S3E10: Managing Time, Energy, and Attention (feat. Nina Kim MD, MSc)
Brooke:
Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.
We are your hosts Rahul Anand, Maya Doyle, Peter Longley, and Brooklynn Weber.
Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.
Brooke:
Hi everyone. Welcome back to Learning to Lead. Joining us today is Dr. Nina Kim. Dr. Kim is a professor of medicine in the division of Allergy and Infectious Disease and an adjunct professor of health systems and population health at the University of Washington. She works at the Liver Clinic and Madison HIV clinic at Harborview Medical Center. Seattle's largest safety net hospital and conducts health services research using the electronic health record. Dr. Kim currently leads the translational research sub core of the UDub, Fred Hutch Center for AIDS Research and co-chairs, the Liver Working Group of the North America AIDS Cohort Collaboration. She's also the associate editor for the UDub Hepatitis B and C online, A CDC sponsored web-based curriculum. She also serves as a faculty for the Infectious Diseases Society of America's Leadership Institute, where she teaches sessions on managing time, energy, and attention. Today she's joining us to share her insight on how to better manage all three of these. Welcome, Nina. We're so excited to have you here with us today.
Nina:
Thanks so much, Brooke. Yeah, happy to be here.
Brooke:
And also with me today is Rahul.
Rahul:
Hi.
Brooke:
And Pete.
Pete:
Hello.
Brooke:
Alright, so to get started, Nina, can you tell us a little bit more about yourself and how you got interested in the area of managing time, energy, and attention?
Nina:
Yeah, so we all have these different roles in our UDub academic universe and I am a clinician scholar, so I spend half my time teaching and seeing patients in the clinic setting a little bit of my time in the inpatient setting. And then the other time is spent on scholarly activities, which include running a data core that helps people as you noted with the electronic health record and learning from that. But one of my side interests that's merged over the last decade has actually been in the space of time management or productivity as it were, but not typically as people know it, which is how do you get as much done as you can in the time that you have. That's not exactly the kind of productivity that I espouse, but yeah, how I came into this work is that there was a point in my life where my life appeared to be going well on paper and I was publishing papers, which is kind of the metric of success in academia, but I felt like I was spinning my wheels, I was putting a lot of effort or activity and still feeling kind of unfulfilled or unproductive kind of feeling stuck how the car's wheels are spinning uselessly in the Mudder sand.
I felt a little bit like that but still in motion, which is kind of this weird paradox. And at that point I had realized, it dawned on me that I hadn't taken vacation for a few years. I dunno how that happened, but that was essentially the hamster wheel that I was on. I was not quite burnout but close and I was having a lot of mental fatigue from that. There was a bit of kind of low grade chronic stress and anxiety and just not having difficulty concentrating or making decisions and feeling busy, but not really feeling like I was really making any progress or finding joy. And so it was around that time I actually read a book called Essentialism by Greg McKeon where it really took this idea of productivity not being, how many tasks can you cram into your day, but how do we put intentionality into how we spend our time? How do we harness the time, energy, and tension we have which are all finite resources for maximal impact, meaning and joy, whatever you want to say without really losing your mind or your health. So that's really how I came to this work. And I guess I would say that I'm not an expert, by all means, this is still a learning process for me, but I've read up a lot about it. So I'm very much a student in this space.
Brooke:
Wow, that's amazing. Thank you so much. I definitely agree that I think a lot of us that are in this field have that sort of rat wheel race. How much can we get done without really stopping and taking in what we're doing? So I think that's so great and I think that you're going to have a lot of amazing points to share today.
Nina:
I was curious, so in this space particularly, we were chatting earlier about how you were feeling a little bit of the weight of being a medical student right now, and I was wondering if you would care to share some pain points about your experience and things that you're wondering about?
Brooke:
Yeah, definitely. I think one of the biggest pain points for me, and I think a lot of my fellow classmates is this feeling that we don't have any time for anything. I think how you mentioned that rat wheel, that's really how it feels for us. I think it's hard as a medical student to know where to put our time and energy because with schools, our school specifically has moved to a pass fail curriculum and then also step one has moved to a pass fail. And so when it's these pass fails, it's harder I know for residencies to compare us all to each other. And so because of that we have to do lots of extracurriculars on top of just school. And so it can be really difficult trying to manage all these, the outside things like the research, volunteering, running interest groups and committees. And because we're doing so many outside things, it can often feel like we don't even have time to study, which is one of the biggest reasons that we're even here in medical school.
