit. If you had to make the decision and weigh the pros and cons of brushing your teeth each and every time, it would be a waste of mental energy. The same is true of going to the gym. Once it becomes a habit, you don’t waste the mental energy deciding whether you should go, you do it automatically. 

Habits are strengthened through a cycle of positive reinforcement. When we brush our teeth, we feel cleaner, we like that feeling, and so we’re more likely to brush our teeth again the next day. Think intentionally about how you can create positive reinforcement for the habit you want to start. After a time, as we start seeing results, the habits become self-reinforcing, but at the start, it can help to provide ‘artificial’ positive reinforcement. For example, you could provide a sense of reward by checking off the days that you exercised on a calendar or a habit tracker. You could share your daily exercise with an accountability buddy. You could create a mini mindfulness activity or mantra that you say after your exercise that acknowledges your effort and creates a sense of accomplishment for you. Your brain ultimately wants to feel good. By tying positive emotions to your habit, you will create your own positive reinforcement loop.  

Step 3: Operationalize your habit plan. Next, we bridge the gap between wishing and planning. If you decided, for example, that you want your new habit to be exercising three times per week, then take a look at your calendar and start to fit in the times. New habits are like tenuous baby plants. You have to take care of them the most in the beginning until they become sturdy enough to stand on their own. Add the activity to your calendar, and be as specific as you can. Instead of ‘exercise,’ include what you will do (strength class) and where (gym). I think about this as the Clue method of planning, after the classic board game. Plan what you will do, where, when, and with whom.  

Separating your planning and doing has another key benefit. If you haven’t planned out exactly what exercises you will do and where, then when the time comes on your calendar for you to exercise, there is ambiguity. Your brain then has to decide in the moment what you will do. The ambiguity leaves room for alternatives, and you may find your brain offering you thoughts instead such as: Exercise sounds hard, maybe I should just stay home and do something else. It won’t matter to skip this time. When you have the details of the activity and the location planned out, your brain tends to give less resistance.  

If your goal is to finish a book chapter or a grant in the next few months, then being specific can help too. You could add the times you will work on it to your calendar, and add specific plans, such as: Do a literature search for the background section and select top 20 articles. Another date entry may be: Read and summarize the top articles, etc. By breaking the big activity of “finish book chapter” into manageable activities, your brain provides less protest. 

Step 4: Consider the inner obstacles. This step is too often missed and is the key to understanding why you have trouble sticking with certain habits. Think about what inner obstacles you may encounter. Of course, there could be outer obstacles, such as unexpected problems at work, loss of childcare availability at home, or any number of things. But the bigger obstacles are always inside us. One obstacle you may face could be, for example, feeling disheartened because you don’t think your efforts will lead to results. Another could be feeling overwhelmed at how far you have to go. Or it could be feeling ashamed that you have let things get to the state they are in. Or it could just be feeling lazy or tired or stressed.  

Next, create a plan for what you will do when you encounter those obstacles. This plan is called an implementation intention and looks like this: 

When I encounter [inner obstacle] then I will ___________. 

Consider what you can to do help lower the height of that inner obstacle or help yourself get over it. This part is very personal and unique to you, but here are a few ideas: 

When I feel worried that I won’t see the results I want, then I will remind myself that results take a long time, and if I give up now then I definitely won’t see results.  

When I feel too tired, then I will honestly and non-judgmentally ask myself if I will feel better after doing the habit or worse? 

When I feel like an imposter and that I don’t know what I’m doing, then I will remind myself that I don’t know everything, but I know enough, and what I don’t know, I can learn. 

Implementation intentions could also be actions. For example: 

When I just don’t feel like exercising, then I will tell myself I can just do it for 30 minutes and then if I want to, I can stop.  

When I feel overwhelmed by the project, then I will stand up, stretch, take a deep breath, and ask myself: “what is the immediate next step.”   

When I feel anxious that I might mess up, then I will text my accountability buddy and review my habit tracker.  

Taking the time to reflect on your own inner obstacles and writing out how you will overcome them is a powerful tool to develop self-awareness and to empower you to create change.   

Step 5: Consider the outer obstacles. Our best-laid plans can sometimes fall prey to outer obstacles that then give us an excuse to not take action. For example, if you had planned to go to the gym, but then the roads were too icy, what will your backup exercise plan be? If you had planned to work on the introduction section of your book chapter, but you can’t because you need a section from another co-author first, then what other part could you work on that could take the project closer to the finished state? 

Having resilient plans will help you keep external obstacles from derailing your progress.   

