Why slowing down is important for wellness in medicine

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Faster faster, faster. Wait, wait, wait. Is faster, more efficient, always better in medicine for doctors? For patients? Not so sure, huh? Stick around to hear how slowing down can actually help you personally and professionally.

Life moves fast

Life moves fast. We all feel it. These days, the online news cycle, social media, the conveniences online, ordering things, getting delivered more, faster, cheaper, more efficient, there’s more events on the calendar or activities. In many of these things, we kind of put on autopilot, doing things almost without thinking, getting home from work, making turns automatically you get home sometimes and realize “how did I make all those turns?” You may have experienced similar things.

Thinking, Faster or Slower?

Clinically, when you see something classic, say it’s red and large tonsils with a exudate, you know what it probably is. Daniel Kahneman and Amos Tversky’s research features in Daniel Kahneman’s 2011 book “Thinking, Fast and Slow.” It goes over two different ways or modes of thinking, system one, which is instinctive and fast, and system two, just slower, more logical and deliberative.

We all live with both of these systems and use them at different times. Having a framework to fit some of these ideas into can really help and considering how you make decisions. So for instance, getting home from work for the hundredth time, not really realizing how you made it there, that’s going to be system one, then performing a procedure, especially the first few times it’s going to be more system two. We’re going to have to stop and think about it a little bit more.

Slowing down

The speed of life these days. And the speed of medicine pushes us each towards system, one thinking, and in many ways, this is necessary. We need these heuristics and patterns to recognize those things that we get good at. And yet, sometimes we need to slow down to do some system to deliberative analytical thinking. We’re going to go over to ways in which this is applied first.

We’re gonna talk about how slowing down personally has benefit for you. And then we’ll go over professionally. How slowing down can not only help you, but also your patients and your connection to the practice of medicine.

Saying No More

So first slowing down personally, and involves creating that time margin. Like we talked about back in episode four, it means saying no to certain things, both personally and professionally, whether it’s extra committees, the extra sports team, it’s not saying one thing is right or wrong for you as an individual, you can’t do it all.

Calendar space and intentionality

So some of these things will be unique to you. Say no, and then when there’s that space on the calendar, don’t fill it all back up. So tempting to say, “oh, here’s something else we could put in there”. But as your schedule says “time slot available,” you could use that margin intentionally, whether that’s for rest, taking some time to reflect, maybe on your priorities, the direction you want your life to be going, the trajectory that you’re currently on and whether you like where that will take you in one, two, five, 10 years from now.

It may mean that you schedule some intentional time with family or friends that you schedule some rejuvenating activities, exercise, hobbies, something else could be meditation, mindfulness, or spiritual practices. It involves thinking and making decisions in line with your priorities.

Personal applications

So for me and my family, 2020 was a year of change. Not only the COVID-19 pandemic quarantine and many things being virtual or postponed, but the birth of our daughter just before the initial shutdowns also led us to some of these intentional choices that we had to make. We went from no kids in the home to a newborn baby, certainly a wonderful gift to our family.

We took advantage of this opportunity for quality time as a family, with more space on the calendar for awhile, this slowing down personally involves creating time margin involves saying no more and not just filling the calendar, just because then finally using that margin intentionally.

Slowing down professionally

So first we had use of time and slowing down in a personal sense, then number two, slowing down professionally. Again, this can mean a lot of different things to different people. It certainly means creating margin that saying no to certain things, whether it’s the compensation committee, the quality team, maybe it’s asking to coordinate something.

Maybe this is an opportunity for you to build community among your colleagues and staff. But maybe it’s just something extra that you just happened to be someone who usually says yes. So you’re going to have to choose whether you want to participate or whether you say no, thank you. You have to figure out what’s your capacity in this season.

So slowing down may mean saying no to certain activities or certain additional responsibilities that you may have some say over, especially if you’re an employed physician could even mean cutting some FTE and your job saying I’m only going to work this many shifts a month. I know it’s going to come with some financial implications that I’m willing to do it. And I know where my finances are so that I can make that happen.

At the individual level professionally

So slowing down professionally at the macro level includes these big commitments, but it also involves the day-to-day workflows. Bringing it back to Kahneman and Tversky’s system one and system two thinking, there are more applications as a physician. We are trained to work hard.

A lot of it self-selects those who are go getters, working hard. I want to take great care of their patients. We know what to do, and then we go do it. Yes. Thinking about it often with quick decisions, order this, diagnose that communicate, “You can discharge that patient.” “You could bring a extra cup of water to this other patient or the families here.” “You can call the social worker. That’d be great.”

Decision making and cognitive errors

Again. It’s about action and doing, you just can’t stop and deliberate over every little thing. The learning and deliberative thought often as part of how we go through our days is more system two, which takes a little bit more thought, a little more reasoning. It’s in contrast to that system one, just going for it with heuristics, I know what to do. We often find ourselves looking at illness scripts, and patterns that help us understand what we’re seeing, but sometimes overusing these heuristics and the system one or automatic thinking, we risk confirmation bias and premature closure. As we consider a clinical scenario, these mental biases and errors are often discussed in morbidity and mortality conferences.

How to be more deliberative

The current pace of medicine is often so much about speed and efficiency. These cognitive risks remain. It’s not that they can necessarily be all explained away by how we change our thought process and though system one is necessary, at times it can be a potential barrier. Yes, it is potentially problematic, but how can you incorporate more system two thinking into your medical practice?

It could be writing out your differential diagnosis could be talking out your thought process with a colleague or even with a patient. “I think this particular diagnosis is more or less likely because of whatever your symptoms are that are more reassuring.” “I’m still thinking about what all this could be.”

Talking to patients

Certainly the differential that you discuss might be shorter than what you’re actually thinking through. It might be longer when you’re doing academic teaching rounds, which teaching can be its own more thoughtful and analytical process. So you might not do all of that in front of your particularly anxious patients who might then latch on to something you said and say, my doctor said it could be “this particular diagnosis”.

But when families are worried, especially about cancer, I go ahead and say, “I know sometimes people worry, this could be cancer and then share about what tests we might do or why their clinical picture is more reassuring or what we’d watch for if things were to change.” Dr. Google is going to say it, so slowing down to acknowledge these things. This allows the patients an opportunity to feel heard, gives me a chance to say, “what else could this be? And am I missing something?”

What about you?

So I want you to pause for a moment and reflect with me, say to yourself, what if I did this, if I slowed down personally and professionally?

• What if I have more margin on the calendar for rest self-care time with family or friends to take up that hobby again, would I feel more peaceful and satisfied how I use my time?
• How much I’m working, maybe slowing down periodically at work could allow me to find more joy and connecting with patients.
• The opportunity to think clinically more often.

So take that scenario, how things would look or feel for you and let it spur you to action this week could be saying no to that committee. It could be putting a date on the calendar time with a friend, significant other or a child. It could be downloading my free PDF guide, Maximizing Your Clinical Efficiency, ten tips to get stuff done.

Whatever it is, take action now!

I know these things have been really helpful for me to go through and I hope they’ve been helpful for you share with a friend because this is too big to ignore. We need to support one another in promoting physician wellness, help them, help me, help us take that next step until next time. Keep up the good work. Thanks for all you do and have a great day!