Nina:
Yeah, that's so interesting. I think what you just described embodies really well this concept in our society, and I think medicine is no exception to this, which is busyness as a badge of honor, which is that more, is that a symbol of how great or how successful you are as how many different things you're doing? And it's more about quantity and I guess what I would push back against is maybe we need to really step back and think about depth and quality of what we're doing. I don't know Raul or Pete, if you wanted to share aspects of that in your own work life or life in general.
Rahul:
Thank you. This is Rahul. What Brooke's saying resonates with me. I think it starts in school, what are you doing extracurricularly? And we know that more than half of medical students actually join medical school already burned out. Forget about burnout in healthcare. 60% are already burnt out when they join. And the same thing I'm hearing from Brooke, like doing extracurriculars to differentiate yourself. And it's the same as a resident because you're looking at a fellowship and you're again trying to differentiate yourself as a junior attending again the same thing because trying to go above and beyond so that you can rise up and have a leadership position. So it seems to me that the hamster wheel that Nina has described begins very early on and it doesn't stop. And I am totally in tune with that, that if you can do a few things better, one of the things Nina taught me from her great webinar was prioritizing if you can put your top three priorities of the day on your board or your list to begin the day, and over time I've recognized that I achieved maybe one or two of them by the way, not even three, then even then your day is just so much better rather than having a long list of two dos, which none of them, you're doing very well.
And the other thing I've learned from Nina is I'm reminded of so many projects that I took up as a resident or as an infectious disease fellow that never were seen fully to completion or if they were completed, they weren't published. And it's because my heart was not in them. And so if you can do a few things that you really care about and do them well, I think again, even from an effectiveness perspective, it distinguishes you so much better.
Petel:
Yeah, I totally agree. I've learned you grow up in society and it's do you keep, keep running on this hamster wheel and then you get to a point where you're just like, what am I doing? Where am I going? Is this really my goals and my life? Am I driving right? You get to that point and I've gotten there and now I'm trying to, I blocked my time and I try to be very intentional. I'm trying to learn how to say no a lot more often, but it's hard, right? I'm in nursing for a reason, I'm a people pleaser, so I'm a rehabbing people pleaser, I guess.
Nina:
I think we all are to some extent. I think this is the myth, the seemingly happy, productive person is the person getting all sorts of things done. But it's a myth that many of us live by, yes, I can do it all or yes, I have to do everything that comes my way. And inherent is that is what I wanted to pull out from what Pete was saying is that we end up saying yes to a lot of things that some of which we really probably should be saying no to. So setting some boundaries. And I think setting boundaries is similar to setting priorities, which is really the idea that what I'm prioritizing is my time and energy. And the idea, and this is a point that Greg McCune makes in his essentialism book, is that if you don't prioritize your life, someone else will.
So when we say yes to a lot of people, what we're doing is we're handing the reins over to other people or other expectations. So that's the other thing is I think some of what Brooke was talking about is all these external or internalized expectations about what you should do as a medical student in order to get to the next rung residency. And that's a conversation that I think we have to have even within our discipline and space, which is that really true? Is that really because I think it is, as we pointed out, a road to burnout.
Rahul:
This is Rahul again. It's making me think of one thing. The next time I interview someone, I'm going to not look at how many things they did, but really look at what they learned from what they did.
Brooke:
I think that's super important because even if you could do something for a short time, but if you take something really, really valuable away, that can be really meaningful. And so Nina, going off that, what do you think is the way that we can manage our time better?
Nina:
Yeah, so I think the big part of this is part of not getting swept up in the wave of doing as many things as humanly possible because none of us can really do that. There are lots of tools out there to kind of think about the tasks that come your way. One of the things I mentioned in the webinar Raul mentioned is a priority quadrant where you say, okay, this is important and urgent, this is important but not urgent. That kind of thing is what am I doing and how can I either delegate or drop? A lot of us don't spend a lot of time delegating or dropping and we spread our attention quite thin. The other point I actually wanted to make too, which compounds some of the busyness that is thrown our way, is really the fact that we live in a knowledge-based society.
Most of us work in front of computers and we've got, our world is full of digital distractions, phone notifications for social media, web browsing, and it's a real assault on our ability to focus our attention than ever before. And there was one study that found that an average knowledge worker and we're all knowledge workers, spent more than 60% of the workweek engaged in really just electronic communication or internet searching with maybe 30% dedicated to actually reading and answering emails alone, which is so, I mean I could say that that's certainly true for me on some weeks, but I want us to sit and absorb this fact that so many of us are spending nearly a third of our time not really creating as much as shifting information around. And I was curious if that describes you on certain weeks or days.
Brooke:
That definitely does describe me. I was just thinking when you were saying that about how usually when I'm finished with the mandatory stuff of the day, the first thing I do is for at least about an hour, I have respond to emails and look through my emails and take care of all those little things. So I definitely spend a lot of time just what you're saying, organizing information.