Another tip is to view everything as an experiment. Vowing to never drink alcohol seems daunting and like you are setting yourself up for failure. Trying out dry January as an experiment is doable and allows you to see how you feel without alcohol. You may find your exercise or writing habit needs to evolve over time. Anticipate the need for adaptability from the start and allow yourself to experiment to figure out what works.  
 

Finally, think about coaching! Working with someone one-on-one to think through the steps to creating change is a powerful way to jump-start your progress. If you have set resolutions in past years and failed to keep them, then to get different results this year, you need to do something different. Make this the year that the habits stick. Coaching is a great way to invest in yourself. If you are curious to find out more, check out the coaching page on my website. Coaching now includes CME credit for physicians.  

No matter how you decide to ring in the new year, I hope you can take time to pause, reflect, regroup, and prepare to meet the new year with courage and optimism. 

We are what we repeatedly do. Excellence, then, is not an act but a habit.

Aristotle

Coaching can help you break through barriers, get unstuck, rediscover your passions, and be more effective in your life and career. 

When my kids were little, they took gym classes. At five years old, they didn’t need a professional coach. They had fun and learned some skills at a local tumbling gym. However, if they were high-performing or Olympic athletes, there’s no question they would need a personal coach. The same is true of us. We need coaching not because we need remediation or because we are novices. Instead, we need coaching because we are already professionals, and to improve we have to be deliberate in our approach.

For the last two years, I have been coached once or twice a week. Those sessions have helped me work through personal and professional thought barriers. They have helped me understand myself better and how my thoughts and assumptions were holding me back or causing me to self-sabotage.

For the last two years, I have also coached others individually and in groups. Through being a coach, I have seen people make changes in their lives and careers and, most importantly, in how they think. Small changes in direction or approach can yield major changes over time.

“Coaching is unlocking a person’s potential to maximize their growth.”

John Whitmore

One-on-one coaching is different from any classes or courses you could take because of the individualized attention and confidentiality. Coaching is not mentorship, therapy, or advice. Coaching is future-focused and seeks to empower individuals with the ability to move forward and grow. Coaching is like having a personal trainer for your mind.

“A life coach does for the rest of your life what a personal trainer does for your health and fitness.”

Elaine MacDonald

My goal is to partner with individuals to catalyze growth and renewal in their lives through coaching. My assumption is that you come to the table as someone who is creative, resourceful, and whole.

If you are interested, sign up for a bundle of mini-coaching sessions. Let’s work together to think through what your life could be like and how to get there.

“Who, exactly, seeks out a coach? If you ask a coach the answer is usually the same: Winners who want even more out of life.”

Abigail pickus

To-do lists can help ensure we are working on what matters most to us. A to-do list can also reduce the cognitive load in trying to keep track of too much in our brains. Research shows that just the act of writing something down that comes into your head can help reduce the mental energy it takes to keep track of it, and can allow you to focus better on the work that you are doing. So task lists are important not just for planning, but for allowing us to focus more fully on everything else that we are doing. Here are the last 5 of 10 to-do list don’ts to help you in your quest to finally create a system that will work for you. These will make more sense if you read the first 5 don’ts.

Each task is an experience waiting to be born… When you look at your task list that way… this will become your future.

Ryder carroll, creator of the bullet journal (quoted in wired)

6. Not prioritizing. Once you have your (very selective) list of projects with subcategories of tasks on your list, the next step is to prioritize them. Figure out what you need to do first based on deadlines, team needs, and importance. If we don’t prioritize then it’s easy to get behind on projects, and also it becomes all-to-tempting to do the easy, urgent, or fun tasks, and put off the important-but-less-urgent tasks that will really help transform our careers or that are important to us. Prioritization may be on a monthly/yearly time-frame, but then on the it’s important to prioritize within your day. What are the 1-3 things that you definitely want to do? Being intentional about your priorities can help keep you from wasting time on things that don’t matter to you. In my own practice, I’ll either write out a quick ‘daily do’ list of my goals for the day, or I’ll add numbers next to the check boxes on my to-do list for what I want to do that day. Under-achieve here. If you make a list of 25 things you deem high-priority for the day, chances are you won’t do most of them.  

The key is not to prioritize what’s on your schedule, but to schedule your priorities.

