"The Efficient MD" Offers Practice Tips and Tools

Nicholas Genes, MD, PhD

Disclosures

September 11, 2007

Dr. Joshua Schwimmer is a busy New York City nephrologist. He's also a researcher, amateur photographer, father, and prolific blogger (he was profiled in this column before). How has he accomplished so much? He shares his secrets on his Web site, The Efficient MD, and he also took the time to speak with me about some of his sources and methods.

Dr. Genes: Why have you started writing this blog? Why "The Efficient MD"?

Dr. Schwimmer: The Efficient MD is the third blog I've written, and each serves a slightly different purpose. The first is Kidney Notes, an informal collection of interesting links related to medicine and technology. The second is Tech Medicine, a more in-depth exploration of technological issues of interest to healthcare professionals and nonprofessionals alike. While writing Kidney Notes and Tech Medicine, I also became interested in innovative ways of learning and helping physicians improve their efficiency to better care for patients. Putting my notes on personal productivity in one place seemed like a good idea, and Efficient MD became the third blog. To be clear: I'm not "The Efficient MD." That's just an ideal, and I need as much help as anybody.

The Efficient MD hosts Grand Rounds
September 11, 2007

Dr. Genes: I think some people might view "efficient blogging" as an oxymoron, because blogging has a reputation (in some circles!) of being something of a time waster. Why blog?

Dr. Schwimmer: Good question. At some point, every blogger (who isn't making a living blogging) probably asks themselves, "Why the hell am I doing this? Is it really worth my time?" The way I see it, writing a blog is like having a dog. It takes energy and time and constant attention, but if it's your thing, the rewards can be enormous and intangible.

In my case, blogging has made me a more efficient writer. It's introduced me to a variety of opinions, ideas, and people that I might not have otherwise encountered. And it's provided me with some unusual opportunities, like being featured in the Google Annual Report; appearing on a conference panel about the future of healthcare with physician executives from Microsoft and IBM; and, of course, being interviewed here.

Blogs are also a remarkably efficient tool for recording your thoughts and sharing them. What doctor doesn't have advice and reference material they'd like to share with friends, colleagues, current or potential patients, or their future self at some later date? Blogs are one way of making this easier. And in a few years, why shouldn't inexpensive mobile phones or PDAs have evolved to the point where blogging -- that is, the mobile sharing of information and media with small or large groups -- is second nature to most people?

Dr. Genes: Regarding efficiency, don't most healthcare providers pick up efficiency tricks in the process of their training? In other words, couldn't you say that all MDs are pretty efficient?

Dr. Schwimmer: Sure. Given the vast amounts of information most healthcare providers need to absorb and process, no provider would be able to get through their day without using some clever tricks to improve efficiency. But in my experience, most doctors come up with these tricks only in order to survive. On rare occasions do people step back and look at systems of practice in order to improve them. Harold Barrows, in Developing Clinical Problem-Solving Skills , calls this "metacognition." Barrows' book in particular I recommend highly to medical students and to anyone interested in thinking more deeply about the way they think about patients and their problems.

Just as physicians devote their careers to taking care of patients, other professionals devote their careers to helping people work better. If you listen, they can provide lots of useful advice. For example, I know many physicians who are undeniably brilliant but whose desks are a mess of papers, lab reports, and charts. Things get lost. They can't find anything, and it definitely reduces their efficiency. There's a simple device that can solve this problem called an inbox. But using inboxes properly is not as intuitive as you might think. It seems so simple, and it doesn't seem like it's something you need to be taught to use. As a result, many people don't use inboxes, or don't use them well.

The one book that might provide physicians with the biggest benefit in the shortest time is The Successful Physician by Marshall Zaslove. It's a wealth of tips and advice for improving clinical practice. Another book I recommend is Getting Things Done (GTD) by David Allen. GTD is a method that I personally find useful. It involves collecting undefined items, processing them to figure out what needs to be done, then organizing the "next actions" to be taken into contextual lists. (I provided a "mindmap" of the GTD system on my blog.) Using the methods in books like The Successful Physician and Getting Things Done can potentially help healthcare providers be more productive in half the time. I'm not exaggerating.

Dr. Genes: Join Dr. Joshua Schwimmer this week as he methodically organizes the best of the medical blogging world into the weekly Grand Rounds, hosted this week at the Efficient MD. Check it out -- it's time well spent.

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