Nina:
Yeah. So I think a huge part of being intentional with your time is really looking at that kind of shallow work draining those shallows. Just really think about sort of curating that time a bit and not getting sucked in. And so I still struggle with this, but I really try to check email maybe twice a day. Most of the time I fail this constant pull like, oh, I might miss something important. But it's really important to understand that these digital platforms are designed to really draw our attention away, and these tools have sort of commandeered our attention in ways that are not helpful to us and the things we want to pursue and our values. So that's one of the things I try to do is I really look and see how I'm actually spending my time and figuring out ways that I can grab time back.
Rahul:
And I want to bring in the concept of energy as well, just see what you think of it. Because time sometimes is in our locus of control, but sometimes it's not. We're just on the schedule and we need to do what we need to do. So managing our energy and attention is more in our locus of control and it can help us use the time better so that we're actually multiplying it and not coming out with a net negative. So as I was thinking through this, there were three points about energy that I was thinking, which we can just define as the capacity to do work. One is that there's many things that affect our energy, four of them being. So one is physical energy where it's like what are we eating, exercise, sleep, so that we are not physically burning out. The other is emotional energy, which is affected by our own emotional states and our social connections.
The third is mental energy. That's our mindset and self-talk. How are we talking to ourselves? And as you mentioned, distraction that sucks away our attention and energy versus play or recreation, which gives us energy and fourthly, spiritual, which is what's powering us purpose or something that's greater than ourselves. So that's the first concept that I thought of. What all impacts our energy. The second is there's certain people or even placer activities that give us energy, which my friend Beth Freddy's from Harvard, she calls these people lilies and others that drain our energies and she calls them leeches. And we need to again, be more aware of who's giving us energy versus who's draining our energy or putting us on the path to burnout, whether it's burning out from doing an activity or burning out from dealing with a difficult situation. And the third thing, I think this is what I picked up from your talk, is that energy is not always this always on because as you said, if we are always on, then that cortisol really does burn us out.
But just knowing when are our times of energy where it's really high. For me it's the mornings and where are times where it's lower and where we need to put work away. It's not going to be productive and we just need recharge or rest. And I think the way it comes together for the best leaders I've seen is in this energy or presence you can feel with them. I can recall a meeting with Bennett Lorber who was the chief of ID at temple in Philadelphia at that time. And I think we spent three minutes together probably, but I could feel as if time had expanded and he was really listening to me and had so much affection and appreciation for our time together and giving me advice. And that moment all his time, energy, and attention had come together for taking care of me. And I could feel that time was very different. I can still recall it very vividly. And then on the opposite side, of course, we can spend time and energy on something without paying attention. I'm with my kids and I'm on my phone and they will constantly remind me, you're not really here. And now I have given a negative valence to that time in my life. So I was putting some thoughts and energy together and just curious how you see the intersection of energy and time and how you manage that.
Nina:
Yeah. Well, I love some of the descriptions. I'll take apart some of the concepts you shared, which is, and I love the fact that you were describing, well the situation with your mentor at Temple who was giving you in some ways undivided attention and creating in that moment a sense of expanded time and our connections with people when we have those kinds of moments with, as you call our lilies, it really does have this way of giving us energy. So I think community, making sure you're spending time with family or people who really support you and are there and care about you have a real way of recharging our energy reserves. I know that that's certainly true for me. And to be really intentional about that, I think when we get busy, we lose track of what fuels our tank as it were. So I love that. I love that concept of someone giving you attention, actually providing energy for you.
Brooke:
Yeah, I would also, based off what Rahul and Nina said, I think I've actually really felt the effects of being around people that feel your energy as well because, and I didn't even really realize it at first until afterwards, but living so far away from my family and not seeing them and then just being around people that are only ever talking about medicine and medical school. And so that's the only thing ever in my head. But then when I get to go home on breaks and see my family, I kind of see that there's this life outside of this life that my head is always trapped in. And then being around them I feel, bring me back to life a little bit.
Nina:
Yeah, I think we have mean as a society in general, I will just reflect on the fact that we don't really emphasize the value of rest, and I think our brains really need rest. I mean really, I feel like some of the best ideas I've ever had, especially creatively if I'm mulling over a project or problem happened when I was resting, when I wasn't sort of like, ooh, in the grips of thinking about it, it was when I stepped back and gained some perspective and sort of taking a break allowed me to take the blinders off as it were and have more of an expanded view on what I was thinking about or yeah, I think I just find that really interesting from a neurocognitive level. So there is huge value and rest in ways in recharging and certainly performance athletes know this and I don't know why we don't practice that or really be intentional about that because I think we can really benefit from it.