Stephen Covey

7. Not putting tasks onto your calendar. The goal with a to-do list is not to catalogue all the things you would like to do with your life, but to facilitate doing them! The next step from to-do list is to put time on your calendar when you will do it. This may be on a weekly or daily basis depending on how you schedule your time. Put the tasks on during a time when you can do them well. I usually schedule deep work for mid morning or early afternoon, which is when I work best. Don’t schedule your most difficult work for a time when you know you will be exhausted from difficult meetings or at the end of a long day if you can help it. Block out the deep work times in your day and then decide what you will do with them. Some writers advocate the death of the to-do list and that we should work purely from our calendar by time-blocking and adding everything we want to do to our calendars. While I’m a big fan of time-blocking, I still find it helpful to keep a to-do list so that I can easily see all the projects I’m working on at once, and I can adjust or delete things on my calendar without losing track of what I need to do next. This is important for me, as my schedule can change in the last-minute if I get called in to cover the Emergency Department if a colleague is sick. I need to have a repository for all my projects and tasks so that I can quickly clear my schedule and re-prioritize.  

The shorter way to do many things is to only do one thing at a time.

– Mozart

8. Giving up because a system isn’t perfect. You will likely never create a system that will transform you into a productivity ninja who never feels overwhelmed or over-tasked. Instead, find something that works and stick to it long enough to figure out a system that works for you. Perfect is the enemy of good here. Also, know yourself. I am frequently in awe (and sometimes jealous) of the beautiful bullet journals that some people maintain. They are often more art than organization, but I feel like I should try something like that. Keep the unrealistic expectations in check. If you know, for example, that you will overload a digital to-do list, then stick to paper. If you know you will lose a paper list, then find a simple digital app. It doesn’t have to be perfect, it just has to work for you.  

9. Failing to celebrate. Here’s the truth: our brains like dopamine. We will always tend to do things that give our brains more dopamine. You can harness that to create the habits you want by celebrating. Did you do that micro-task? Yay! You turned your computer on and opened the file that is intimidating you. Celebrate. Engage some positive self-talk. Celebration is one of the key features of creating successful habits. In fact, the main premise of Tiny Habits is to make ridiculously small actions that form the seeds of habits. Those seeds are watered by celebration and positive self-talk. Did you manage to not lose the to-do list this week? Strong work. Did you prioritize? Round of applause. It may sound silly and would probably sound condescending coming from someone else, but celebrating your small wins is what will carry your habits and actions further than any self-criticism.  

When you celebrate, you create a positive feeling inside yourself on demand. This good feeling wires the new habit into your brain. Celebration is both a specific technique for behavior change and a psychological frame shift.

BJ Fogg (Ideas.ted.com)

10. Failing to reflect. The reality is, “a scant minority of us check off everything every day. An equally tiny minority simply Cannot Even and are curled in a fetal ball awaiting imminent firing. But most of us? We’re just sort of … meh” (Clive Thompson, Wired). Look at the things that you didn’t check off. Should they be lower priority? Can you delegate them? Do you even want or need to do them in the first place? Did you avoid them because they are frustrating or induce self-doubt and fear of failure? Or are these things that you want to spend your short, mortal life on? Reflecting on what you are doing and why can help you ruthlessly prioritize for the future to make sure you are spending more time doing what matters to you… which may not be work at all.  

A functional system to manage your projects and tasks can save you heartache, missed deadlines, and mental overwhelm. But here’s the key, it has to be functional. The best-laid plans and resolutions to finally use that to-do list app, put everything into your google tasks, or get yourself together often fall by the wayside faster than gym memberships in February. We bounce around from app to bullet journal to notebook trying to find something that we can finally stick with.

Every single time you write down a task for yourself, you are deciding how to spend a few crucial moments of the most nonrenewable resource you possess: your life. Every to-do list is, ultimately, about death.

Clive thompson, (Wired).

To-do lists can help us make sure we are working on what matters most to us. Here are the first 5 of 10 to-do list don’ts to help you in your quest to finally create a system that will work for you. 

1. Giving up and not having one. Very few people can function without some sort of system to manage their projects and tasks. A few people are able to work purely from their calendars or keep everything in their heads, but most of us need some sort of list to keep track of things. Even if your past attempts have failed, it’s worth trying a few new ideas to create a system that will work for you. Without a to-do list, it is very easy to get sucked into the trap of just doing the things that are urgent or the things that are easy. You also may find yourself missing whole projects, deadlines, or opportunities that are important to you. 

Dost thou love life? Then do not squander time, for that is the stuff life is made of.

