Serious issues with multi-tasking

[scharnhorst]

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Hi guys
I am a 3rd yr resident in FP
I have a serious problem , for last few months I have been having some serious problems keeping up with things
like medical records , meetings , conference attendence [ mostly because I forget to sign in ! ]
my patient care has been great , i got very good recommendations in both inpatient and outpatient rotations.And passed USMLE step 3 [85], did reasonably well on inservice
my faculty is understanding but i am very embaressed as i keep missing appointments and late signing off on charts [ only about a few days though] ....for this part alone i am on probation but i cant seem to figure out a way to deal with this , i have tried all kinds of methods planners calenders but I seem to have very poor shortterm memory when it comes to this.I mark things in my calender but forget them just before the required time as I get distrcted in clinic or wards.
what shud I do ...i am extremely frustrated please help !
I am scared to death of diagnosis like ADHD thats why i am not inclined towards a official evaluation but if i keep screwing up can i program fire me ?
if I dont go for an official eval my program will think i am just careless and not willing to improve .....
It makes me feel horrible , today I missed my advisor meeting as I was at another clinic and felt like crap all day and ended up missing the noon conference as well [ as i took the wrong exit on the highway TWICE as my mind was preoccupied with missing my advisor meeting]....it looks really bad

it might seem a trivial issue to some but please I need some help ...i dont think i am plain stupid but i dont want to hide behind excuses either ....

thanks for reading

 

[scharnhorst]

I am also applying for geriatric fellowship this year .....

Obviously my deficincies that i outlined above will be known to the program ...is there any reasonable chance that geriatric fellowship programs will consider my applications?

I have some really good recommendations for my clinic /hospital work but obviously other aspects of my eval will suck a lot
In all honesty ....I dont blame any of my attendings at all they have been very fair

but I dont want to lose my career because of some issues which dont directly affect patient care , any advice is welcome

 

[finished]

you mentioned that you have tried various calendars. have you tried a paper calendar with one month printed as a blank grid (one month per page and each day in its own box)? you could fold it up and put it in your pocket and keep it with you at all times. i started using one like this long ago, and it's the only thing that helps me, because i put only non-routine things on it (so they stand out from my "regular" schedule). you kind of have to write small, but it provides a good overview of each day, and if that day is "blank", then you know you just need to do your regular schedule and have no extra meetings. i don't have a busy schedule like you do, so i have six months (Jan-June and July-Dec)stapled together, but you could do one month at a time.
i also found a similar "weekly" grid in the dollar bins at a crafts store, if a month is too long. they come in pads of ~50 sheets.

another thing that may help is keeping a checklist for each day in your pocket. you could make it the night before (leaving room for things that come up the next day) and write in scheduled meetings, etc. not only will you be refreshing your memory of upcoming meetings the night before, but if you get into the habit of checking it every hour or so, you'll stay reminded of things you have to go to or do.

have you tried setting an alarm on your watch or pager?

the only other thing i can think of is perhaps attaching colored clips to your watchband, with a different color for a different type of event (for example: green for meetings, orange for lectures, etc). you can remove them when you have signed in or the event is finished.

for the patient notes, maybe it would help to keep a list with you on wards or in clinic and write down the names (or initials) of patients that you still need to do notes on, then cross them off when they're finished

good luck to you. sorry you are having difficulties in this area

 

[LadyGrey]

I'm a student, so obviously my to-do list isn't quite as complex as yours. But I wear my Treo on a belt clip (I know, I look super cool) and keep it on vibrate. I often set alarms in the calendar to remind me of things. I assume most phones with any calendar function have something similar you could use.

FWIW, I don't think this means you're stupid. I know some very smart people who are terrible about stuff like this. My husband swears by some variation on the GTD method (Google "43 folders"), which sounds crazy to me but maybe will give you some tips.

Also, once you come up with something that works, you will have something helpful to offer your patients in fellowship, who will be having even worse problems with remembering stuff. 😉

 

[Winged Scapula]

The alarm on your pager or cell phone will save you. Our program coordinator used to send group pages to every resident 15 minutes before mandatory meetings; that helped as well. Perhaps if some of your colleagues also have trouble going, this might work for the group as a whole. As far as signing in, the sheet should be right by the door when you walk in so its the first thing you do when you walk in.

Most residents have a list of patients. Make yourself notes on this list - H&P, check labs, order X, call consult Y, etc. There are lots of things to remember as a resident; these will become second nature. But until they do, right down even the most mundane tasks, check the list obsessively and don't cross anything off until its been done. I used to use a red pen for tasks so they would stand out on my list.