Pete:
Nina, what that brings up for me is the blue zones. If you really look at it, they're not in stressful environments and they take naps in the middle of the day and they try to eat healthily and companionship and all that, but the thing I'm taking away is they do rest and it's not like they're on the go when their eyes are open until they pass out.
Nina:
Yeah, there's an aspect of self-care that's built in to what they do was so important. One thing I wanted to bring up just as a question is we're talking in the subject of managing our attention and focus is really how do you deal with procrastination? So that's something that I think all of us struggle with and it can be a barrier for us making effective use of our time. And just wanted to bring that up as a topic and curious about when you find that that happens and what you think is at the root of that.
Pete:
I think I'll go first. I've been noticing it lately and I'll call it out. I'll be like, what am I procrastinating for? And it will be like, it's a task I don't want to do, or if I get into it, it's going to take me a longer time or those are my expectations. Sometimes though it goes quicker, but I've just been calling myself out, I guess, and saying, alright, because when I work from home, I'll be like, all right, I'll got to go empty the trash, or I got to go empty the dishwasher or do something besides do work. And I'll be like, what am I doing? I'm supposed to be, and that's part of it I'm supposed to be, but I have work to do, so why don't I get to work? So I've been just keeping myself honest.
Brooke:
Yeah, I would definitely echo that I was, because start with something very similar. I was going to say things that I don't want to do or things that I think are going to take a long time. And then something that I was also thinking about is because of those two things, I think a lot of times, whatever it is that I'm procrastinating, I work it up in my head a lot where I'm like, oh, this is going to be this huge big thing. And then that pushes me further away from doing it. And then what I've noticed is that once I do it, I feel really good. I'm like, oh, that wasn't actually as bad as I thought it was going to be. And I feel like that's such a theme for me. But yeah,
Rahul:
I echo what Brooke's saying that if there's a big task, then I'm more likely to get distracted into something that's easy, like an easy dopamine hit, checking some game scores, et cetera. And so breaking the task down into smaller chunks definitely is helpful. The other thing I'm going to offer is a defense of procrastination. And I first heard this from Adam Grand from Wharton, which is clearer to me after learning design thinking, which is that we do operate in these two phases. One is exploration where we do open up the funnel and take our time to explore the idea, talk to people, get perspectives. We're looking for information and perspectives. And then there is the second phase where we have to converge and make a decision. So sometimes waiting while one is intentionally gathering information is helpful, and the creative people will do this more where they will wait longer and then they will close the funnel very quickly into making decisions.
But when it has to be very intentional, and if you're working in a team, you have to guide the process almost because others don't know what you're doing. And they may see it as procrastination, but there is a method to your madness at times. And then I think the other thing, what Pete brought up happens to me as well, which is where I clearly know what needs to be done. I have the information and there is my immunity kicking in, or you can call it my fixed mindset or whatever. And there I have to either coach myself and just begin. The hardest part sometimes for me is to begin the first step and then the rest happens. Or it may be for somebody else, they may need an external coach to hold them accountable or a partner. A lot of companies and projects have co-chairs or co-founders for that reason that they're helping keep each other accountable and getting through roadblocks. So I think those are some of the perspectives that I have.
Nina:
Yeah, no, that's great. And I'm glad you pointed out that sometimes procrastination is intentional and it's part of the creative process and maybe a form of absorbing and resting your brain or exploration as it were. But a lot of times though, I think procrastination is actually inherent or embedded in that is as Pete and Brooke mentioned, like task aversion, basically you think the task is kind of big and nebulous or has some difficulty and it's sort of triggering this avoidance. And I also want to acknowledge particularly in our, many of us are kind of type A personalities, there might be a fear of failure or judgment or not doing it exactly right when ultimately you want to just get started and just lower that barrier to getting started. And Rahul mentioned this concept of just breaking down the task into smaller chunks. So maybe you're not going to sit down and write the whole paper, but if I can just at least jot down my thoughts on the intro or sketch out a rough outline, it starts getting you on your way to doing the work. So yeah, that was just something I wanted to bring up because it is something that some people really struggle with.
Rahul:
We have an activity in our course, the building the marshmallow tower, and what happens at the end of 18 minutes is that people haven't put the marshmallow on top and they will in the last 15 seconds and instead of being a great tower, it all comes crashing down. And I think the students love it because it drives home the point to them that you just have to put the first set of sticks in the marshmallow together, build a prototype and get started, and not worry about it being the perfect choice. And especially I think in healthcare, especially physicians, I think finding the single best answer from a set of multiple choices is drilled in because of the multiple choice question system, and they will tend to, the world falls apart when a question doesn't have one correct answer and that hold you back in these situations where life doesn't have a correct answer. There's just like you try things and you learn or with one versus the other.