Benjamin franklin

2. Having too many lists and losing them. Maybe your problem is not that you don’t have a to-do list, but that you have 25 different to-do lists, all on different post-it notes that are scattered around your home, office, car, purse, or are scribbled on the back of napkins, boarding passes, or even your hand. Pick one place to put everything. You can categorize it by home, personal, administrative, and by different work projects. Find a place that will be easily accessible so that you have a reliable physical or digital place to go. I’ve tried almost all the apps and programs out there to be able to compare and contrast them. My favorite app-website combo is Trello for keeping track of lists. However, I personally come back to my trusty pen-and-paper method. I keep blank sheets of paper in a folding clipboard in my bag, and I write headings with the tasks under them. Each heading is a different project or initiative, and the tasks are below them with check-boxes and deadlines if applicable. The beauty of a piece of paper is I can’t overload it, I can see all the projects easily, and I love the feeling of checking them off when done. Once a sheet starts to run out of room or most of the things are checked off, I start a new paper and copy over things that are still active or unfinished. This act of re-writing forces me to assess whether I still want to do them, whether they are important, and why I didn’t get to them in the last few weeks. I also keep a separate list of things that I want to hold onto for longer. For example, my to-be-read list of book recommendations lives in Trello, along with my ‘Someday Maybe’ list of things for the future. Those don’t need copying out every few weeks and are easily accessed when needed. 

3. Listing projects rather than tasks. If you put something enormous on your to-do list, such as write grant, buy house, or get new job, then it’s very easy to succumb to mental blocks and overwhelm when you look at the item. The negative feeling will then drive you to do easier work as you tell yourself: “Let me just deal with my email before I go get new job!” Or you may avoid the project or the list altogether. One of my favorite lessons from David Allen’s Getting Things Done book is the importance of understanding the difference between projects and tasks. Projects are anything that will take more than one step, whereas a task is typically a single step and can be done in a single sitting. Listing tasks rather than projects will force you to think through what the tasks are for a given project. Depending on the complexity, there may be many tasks and sub-tasks. You don’t necessarily have to map them all out at the start, depending on the project. Start by listing the most important things and the tasks that are bottlenecks that you have to do first to move the project forward. The more overwhelmed you feel when looking at a given project, the smaller the tasks you should write. We frequently procrastinate to avoid negative emotions associated with a task. Procrastination is “a way of coping with challenging emotions and negative moods induced by certain tasks — boredom, anxiety, insecurity, frustration, resentment, self-doubt and beyond” (Charlotte Lieberman, NYTimes). Making tasks as small and manageable as possible helps reduce the negative emotions and overwhelm. If it’s a particularly frustrating task, find ways to make it fun: do it with someone else, do it in a location you like, do it with good music on, and break it down into micro-steps in your mind so that your brain doesn’t throw its hands up and walk away whenever you contemplate the work. As an example, writing papers is one of the necessary but often frustrating parts of academia. Specifically, wading through a panel of reviewers’ negative comments as they shred your manuscript that represents months or years of work can be a task that is laden with negative emotion. The task on my list may be: Revise manuscript based on reviewer comments. By breaking the revision down into achievable tasks, I can focus on the immediate next step rather than on all the frustration and self-doubt that arise when reading criticism of the work. In my mind I break it down into micro-tasks:
   1. Turn on computer
   2. Open file
   3. Read overall summary
   4. Review positive feedback
   5. Read rest of feedback
   6. Go through paragraph by paragraph and perform edits, etc.  

The real problem is a lack of clarity and definition about what a project really is, and what the associated next-action steps required are. 

DAVID allen

4. Not coming back to it. It’s all well and good to have a long, organized list of all the tasks you have to do, but it won’t help you unless you come back to the list and then plan when you are going to do the different tasks. Create a cadence, whether it’s in the morning, at the start of the week, or several times during the day, when you go back to your list and either schedule or do the tasks. Frequent list-checks allow you to prioritize and adjust and make the most of time that you may have when a meeting is canceled or another task takes more or less time than you had planned. Keep the list with you physically or digitally during your working and planning time and check it at least daily to update your plans or update the list. I typically look at my list at least each morning when I get to my office. I take a few minutes to review the most important tasks. I’ll already have most of the day time-blocked out (see item 7 next time for more on time-blocking) with what I want to do, but then I can plan to use interstices for other faster tasks in between time blocks.  

5. Putting everything on it and then getting overwhelmed tossing in the towel. This is important. Be selective, like more selective than my non-pescatarian 9 year-old daughter who will only eat 1 food item per food group. Be even more selective about what goes on your list. Let’s get a little existential here. We all fall prey to the idea that: If I just got myself together, I’d be able to do everything I want, I’d be a great spouse, parent, sibling, co-worker, mentor, mentee, and I’d finally achieve inbox zero and everything checked off.  Digital platforms make it particularly easy to add more and more to our lists. We often feel an initial sense of optimism and structure when we see our growing lists within our pre-determined categories on our latest app. However, we then enter a period of avoidance and dread when we contemplate opening the app to see our lists that have enough work to carry us comfortably into the next decade. So we delete the app and go back to whatever system or non-system we were using before, or we pick up the next trendy option. We are notoriously bad at valuing the future. This is true of future money and future time. An hour of my time today may be incredibly precious, while I might give away an hour of time next month more easily. Value your future time and self at least as much as your current time.