Finally, if these problems are new, then you might have to question what the cause is. Depression, stress, etc. can all result in an inability to coordinate tasks and focus. Perhaps you need to be evaluated although this must be done discretely as programs have been known to use psychiatric diagnoses in an effort to fire residents.

If you are already on probation, then you'd better believe your program can fire you. I suspect they already have a file on you with what they consider to be "cause". It seems a bit unlikely that you would be on probation for missing some meetings and signing charts a "few days" late. There has to be a pattern of misdeeds, or else the program is actively trying to get rid of you and is trumping up charges. What are the stipulations of your probation; what is required to get off and how are you being evaluated?

You MUST find a way to rectify your problems, get off probation and finish residency, otherwise the questions about fellowship are moot.

 

[scharnhorst]

The alarm on your pager or cell phone will save you. Our program coordinator used to send group pages to every resident 15 minutes before mandatory meetings; that helped as well.

thats a great idea thanks

Perhaps if some of your colleagues also have trouble going, this might work for the group as a whole. As far as signing in, the sheet should be right by the door when you walk in so its the first thing you do when you walk in.

i am usually running late for conferences and simply forget as my mind is preoccupied with something else

Most residents have a list of patients. Make yourself notes on this list - H&P, check labs, order X, call consult Y, etc. There are lots of things to remember as a resident; these will become second nature. But until they do, right down even the most mundane tasks, check the list obsessively and don't cross anything off until its been done. I used to use a red pen for tasks so they would stand out on my list.

i think , i didnt express myself well, taking care of patients has never been a problem all attendings have given me good evals for inpatient /outpatient rotations.Even getting things done before or after rounds has never been a problem

Finally, if these problems are new, then you might have to question what the cause is. Depression, stress, etc. can all result in an inability to coordinate tasks and focus. Perhaps you need to be evaluated although this must be done discretely as programs have been known to use psychiatric diagnoses in an effort to fire residents.

My attendings have been very helpful , should I disclose to them that I am getting myself evaluated ?
my 3 big fears are
1-they will feel i am trying to find excuses for being disorganized
2-as u mentioned may use this to fire me
3-if some doc labels me ADHD what do I do ? am I screwed for life then?

If you are already on probation, then you'd better believe your program can fire you. I suspect they already have a file on you with what they consider to be "cause"

i do believe that trust me

.

It seems a bit unlikely that you would be on probation for missing some meetings and signing charts a "few days" late. There has to be a pattern of misdeeds, or else the program is actively trying to get rid of you and is trumping up charges. What are the stipulations of your probation; what is required to get off and how are you being evaluated?

thats the problem all these things come under professionalism
and endpoints for getting off probation are basically improving organisational skills[ may i add not patient related on wards more than 2 senior attending commented on how well i served as senior ].For a few weeks i am perfectly fine then I miss a chart in electronic records or miss a meeting and its back to square one....thats the most frustating part !
My advisor is really nice guy and i believe he wants to help ...which makes me feel even worse as I am letting him down.

You MUST find a way to rectify your problems, get off probation and finish residency, otherwise the questions about fellowship are moot

But what should I do now ? as applications are being sent now to fellowship progarms
What should I ask my PD to do ? I personally know the doctors at the geriatric programs too should I talk to them as well?
I dont want to understate the importance of these organisational issues at the same time I dont want these temporary issues to destroy my career .....

 

[Winged Scapula]

thats a great idea thanks


i am usually running late for conferences and simply forget as my mind is preoccupied with something else

It happens to all of us but since the repercussions for you are so dire, you must find a way to fix it. Either an alarm on your pager, if you have an SO with a vested interest in you doing well have them page/call you 15 minutes before mandatory meetings, etc.

i think , i didnt express myself well, taking care of patients has never been a problem all attendings have given me good evals for inpatient /outpatient rotations.Even getting things done before or after rounds has never been a problem

Perhaps I didn't express myself well. I understood that you had great evaluations; my comments above were common steps people do to help them stay on task, to not forget about things like signing off on charts (whatever that means).

You simply have to find ways to be efficient, and not put things off. I always regret it when I don't finish my charts for the day and then just find more work to do the next, thus I rarely break my rule about not doing anything else until the day's work is done. During internship (and even beyond), I was known for being efficient because I would capitalize on time and do things like call consults from my phone in the hall while the attending was yakking with the patient about last night's ball game or have "pre-fab" orders written up for all the basics (with specifics for each patient added on below). Whatever you are doing that is making you not get things done needs to be rectified in any manner you can muster.

