"Never put off until tomorrow what you can do the day after tomorrow."
As I have yet to have a typical day, I’ve decided to simply pick today and track where it takes me:
6:45—Out the door. I have a 20—30-minute commute to work, which lets me consider the day’s tasks, watch the sunrise advance across the plains, and remind myself that New Mexico is a beautiful place.
7:15—At my office in the department of psychiatry. I awaken my computer, review my schedule and to-do list, scan my emails, curse the spammers, answer e-mails that need an immediate response, and check a few websites that I routinely monitor. An e-mail from the New England Journal of Medicine lists the contents of the latest issue. I notice an article on childhood obesity, so I download it and forward it to a division colleague conducting research in that area; I also drag a copy to my transfer-to-tablet PC folder for later reading (my tablet PC is, among other things, an electronic file cabinet full of readings, reference documents, and works in progress, saving me from carrying around piles of paper). I take a quick run through the accumulation of papers on my desk from recent meetings and mailings. I find something I want to add to my CV, so I do so. I transfer a few other items from the stack to my to-do list.
7:40—It occurs to me that it would be useful to review the preceding batch of "Day in the Life" essays from Academic Psychiatry, so I download them for later review. These also go to my tablet PC.
7:46—I’m scheduled to attend a meeting of the Bernalillo County Democratic Party this evening, featuring a panel discussion "regarding the University of New Mexico (UNM) Hospital and the current care provided to indigent and underserved families." In preparation, I visit several websites to review information on public sector health care in New Mexico and to obtain current data on UNM’s (substantial) programs and efforts. The Internet is a blessing.
8:00—OK, actually 08:15, since I spent 15 minutes looking at other interesting websites that I ran across during the above Web surfing. The Internet is a curse. The next half-hour is devoted to reviewing and revising our child/adolescent psychiatry fellowship orientation manual, in preparation for our July orientation.
8:40—Coffee break and a lap around the department to say good morning to colleagues. Very important.
8:45—I have a patient at 09:00, so there’s too little time to pick up a big project, but too much time to stare out the window and meditate on life. So, I pull the file on one of our second-year child fellows and scan it preparatory to writing a letter of reference. Also time for another pass through my e-mail inbox.
9:00—I meet with an adolescent patient; it is good to be a clinician for an hour. When I began to move into administration, I promised myself I would continue to see patients, because seeing patients is the core of being a physician. More mundanely (but importantly) seeing patients also gives me valuable firsthand experience with the infrastructure supporting (or confronting) our medical staff’s clinical efforts—billing, scheduling, medical records, utilization review, and such.
9:45—I return a call from the mother of another patient.
10:00—Children’s Psychiatric Center Clinical Leadership team meeting. This is a biweekly meeting of the leaders of the division and its clinical programs. We each bring a list of accumulated items to the meeting, so it is almost always a busy and productive time. Knowing we have this meeting on our schedules saves us from having to track each other down as often.
11:00—The associate dean for clinical affairs (ACDA) calls about a patient in the emergency room. The patient has presented with a complex mix of medical, psychiatric, ethical, and legal issues. I walk over to the ER to see if I can help sort things out.
12:30—I pick up lunch on the way back from the ER and eat at my desk while I search online databases and my hard drive (Google Desktop is good) for several classic articles on leadership and organizational functioning, in preparation for a child psychiatry seminar I’m teaching on administration and practice management. While I’m thinking of seminars, I check the schedule for my developmental psychopathology seminar to verify that the next session’s presenter is scheduled and all arrangements are in place.
13:15—The division manager and I meet to plan the upcoming department graduation ceremonies. As division training director, I’m responsible for the division’s part. Afterward, I go down the hall to coordinate with the general psychiatry residency folks.
14:00—I walk over to Clinical Affairs (across the plaza to another building). I return a call from the medical director of a local affiliated program about a credentialing issue. Our director of provider credentialing and I meet to review credentialing matters for next week’s Medical Executive Committee meeting; we also review two fast-track medical staff applications.
15:00—I meet with the ADCA and the medical director for quality management. We discuss implementation of new Joint Commission on Accreditation of Healthcare Organizations (JCAHO) regulations, quality management projects, the patient safety net computerized incident reporting system, and possible changes to our risk management review process.
16:00—Back to the Department of Psychiatry, where I write the letter of reference I’d mentioned above, order two books from an online bookstore, and select an article to hand out to the child psychiatry fellows at my next clinic.
16:30—I have a great time meeting with one of our child psychiatry fellowship graduates. She’s currently a research fellow at the National Institute of Mental Health (NIMH), and is in town coordinating a research project with our MIND Institute. We talk about her research, her career development, and the scarcity of green chile in Rockville, Maryland.
17:30—I finish my patient charting from this morning, make another pass through the emails, and get ready for the next meeting.
17:55—I walk across the street to the Law School to attend the aforementioned Bernalillo County Democratic Party panel presentation about UNM Hospitals. The discussion is … impassioned.
20:00—I call the ADCA and review the preceding meeting. I decide it is time to go home, so writing up my impressions of the meeting will have to wait until tomorrow.
20:45—Arrive home (later than usual)
What do I note when reviewing this log of the days’ activities? Several things:
1. I remember why I try to limit my scheduled appointments to no more than 5—6 hours per day. Emerging issues and urgencies are frequent in my jobs, and if I do not preserve room and flexibility to accommodate them I end up having to cancel meetings. I remain mindful of my active projects (such as the above-mentioned preparations for orientation and graduation), especially the next action needed to move them along, so any ‘unfilled’ hours are readily filled with work on these projects.
2. I’m reminded how technology enhances my capabilities (despite the occasional frustrations with software conflicts or website downtimes). Cell phone, PDA, USB key, tablet PC, desktop PC, e-mail subscriptions and listservs, online databases and journals, the Internet—such things are tremendous assets.
3. Standing meetings of people who always have business with one another are very useful, especially when the agenda includes sufficient room for whatever we might bring to the meetings.
4. Face-to-face contact is vital—not just for communication and coordination, but because life is all about people, and being with one another is essential for sanity, perspective, and support.
5. What needs to be done is always greater than the available time in which to do it. Prioritizing is always a challenge, and priorities are always changing. Inflexibility is deadly. As a corollary, the workday rarely reaches a clear-cut end. At some point, it is simply time to go home. And now it is time to e-mail this …
Dr. Bailey is Attending Child/Adolescent Psychiatrist, Director of Training, Division of Child/Adolescent Psychiatry, Assistant Dean for Clinical Affairs, University of New Mexico Health Sciences Center, Albuquerque, NM.