We have a limit, a very discouraging, humiliating limit: death. That’s why we like all the things that we assume have no limits and, therefore, no end. It’s a way of escaping thoughts about death. We like lists because we don’t want to die.

Umberto Eco (in The Atlantic)

I’m in the middle of a deep reset. This is a time in which I’m assessing my current practices, how I spend my time, where I focus, and deciding what habits and practices I want to keep or change. Having just finished my MBA and received tenure at work, it is a natural time to take stock and reassess. We’ll call it a midlife renaissance. This is a helpful practice to do every few years or so. I don’t do it in January, to avoid the cliché of the New Year’s resolutions that are abandoned before Valentine’s Day. Without periods of reflection, it’s easy to find yourself being productive and efficient, running 90 miles an hour, only to find out you’ve been running in the wrong direction.

Your future is created by what you do today, not tomorrow.

– Robert Kiyosaki

There are three major areas I’m evaluating as part of the deep reset: Work, interpersonal, and wellness.

Let’s think about the work or career realm first. It was a running joke in my MBA class that many of us pursued the degree to help figure out what we wanted to do next. Then, in our flowing graduation robes and stylish mortarboards caps, our relatives and friends gathered to watch us walk across the stage and to ask us all the same question: What are you going to do now? – And many of us felt like we were still no closer to figuring it out. No matter how old you are, I don’t think you have to know what you want to do when you grow up. But it’s helpful to have guiding principles.

In a recent discussion with the deeply thoughtful and talented Dr. Rob Orman on his Stimulus podcast, we talked about his ‘pillars’ or key principles that mattered to him. His guiding principles are to:

• Spark joy in the lives of others.
• Be present as much as possible.
• Be of service.
• Facilitate awesomeness.

By holding up his decisions and activities to the light of those principles he is able to guide his choices and priorities. For myself, my guiding principles for my work and career are that I want to:

• Relieve suffering.
• Solve progressively more challenging and interesting problems.
• Be able to work with creativity and autonomy.
• Work with great people that I can learn from.

As long as these principles hold, I would be happy with many different potential jobs or careers. It could be relieving suffering among patients, among students, among faculty, or for clients. It doesn’t matter as much what realm I am solving problems in as long as I am able to use my strengths and abilities in interesting ways to bring creative solutions. This is the first step, to figure out what themes are most important to you. In another post, I’ll tell you more about deciding what results you want.

What are the key requirements or pillars for your work or life?

Build your own dreams, or someone will hire you to build theirs.

– Farrah Gray

How many times do we tell ourselves: I only have 5, 10, or 20 minutes free, I can’t get anything done? I frequently think about the lines from the poem If by Rudyard Kipling:

If you can fill the unforgiving minute
With 60 seconds’ worth of distance run,
Yours is the world and everything that’s in it,
And – which is more – you’ll be a man my son.

Kipling

What can possibly be done in 60 seconds? It turns out a lot of important things can be done in 60 seconds if you sprint. Quite literally, think about the fastest hundred-meter dash. The record time is 9.58 seconds. In one minute, that run could be done six times over. How many unforgiving minutes have we wiled away doing nothing of value? If we strung all the unforgiving minutes that we spend scrolling through Facebook, staring at the ceiling, or cataloging all the things that we should be doing, they would add up to hours a day. The key is being intentional about those small pieces of time instead of letting them pass or giving our attention away mindlessly to the lowest common denominator.

It is true that for complex projects that require a deep focus, we do better if we have larger time blocks. However, we can frequently get a decent chunk of work done even in smaller time blocks if we are intentional about it.

Instead of wasting those smaller increments of time, what if we used them in ways that propelled us forward? The first barrier is always in our own minds. Here are three tips to overcome the barrier and make the most of those small interstices of time.  

1. Change the narrative. Instead of continuously telling yourself it’s not worth starting anything since I only have a few minutes, change the narrative to I’m curious how much I can get done if I sprint for 10 or 20 minutes. Often, I’m surprised by how much I can fit into that time frame if I approach it with openness, curiosity, and an internal challenge. The competitive twinkle in my eye moves me forward to see what I can do like I’m racing against myself.