Nina:
Yeah. So I was curious, Brooke, if you had other questions around some of this area. I'm kind of thinking about some of what you were saying about the sense of overwhelm with the quantity of things that are on a given medical student's plate, and I think how do you think you could manage that?
Brooke:
I think I'm going to take a lot from things that you've shared so far. I think definitely is putting up some boundaries around my time. I don't think that I'm the greatest ever at doing that, so I think that that would be a good place to start. And then also prioritizing. I think that that's something that I also do struggle with a bit where I have this long list of tasks, but I don't really put them in an order of which ones I really need to get done versus ones that I could maybe wait a little bit. I just look at them and I'm like, okay, which one's next? And just go through, I don't really think this one's the most important or most urgent. And so I think that's also partly goes into why I stay up so late at some nights the end of the day when I'm finally at the most important, most urgent one that I probably should start the day with. Interesting. Yeah, so I think that's some of the things I'm going to do.
Nina:
Yeah, it's sort of a foreign concept. It's still a concept that I think people struggle with, but we have too many things on our to-do list. We really do. And some of the concept that has really come around in the productivity literature is that we really should just have one or two things that really what I call our deep work or our project or problem or think that we're trying to really work towards or accomplish. Usually the one that is a little more thought intensive, that thing really should be the one thing you want to get done, and you can do it in what I would call sprints, which is like once your brain has been tackling that, it's easier to pick it up the next day and keep working on it. And to take advantage of that ability to continue the work. It's harder to pick things up after you have left it growing stale for a little while.
So really it should just be, I'm similar to Rahul that most of my cognitive energy is at the early part of the day. I'm a lark, I'm a morning person. So I dunno if you guys have heard the concept of Eat the Frog, this is, I think it originated from Mark Twain, which is the thing that's making you procrastinate is usually the thing you really need to get done. You want to tackle that first. Eating the frog or doing that first actually really gives you a sense of accomplishment that helps you with the rest of the day. So I usually try to eat the frog or do my one big thing that I really want. If I really need to get paper edited or feedback to someone, I've got a deadline. I want to tackle that first. The other strategy I would bring up too is that you can actually impose deadlines on yourself. Some people take advantage of that accountability, and you just have to know if that's something that would end up motivating you. Creating that sort of time limit or time bound allows you to fuss less or just not procrastinate as much. That's actually a strategy that some people have used to build in accountability when there isn't necessarily accountability.
Rahul:
I love that, Nina. I would just add that if Mark Twain was living in this age, he would go plant-based and say, eat the broccoli.
Nina:
I love it.
Pete:
Nina, I wanted to go off of what you were saying. The way I try to prioritize or at least keep myself organized, again, I'm using my calendar and I'll put things that I need to do and I put it on the calendar and there's a couple things where I like, okay, now I can grab it and just bump it to Monday instead of rewriting my whole to-do list. I'll grab the appointment and I'll move it in my calendar, but it stays in front of me. So if I feel like doing it that today, I'll do it and get through it. If not, I know I've got some play and I'll just take the appointment and I'll move it to another day. I guess I use my calendar a lot.
Nina:
No, I like it because I actually think that you're using it in a really smart way, and that's one of also the motivation that I went into time management productivity is like, how do I work smart and not work hard? How do I feel like I'm off the hamster wheel and being more intentional about what I do is you're using your calendar and looking at the things you need to do, and almost like time tiles, you're moving things around to serve you best
As it were. You're like, okay, this is how my day could go, but maybe I should move things around. I have done that sometimes when, yeah, I try to do that for meetings. I try to have them kind of toward later in the day and less in the morning where my cognitive energy is there. So I'm doing a little bit of what you're doing as well. And to be honest, I will acknowledge that you and I as faculty have more flexibility to do that. Someone like Brooke or who is really locked into a class schedule may have that less, but Brooke, there will be a time in your life when you have more flexibility and you should make ample use of it.
Brooke:
I'm looking forward to that time.
Nina:
Yeah.
Brooke:
Thank you so much, Nina, for joining us today. We're so lucky to have had you on our podcast. You've shared so much valuable information along with some amazing tips and tricks on how to better manage our time, energy, and attention. And we also want to thank you, our listeners. Until next time, keep learning and leaving.
Brooke:
Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences.
Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, and Brooklynn Weber.
The student producer is Brooklynn Weber, and the executive producer is David DesRoches.
Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.