My attendings have been very helpful , should I disclose to them that I am getting myself evaluated ?

Absolutely not.

They are not your friends. If they need more "ammo" in the case against you, knowing you are seeking psychiatric help may be all they need to fire you. Please read some of the threads here about "disciplinary psychiatry" - ie, forcing residents to undergo evaluation and treatment, having access to those records and then using the content to discipline or determine your status as a resident.

If they have not forced you to be evaluated, but you recognize that there is a CHANGE in your ability (which it sounds like there has been), then you should seek counsel from someone not affiliated with your residency. It may cost you more (depending on insurance coverage) but it is worth it. You may have to disclose this when you apply for a license or another job, although most states/employers only care about whether or not the problem affects your ability to function.

my 3 big fears are
1-they will feel i am trying to find excuses for being disorganized

Unlikely, especially if you have been organized for the previous years up to now.

2-as u mentioned may use this to fire me

More likely.

3-if some doc labels me ADHD what do I do ? am I screwed for life then?

ADHD isn't something you catch. Why would you all of a sudden have it now when you have been performing at top notch all along? It is clear that some people coast along in life and never get diagnosed. But your posts make it sound like the problem is new and heretofore unexperienced.

But let's say you are diagnosed as ADHD. You are not "screwed for life". There are plenty of doctors with this diagnosis. What is important is whether or not you are being treated, not whether you have the diagnosis.

thats the problem all these things come under professionalism

See, I am still unsure that this is about missing a few meetings and signing a few charts late. Who doesn't do that? Be honest with yourself, are there other reasons they could be looking to get rid of you or are the problems more severe than you are letting on or realize?

I missed a lot of mandatory meetings during residency and forgot to dictate some discharge summaries or sign some charts but I wasn't ever put on probation for that. An official probation is serious stuff and not usually done for what seem to be picayune details, IMHO.

and endpoints for getting off probation are basically improving organisational skills[ may i add not patient related on wards more than 2 senior attending commented on how well i served as senior ].For a few weeks i am perfectly fine then I miss a chart in electronic records or miss a meeting and its back to square one

What are the specific goals? "Improving organizational skills" seems rather vague. Are they expecting a certain time period with no missed meetings and missed charts? It needs to be specific or you will never know if you have met the requirements to be off probation. Are you having more troubles now because of the increased work load and expectations as a senior resident?

....thats the most frustating part !
My advisor is really nice guy and i believe he wants to help ...which makes me feel even worse as I am letting him down.

He'll get over it believe me. But if you really want to do well and make him happy, there needs to be clearcut goals set in place for you, with a plan for remediation and a time limit for this probation set.

But what should I do now ? as applications are being sent now to fellowship progarms

Continue going forward with plans to apply to fellowship. If the time comes when you are asked (IF you are asked) whether you are in good standing at your program, then you can be honest, but I wouldn't say anything now.

You will need to identify faculty who are supportive because fellowships may require LORs.

What should I ask my PD to do ? I personally know the doctors at the geriatric programs too should I talk to them as well?

About what? Tell them that you are on probation but you don't know if and when you might get off it? Your focus right now should be finishing residency; go ahead and apply for fellowship programs with the assumption that you will finish. If the word gets out that you are on probation, then you can address it.

I dont want to understate the importance of these organisational issues at the same time I dont want these temporary issues to destroy my career .....

Again, I am suspicious that something else is going on. Either you have had a change in your abilities (either due to physical or psychological problems) or your organizational skills were adequate as a junior resident but they are not sufficient as your responsibility increases and the faculty is putting you on notice that this is the case OR "organizational skills" is a red herring for some other reason they are looking to fire you.

In other posts you allude to personal problems which prevented you from taking Step 3 when you should have, so perhaps the problems HAVE been on-going for quite some time and faculty was cutting you some slack but finally realized that without probation you weren't going to get better.

 

[lowbudget]

i am usually running late for conferences and simply forget as my mind is preoccupied with something else

Therein, my friend, lies the problem.

I don't know you, but you're probably a procrastinator. You procrastinate, things pile up, you try to keep it organized, you obscess over the things that need to get done, and you forget because it just piles up. Just a guess.

For you, I'm willing to bet, keeping organized isn't in your nature. In fact, getting organized is just yet another thing "to do". Making a list is another "to do".