2. Keep a list of some tasks that can be done in 10 or 20 minutes but avoid getting sucked into excessive email. Email tends to sprawl and expand into all the time you give it. If you can, make the short tasks things that are either easy or fun. If you aren’t sure what to do when you have 5 minutes free, then you’re more likely to waste the time. If in doubt, try spending the time meditating to help clear your mind.

One of the most valuable things I do during five-minute breaks is to write down all my thoughts. This helps reduce the mental clutter and creates the clarity of a “mind like water.” This practice is particularly important the more stressed, overwhelmed, or busy your life feels. People I have worked with often describe a buzzing or cloudy sensation when all the thoughts whirring in their heads are annoying, indistinct, and sometimes toxic. Taking one or five minutes to gather all your thoughts onto paper and clear your mind helps clear so that you can concentrate better.  

3. Leave tasks as cliffhangers, so that when you come back to them you can jump right back in. I think about the concept of in medias res, a Latin phrase referring to the practice of starting a narrative in the middle of the action. At work, we frequently feel like we need ramp-up time before we can get going. Instead, jump into the task in medias res, at a sprint. Some writers recommend stopping in the middle of a chapter or even in the middle of a sentence when you’re writing so that when you come back, you’re right back in the action. You could also leave easy, low-hanging fruit. If you know you have to edit a figure, leave that work for when you just have 15 minutes free, and you can easily knock it out then, while saving your bigger chunks of time for the harder work of writing or planning.

We can never get more hours in the day, but we can gather up and live intentionally in the small pieces of time that we waste because we tell ourselves they don’t matter. So much of our lives are spent in the sum of little 5, 10, or 20- minute increments. Think about how you can create more value, peace, or mental clarity by filling those unforgiving minutes with distance run.

Walking through the sliding glass doors at 10:55pm on a Monday, I found myself wondering if it would be a good shift or a bad shift. In Emergency Medicine a “good shift” has to strike many delicate balances. It can’t be too busy, but it also can’t be too Q-Word-That-Must-Not-Be-Named. It should have some high acuity patients, but not so many that care becomes unmanageable. The staff and residents should be fun but should also work efficiently. On reflection, a “good shift” seemed to rely on many factors all of which were outside my control.

After years of feeling at the mercy of all the external factors that determined how my shift went, I realized my thinking needed to change. The philosopher William James famously said: “I don’t sing because I’m happy, I’m happy because I sing.” I needed to learn to sing. 

To understand how to create good shifts irrespective of external factors, I turned to the ancient philosophy of Stoicism. One of its core tenets is that we must focus on what is within our control.

“Happiness and freedom begin with a clear understanding of one principle: Some things are within our control, and some things are not. It is only after you have faced up to this fundamental rule and learned to distinguish between what you can and can’t control that inner tranquility and outer effectiveness become possible.”

Epictetus

Too often we ignore his admonitions and we focus our efforts on things that our outside our control while paradoxically relinquishing control of things that are within our control. Things within our control, per the Stoics, are our own thoughts, emotions, and actions. We relinquish control of them by allowing our emotions to be unduly affected by external things. “That person said something that made me upset,” or “I’m angry because I couldn’t get something I needed.” On the other hand, we try to control things that are outside our circle of control, such as other people’s actions or opinions, politics, coronavirus, or even the weather. We try to control them in our minds by resisting their presence, continuously wishing them away, or perseverating that they should be different. In order to have the inner tranquility and outer effectiveness Epictetus encouraged, we must give up the fiction that we can control things outside ourselves and maintain better control of ourselves.

Here are three practical steps:

1. Maintain agency over what you do have control over. Agency means taking rather than abdicating responsibility for your thoughts and emotions. You can also think of agency as power. If you prime individuals to feel powerful they show greater “executive functioning, optimism, creativity, authenticity, the ability to self-regulate, and performance.”(1) When you give up control of your own thoughts and feelings, you are giving up your own power. By claiming ownership over your own thoughts and feelings, you are accepting that whether you have a good shift or not is entirely up to you, not external things.

He is most powerful who has power over himself.

Seneca

2. Even out your standard deviation and raise your mean. Imagine a graph of your personal shift quality vs time. Some shifts are truly terrible. Others are fantastic. Most shifts, however, fall within 2 standard deviations of our mean. By choosing to make most shifts a ‘good’ one, it does not mean artificially trying to like the terrible shifts. Instead, it means smoothing out the variation, and raising the mean itself.

