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I was recently interviewed by Dr. Bradley Block for his podcast Physician’s Guide to Doctoring. Dr. Block is an otolaryngologist who thinks we spend too much time learning about the Kreb’s cycle and not enough time learning about more practical things.
He was gracious enough to invite me onto his podcast to share a little about my coaching journey, charting, and productivity in general. What follows is the transcript of our discussion.
You can listen to the podcast episode by searching for his podcast in your favorite podcast app or by clicking here to listen on his page!
Where He Makes Me Sound Like a Superhero!
Brad
Dr. Junaid Niazi is a Board Certified internist and pediatrician who works as a primary care physician for a large healthcare organization in the upper Midwest by day, and by night, he’s known as Prosperous Life MD.
He’s a physician life coach, and he blogs and coaches physicians on all things wellness, productivity, finances, and careers. He also has a group coaching program to help physicians complete their charting at work. And that’s why he’s on the show today.
His interest in charting also landed him as an Information Services medical director where he optimizes the EHR for physician use and patient care. He’s going to help you conquer your charts and go home on time. How? By standing over you and forcing you to finish the chart before moving on to the next patient. How? By convincing you that whatever you can do with the extra time is going to be more rewarding than whatever it is that you’re doing to waste time, instead of finishing your charts. Are my kids more fun than scrolling on Twitter–what I do to waste time? Usually. What’s your reward? Finish your charts.
We also talk about Parkinson’s Law, and why it isn’t some forgotten formula from physics class or your neurology rotation, and how realizing its truth will help you get stuff done. He’s also anti to do list. How’s that possible? So we talk about why to do lists are the devil and make you feel like garbage and ultimately less productive.
Dr. Niazi completed his undergrad studies at Rice University, medical school at Baylor College of Medicine, and residency at the University of Minnesota. He’s married to a pediatrician and has two lovely, rambunctious toddlers.
Dr. Junaid Niazi thanks so much for being on the podcast.
Junaid
Thanks for inviting me on, really excited to be here.
Brad
So tell us your charting coaching origin story, how does one go from mild mannered physician to a charting coach?
So mild mannered.
Run Towards Something
Junaid
I’ll talk about how I got into charting a little bit later, but just how I got into coaching in general, first, if that’s okay? So I did everything that doctors always do, you know: get good grades, high school, college, etc. Went to med school, went to residency, got my first attending job, and I was like, “Hey, I’ve made it, right? This is it!”
But it just seemed like, despite this supposedly being “it,” it just wasn’t right. Just seemed like there were parts of my life that weren’t really working. And you know, I slowly started to come around and realize that I was just sort of burning out working in primary care medicine. A lot of that had to do with just the disillusionment with the system.
And I had personally subscribed to the FIRE mentality. So that “Financial Independence Retire Early” idea, which is you know, you work hard, you earn a lot for a few years, and then you pull the cord to do whatever you want to do. And that didn’t quite feel right. And it was creating a lot of scarcity for me. So you know, more than just not wanting to spend money, it was coming from a place of lacking rather than really being cognizant of, acknowledging, and even being grateful for all that I do have.
Brad
Sorry—could you expound on that a little bit? Or rather expand on that a little bit? What do you mean, by like, you’re experiencing, you were just like, paring down so much on your expenses, that it just, it became a source of stress rather than a source of fulfillment?
Junaid
I wasn’t even paring down that much on expenses. You know, my wife and I are both just naturally frugal. But it was more when you’re approaching everything from this mentality of “I just need to do this for, you know, 5-10 years, and then I’m done—I’m doing my time,” so to speak, you’re really approaching life from this place of scarcity and that seeps out into the rest of your life. You really start taking for granted all the good things, all the good parts of your life, and I think that exacerbates burnout for a lot of physicians. I think that’s why a lot of physicians feel even more trapped in medicine than they otherwise would just from the burnout itself that they’re experiencing. Does that help clarify?
Brad
It’s almost like a paradox. Like you choose this FIRE lifestyle, or rather, you’re trying to get into this FIRE lifestyle so that you don’t need to work. And then you find out, “Hey, I can work just for the love of it.” But in the meantime, you’re hating it, because you have to. It’s like a mindset shift that really just messes with you.
