For Teachers & Professionals

Time management to address Sexual concerns

Time management is a constant personal and professional challenge for physicians. Duty to the patient is a unique professional responsibility that regularly challenges physician time management. The duty of patient care and the unpredictability of work given interruptions, unforeseen patient-care-management changes, emotional and physical fatigue, and erratic schedules or work duties, may not be entirely controllable or changeable. Undergraduate and graduate medical education curricula do not consistently incorporate physician time-management skills. Young doctors frequently neglect individual time allocation and task prioritization, thus, they develop poor time-management habits that ultimately lead to increased stress and decreased productivity.  

If one thinks about medical practice and time management, the associations that come to mind are rush, stress, lateness, alarm and other negative images. Medical practice is achievement-oriented, practice is what is productive and immediately necessary. Trainees may fail to identify individual limits, ultimately increasing stress and diminishing productivity.

Time management is often reported as a reason to avoid sexual-health-related topics. It may be just an excuse to overcome the embarrassment of talking about it, or it may be the reality of the clinical setting. Learning strategies to manage time may solve part of the issues related to it.

So how can time be managed? Through a process called managing workflows. It assumes a set of behaviours that start with ideas and result in a finished product. Good workflow management incorporates several elements: setting prioritized goals; effectively allocating time; respecting cognitive limits.

General time management rules:

1. Identify goals, values and priorities

Use physical support to collect all items, like deadlines, projects, tasks, and ideas. Use functional, organized and readily accessible tools like calendars or to-do lists. Having a system upon which one can trust, releases the stress of bearing in mind multiple elements of: ‘what have you forgotten?’ or ‘what do you have to do?’, leaving more energy to dispense on effectively doing things.

Prioritize basing the task on two parameters: importance and urgency.

2. Manage the workflow and allocate time

Once you have the items written, process them. Break down projects into component tasks and allocate time. Take the time to review if you need to re-prioritize something. 

Increasing physicians’ control over their schedules can allow more flexibility to meet patient needs. This will also enhance physicians’ sense of autonomy and control over their work environment and is likely to improve physicians’ motivation, morale, and satisfaction. Specific strategies might include appointment slots of variable lengths, blocks of time for patient care rather than assigning a specific appointment time to each patient, and building into the schedule “catch-up” time and time for same-day appointments. A system to minimize the visit “no-show” rate will reduce physician “down-time” 

A specific time management rule in individual patient encounters is to improve the physician’s communication skills. Although it may at first seem that an approach that emphasizes physicians listening and asking open-ended questions would require more time, it has been found that this is not the case if physicians follow specific strategies:

1. Set an agenda early in the visit

This helps avoid late arising concerns that may be the most important issues to the patient (“by the way, I’ve been having these chest pains”). By not interrupting the patient’s opening statement, and by using facilitating comments (e.g., “is there anything else” or “uh-huh”), rather than immediately pursuing details of individual symptoms, the physician will have a better opportunity to discover the full range of patient concerns. This process rarely takes more than 2 to 3 minutes.

2. Listening actively to the patient’s story

In his or her own terms rather than attempting to control the interview. This facilitates assessing the patient’s emotional agenda. The use of continuers and open-ended questions rather than closed-ended questions helps establish symptom content and emotional context. Paying attention to the emotional agenda presented by the patient leads to enhanced opportunities to support and encourage the patient.

3. Use empathic statements

Phrases like “You’re really feeling overwhelmed by these problems” and legitimizing statements like “It must be upsetting to have these problems” are useful in order to assist the therapeutic support of the patient. Solicit patient attribution. This helps manage uncertainty without wasting time. Ask the patient “what do you think is going on,” or use other statements to solicit the patient’s viewpoint. This also allows for a better understanding of how much uncertainty in the diagnosis of a symptom is acceptable to a patient and a more direct assessment of the patient’s true concern (“does this abdominal pain mean that I have cancer?”). Take advantage of the patient’s personal knowledge developed through continuity in the relationship.

4. Establish an agreement

There must be agreement on the goals of individual visits and medical care. This can be done by involving patients in their care.

5. Use the team approach

A team approach may help manage a physician’s time more effectively. This strategy involves the efficient use of support staff to manage time and competencies more effectively.

REFERENCES

Dugdale, D. C., Epstein, R., & Pantilat, S. Z. (1999). Time and the patient-physician relationship. Journal of general internal medicine, 14, S34.  Pitre C, Pettit K, Ladd L, Chisholm C, Welch JL. (2018). Physician Time Management. MedEdPORTAL.;14:10681. https://doi.org/10.15766/mep_2374-8265.10681