3. Change your own mind. Shifts are difficult. They often consist of an 8 or 12-hour exercise in tolerating a continuous stream of small frustrations, insults, barriers, and setbacks. The Stoics have many provocative things to say about enduring hardships. Marcus Aurelius wrote: “Ask: What is so unbearable about this situation? Why can’t you endure it? You will be embarrassed to answer.” The only way to be able to decide to have a good shift is by changing our own minds.

To bear trials with a calm mind robs misfortune of its strength and burden.

Seneca

We can change our minds by employing a practice the Stoics called meditation, which is similar to cognitive therapy.(2, 3, 4) Stoic meditation consists of becoming actively aware of one’s thoughts, analyzing them, selecting the thoughts we wish to entertain, and rejecting futile thoughts. At 2am when I am unable to get a patient a ride back to her nursing facility, the thought “I should be able to get the patient home” is futile and leads only to frustration. The thought “this should have been fixed already” is useful only if it leads us to action to fix it, but on its own is a waste of precious cognitive bandwidth.  Entertaining futile thoughts leads to a sense of learned helplessness that reduces our ability to think creatively and solve problems. 

Perhaps the most shocking of Aurelius’s statements on enduring hardships is this one:

If it’s endurable, then endure it. If it’s not endurable, then stop complaining. Your destruction will mean its end as well.

Marcus Aurelius

The ED, the challenges of providing healthcare within a broken system, and patients in need of help will be here long after each of us. We must endure the challenges while we also work to remedy the problems.

The mind adapts and converts to its own purposes the obstacle to our acting. The impediment to action advances action. What stands in the way becomes the way.

Marcus Aurelius

When we work to overcome a challenge, we gain the inner tranquility and outer effectiveness that were the things we needed most in the first place. By managing our minds, we can repurpose obstacles into opportunities to build strength.

This is my challenge to you: Maintain ownership over the things that are in your control. Choose your thoughts intentionally. Raise your mean and decide to measure the goodness of a shift not by the external circumstances you face but by your attitude in the face of those circumstances. Then, and only then, will a good shift be something you create, not something you hope for.

This article was first published on KevinMD.

The end of COVID is in sight but there are still months to go. Maybe you have been struggling with getting things done while working from home and de facto homeschooling your kids. Perhaps you’re feeling cooped up after a year of going only from your home to the grocery store and work. Or, maybe you’re chronically exhausted from the constant mental strain of the year and find yourself mindlessly surfing on your phone and avoiding the tasks you had planned to do more often. How can we persevere when our strength has been collectively sapped over the last year and our sense of grief at what has been lost will persist even when isolation and distancing are over?

To answer this, I’ve turned to three very different physicians and scientists. Here are practical ideas drawn from their wisdom, expertise, experience, and experiments for how to persevere through our current and future challenges.

1. Create meaning –  Viktor Frankl’s book, Man’s Search for Meaning, easily ranks on the list of top five life-changing books for me. In it, Frankl, an Austrian psychiatrist and holocaust survivor, explores what allowed some individuals to survive the unthinkable conditions of concentration camps without losing their humanity or giving up hope. After his liberation, he formalized his findings into a form of psychotherapy called logotherapy, from the Greek logos, or meaning/reason. He observed that when his fellow inmates were able to maintain a sense of meaning for their lives despite having been stripped of everything else: their wealth, connections, family, belongings, homes, clothing, health, and freedom, that they were able to maintain hope and their sense of self. He explains: “Logotherapy is composed of three basic principles. The first basic principle is that life has meaning in all circumstances, even despondent ones. The second principle is that the main motivational force is the desire to find meaning in life. Lastly, the third basic principle states that humanity has the freedom of attitudinal choice, even in situations of unchangeable affliction.”

Frankl articulated three main ways in which individuals create meaning for themselves even in the worst possible circumstances. Consider which one resonates most with you and how you could focus your energy on creating more meaning in that area.

i) Creative. This is through creating new things, whether it’s writing, or creating new online content, or creating new programs, or designing new ways of teaching, new care delivery models, or new protocols.  

ii) Experiential. He talks about how one evening in one of the camps, there was a beautiful sunset and the inmates called to each other to come outside and see it. They were able to find meaning through the experience of beauty in that moment even with all the horror going on around them. Experiential meaning can come from the experience of beauty in nature, music, art, or in the experience of inter-personal relationships and connections.

iii) Attitudinal. I think of this as the warrior mindset. You find meaning through being brave. You find meaning through courage, through the attitudes that you display, and the person that you are in the face of challenges.