Junaid
You’re running from something, I think that’s the problem. In life, if you find yourself running from things that usually leads you nowhere. You need to be running towards something. And you hear this a lot when people retire, right? So a lot of older physicians, if they don’t have something “to retire to” they either come back to medicine a year later, or they sort of feel lost or dissatisfied with their post-career life.
Brad
Or they just lurk around the doctor’s lounge and watch Fox News and complain.
What’s this “doctor’s lounge” of which he speaks. And ewww Fox News.
Junaid
Yeah, whatever floats their boat, exactly. But those that like, there’s some that you know–“I’m going to do this, I’m going to travel, I have everything planned out”—they’re retiring to something. And I think it’s that same sort of mental shift that a lot of us need to have. And that’s what I was lacking, I think I was one foot out the door with medicine. And that affects how you show up in everything, too.
I Got Ted Lasso'ed
Junaid
I was sort of grappling with these types of mindset things, and I don’t think I was necessarily aware of them at the time. But I stumbled across the Life Coach School Podcast, which is hosted by Brooke Castillo, who’s a master life coach. I really started to binge her content, right. So I’d always to that point thought coaching was very sort of woo-woo, fluffy sort of material, but she was presenting it in a very sort of sensical, straightforward fashion that incorporated psychology and neuroscience. So there was a sense of familiarity with that just with, you know, my medical background.
And she really promotes self coaching, so actually learning a system to coach yourself. I started dabbling in that, doing it more and more, and I started to see some changes in what I was thinking. I started recognizing patterns in my life that weren’t serving me and you know, including on work, money, parenting, you name it. And I started to become more satisfied with where I was in this moment in all of those domains. So it felt like a weight was lifting or you know, curtains were opening, you know, whatever analogy you want to use.
And when you start understanding through coaching, that the results in your life are really driven by your thoughts, and not necessarily the circumstances in your life, that is actually a very empowering realization, because the nidus of control of your life then resides with you, not with those external circumstances.
And I was really prior to that abdicating my autonomy to those circumstances, right? “This is happening to me, that is happening to me,” versus now I’m like, “Hey, that’s happening, and I get to choose what I think about that, and how I show up in regards to that.”
So the next step was I joined a physician group coaching program. If you’re a male physician, this is actually tough because probably about 95+ percent of physician coaches out there are women physicians, and you know, their niches are usually other women physicians. So it took me a couple of months to find a group coaching program. One of the women’s group coaching programs decided to let me in, which is very generous of them and all the members involved, and I did that for two months.
Having a another physician who’s trained as a life coach reflect back to me what I’m saying and show me what I’m thinking—because the manifestation of our thoughts out loud as words is where people see what you’re actually thinking—allows them to then tell you, “Hey, why are you thinking this?” They can show it to you and you can understand, “Oh, this is a pattern” like “I’m starting to see patterns of thought here,” that just really accelerated transformations for me.
The Young Grasshoppa Becomes the Master
Junaid
And just going through that process, I knew I wanted to go through a coaching school to learn skills for myself. And also just for my fellow physicians. A lot of coaches are specialists and there’s more and more primary care physician coaches coming up. But you know, I really wanted to share coaching with primary care especially.
So I actually signed up for the next cohort at the Life Coach School run by Brooke Castillo, who I mentioned earlier. Went through that six month training, came out of that, and I actually did some coaching with Dr. Jimmy Turner, of The Physician Philosopher, he has a program, and did my own one on one coaching with other physicians.
With working through Jimmy’s program, I realized I kept chiming in on group coaching calls about things related to clinic workflows and efficiencies and charting. So Jimmy actually challenged me and said, “Hey, do you wanna just do a focus call on this for our group members?” I said, “Yeah, sure.” And that’s sort of where my niche came from.
I did this focus call and people responded to it very well. One person the day after that call implemented some of the stuff we talked about in clinic and she got home for the first time in her life at 5:30pm and was able to eat dinner with her family. Prior to that she was staying in clinic till 9-9:30pm!
With 3.5-4 hours back in her life daily, she does what she wants!
Brad
Wow! That’s a dramatic difference!
Junaid
And so that’s where I sort of stumbled across charting as a niche for coaching. I realized I was onto something and I said, “Hey, let me explore this further,” and I actually went on to develop my own program. I’m currently in my second cohort of physicians. So now, you know, I’ve helped dozens of physicians through my group program as well as one on one.