All those things you've listed are the easiest things to accomplish. They are also the easiest things for faculty to throw you out of the program for: it's easy, observable, quantifiable, and measureable. But since you've made it to R3, it's unlikely they'll fire you. They probably want to get rid of you by graduating you more than anything else. Which is sad, really; because nothing will have changed and you'll just suffer with your problems in another setting.

Who cares if you're ADHD? What are you going to do, take a pill and your problems will go away?

Listen, what you need to do is try hard to bring change to your life. Even medicated ADHD's have to learn how to compensate.

So here's what you do:
1) Do today's work today. No more procrastinating. If charts need to be signed, you don't go home until they're signed today.

2) Develop good habits. Go about your day the same way every day. Even if it means sitting down the beginning of the day and visualizing in your brain how your day will proceed, do it. And once you've habitualize, it'll feel strange to *not* do things. Do you wear your underwear every day? Ok then. You should be able to sign in everyday for conference.

3) No more obscessing. No more self-hating. Yesterday's mistakes are yesterday's. No one's perfect, so if you screw up, take 15 minutes of concentrated time feeling bad about it, and then you're done. Move on. You're lucky that missing the exits was the only you did, and you didn't kill someone on the road.

Once you start getting more control of your own life, you'll have less things to-do, which means there will be less clutter to preoccupy your brain, which means you'll start enjoying your work and your life. (And if you've given a good effort, and need some help, get evaluated. There's no shame in it.)

 

[Doctor Grim]

I agree with the above post. I had a couple of attendings with ADHD and they're all superb physicians on meds. So that's no excuse.

You need to prioritize things and get things done if possible on the same day. Always dictate your discharges the minute you write "pt may go today" You can always add an addendum. Always do your clinic notes at the end of your clinic session. If you have to eat your dinner late or be the last person in the clinic, so be it.

Sooner or later you'll be more proficient and can manage your time better.

It's better you figure this out before your geriatric fellowship. You're expected to perform at a higher level as a fellow esp. after you have completed your residency and most likely be board certified. A lot of times you'll have to perform independently.

 

[Doctor Grim]

You're a PGY3. Is it possible that you have ADHD and have gone this far without treatment? I doubt you have it.

 

[dragonfly99]

I agree with the above comments, especially Winged Scapula's.
OP, do NOT give your program any more ammo. Do not kid yourself. If you are on probation then the next step is either that you squeak through residency, they fire you, or they remediate you by making you do extra months. #2 and #3 are both bad.

There really isn't any excuse for missing conferences on a regular basis. Get an alarm or set your cell phone or pager to go off at whatever time (like 20 minutes) before the conference and then GO. If you are at an off site location it is hard, but you NEED to do this. If you have a best friend or wife/significant other who can help you, have that person call you daily before the noon conference (or whatever other required conferences). If there is only one a day or something, it shouldn't be THAT hard to get there.

Make sure you sign off on all charts, finish all discharge summaries the day the patient goes home, etc.

These 2 things are definitely things that can and should be done pretty much perfectly...otherwise you are just giving your program ammunition to get rid of you.

I am afraid that despite what you say, someone or some people in your program are concerned with either your clinical skills and/or they don't like your personality, because putting a resident on probation is a big deal and usually if a program does this they are at least considering terminating the resident. Lots of people get through successfully also, but you have to realize that you are being threatened.

Agree with getting an outside mental health evaluation, and also consider a medical evaluation. It's probably nothing medical, but if the problem is new it could be you have thyroid dz, etc. Mostly likely this is just general organizational issues which have been noted by attending(s) and now you've been put under a microscope. The program will now notice any and all mistakes you make, so make sure you keep all your paperwork done, dress nice, smile and be pleasant to all attendings and patients, show up to all conferences, etc. Those are all things you can absolutely control.

 

[elwademd]

lots of good advice.

i'd just add, if you have a cell phone, use it. it's a part of being professional. which, depending on your program, is a big push within the last few years, as it is one of the "core competencies" of residency.

so, if you're going to be late, pick up the phone and call the person that you're going to be late to a meeting. if you have 2 places to be at once, you clearly can't do it. so, you make a call.

lots of people are late or miss meetings. not everyone makes a call to let someone know. be that person that calls.

 

[Old_Mil]

Have you thought of getting a palm pda? If you enter the dates and times for conferences on there, you can set it to give you an alert a certain amount of time beforehand...