So reflect on this: How do you find meaning in your life? When we don’t have meaning in our lives, we have an existential vacuum. Just like in physics, vacuums quickly get filled up. We tend to fill up our existential vacuum with other things: distractions, easy work, mindless entertainment, or unneeded food or alcohol.

We can create meaning even in the worst circumstances by bearing witness to our uniquely human potential.

We must never forget that we may also find meaning in life even when confronted with a hopeless situation, when facing a fate that cannot be changed. For what then matters is to bear witness to the uniquely human potential at its best, which is to transform a personal tragedy into a triumph, to turn one’s predicament into a human achievement. When we are no longer able to change a situation… we are challenged to change ourselves.

Viktor frankl

2. Combat ego-depletion. It takes energy to create meaning, to turn our tendencies towards despair and inaction into hope and action. It also takes energy to do difficult things. When you’re on a diet, have you noticed how you may be able to have a small, healthy breakfast and lunch, but then after dinner you have no willpower left and you indulge in ice-cream, brownies, wine, and Netflix? The reason for that, the psychology literature tells us, is because we have a finite amount of willpower.

Roy Baumeister has written many of the articles on the topic, and they’re summarized well in his book, Willpower: Rediscovering the Greatest Human Strength. The experiments show that when we exert willpower in one area, whether that’s at work or dealing with children’s school at home, it drains the willpower we have available to us for all other areas. I think of it like a pitcher. You have a finite amount of willpower, and as you use it, you’re pouring it out. By the end of the day, you’re in a state called ‘ego-depletion’. Your willpower pitcher is empty. In that state you both feel temptations more keenly and you have less ability to resist them. So, you indulge, collapse in bed, and vow to do better the next day, only to repeat the cycle.

To break the cycle of constant, complete ego-depletion, first, understand and notice what depletes and what restores your willpower pitcher. Resisting temptations depletes willpower. Removing temptations from your notice can preserve your willpower. For me, this means turning off notifications on my computer when I’m working so that I’m not tempted by their easy distractions. I turn off my phone or watch while working. I put the cookies in the pantry, so I’m not tempted by them. All of these small actions reduce my willpower expenditures throughout the day.

You also have to restore your willpower pitcher. That means taking time to do things that bring you joy. For me, exercising, being outside, connecting with friends, baking with my kids, or reading a good book restore my willpower. Self-care is not about mindless or selfish “ME-TIME,” it’s about meaningfully restoring your sense of self and your ability to continue to do difficult things.

3. Connect – One of the cruelest aspects of COVID is that it hamstrung our ability to cope with difficulties by isolating us from the very friends and family we usually lean on for support. It amplified and exacerbated the sense of loneliness and isolation that was already rampant. Prior to COVID about half of Americans reporting feeling lonely. Loneliness leads to worse performance at work, with 16% lower profits, 37% higher absenteeism, and 49% more accidents. In addition, the health effects of loneliness are staggering, with 30% higher rates of coronary artery disease, and negative effects on longevity that are equivalent to or worse than those caused obesity, drinking, or smoking.

I found that people who struggle with loneliness, that that’s associated with an increased risk of heart disease, dementia, depression, anxiety, sleep disturbances and even premature death.

Vivek murthy to npr

Vivek Murthy, the former and current surgeon general, wrote a timely book about the importance of connection, called Together: The Healing Power of Human Connection in a Sometimes Lonely World, released presciently in April 2020. In it he explains the importance of creating connection to our health and ability to thrive and overcome challenges. He argues that loneliness undergirds many of our current public health crises, such as alcohol and drug addiction, violence, depression, and anxiety. Often there is a sense of shame around loneliness. We avoid admitting to others and to ourselves that we are lonely because we thank that could mean we are unlikable or deficient. Instead, think of that feeling of loneliness as an indicator light reminding you to ‘refill your tank’ and spend more time meaningfully with others.

To combat loneliness and create connections, Murthy exhorts individuals to spend time with others each day in a meaningful way, giving them your full attention rather than trying to multi-task or scroll on your phone. He also encourages us to create connections through service to others and to understand ourselves better through intentional time in solitude or meditation.

Think about your own life. How much of an existential vacuum do you feel? How can you instead create more meaning? Do you feel constantly drained and in a state of ego-depletion? How can you protect and preserve your willpower and also refill your pitcher more frequently? How isolated or lonely have you felt? Where can you connect meaningfully with others through your work, home, or service?

We persevere better together. Join me, on a quest to constantly create more meaning, restore our sense of self, and foster intentional connections.

A version of this post was first published here on the medical blog, KevinMD.