All Charting and No Play Makes Junaid a Dull Boy
Brad
But you had a background in charting, right? Like through your hospital, right? You’ve been on committees or, like you were able to incorporate another area of expertise and kind of mesh the two together?
Junaid
Certainly. Just entering primary care in this day and age obviously involves a lot of charting. My wife’s a pediatrician, too, and, you know, our first year out, we would be sitting on opposite ends of the couch every evening and many a weekend night just typing away at our keyboards. And this was before we had children. And I realized: something’s got to change.
So I became very intentional, examining my work day, you know, down to every visit, seeing where am I spending my time? How can I make this better? How can I improve workflows? And there’s a lot of navigation there, right? There’s administrative burdens just from the organization you work for. You know, medical assistants in one organization can do X, Y, and Z. At another organization, they’re not allowed to. So there’s a lot of navigating that.
But part of that interest led me to a role within the organization where I’m what’s called an Information Services medical director—one of five on the ambulatory side. So, you know, we try to make our EHR as user friendly for end users, as well as just making it better for clinical care. And you know, where we fit in is, we try to take sort of all our clinical background and mesh that into the decision making for any tools that are rolling out.
And, you know, I think we’re all on the same page, where we’re really just trying to make charting a little bit less of a burden. And one of our mantras is, “Hey, if they’re putting something new, then we got to try to take something else out.” Maybe we’re harnessing a little bit of that CMS mentality for budget neutrality here!
Brad
But does that always work? Because sometimes, with like CMS requirements, they’re not budget neutral. They always want to collect more information. So now you have to do this. Now you have to record that. Now you’ve got to record this. So are you able to do that, even though their requirements for data entry continue to increase?
Junaid
Yeah, so specifically, for some of their, you know, for example, a Medicare wellness visit, there’s new things coming in—quite a few new things coming in the last couple of months. And we can’t stop those. But they’re also other things that the EHR has designed itself to alert us to things and a lot of that causes alert fatigue. A lot of it’s not utilized. We actually ran some utilization reports and found, you know, over over an 18 month time period, 99% were ignored. So if they’re ignored, they’re clearly not serving any purpose.
So we removed those ones that weren’t serving any purpose at all. And you’d be surprised at how much stuff accumulates over time in an EHR! Or maybe you’re not surprised at all, because you deal with all the data that accumulates in the EHR. But all the other stuff also accumulates—all the alerts, all the prompts, everything. So yeah, you know, we have to give in if CMS says there’s something that needs to be included. For example, now we have to screen for substance use disorders. Also one of our local payers is making us screen for urinary leakage. So, you gotta do what they say that you gotta do.
Brad
Okay, that’s specific!
Let's Do This...Just Do It!
Brad
So when you were—and this might be getting into the charting—but for yourself, what were some of the higher yield things that you noticed about yourself that helped you to become more efficient?
Junaid
Yeah, so two main things really drove my efficiency. The first one was learning to really type well during the visit while the patient was talking. And actually this took a while! I learned and have become very adept at writing down their last response—typing that—while I’m asking a different question, which is like a brain teaser. At first, you know, when I first tried to do it, I’d misphrase or mix up the two things. But that’s like second nature. Now I can just type what they said while I’m asking a new question, and that just took practice, honestly, and a lot of fumbling, but now it’s very smooth.
And the second one was making sure I did every chart, closing it while the patient was there, or right after the patient left before he went and saw the next patient. And that’s paid off dividends. Even if you’re running behind in clinic, your brain will offer up 1001 reasons why you can’t do that. And, you know, all those reasons lead you to make a decision that will later impact you and keep you stuck at work late. You know, before I did any of this, I was getting to know the janitorial staff at our clinic really well. I had the lights turned out on me. All kinds of things.
Now that I have kids and daycare is right next to my work, I’m the one responsible for picking them up. So, you know, I have to get out of there as fast as I can. And, you know, COVID’s been a little bit of an exception with getting called away to daycare early in the middle of the day, but excepting that, you know, maybe five days this year so far I’ve had charts to do after I’ve left work at 5pm or 5:30pm.
Brad
How do you get yourself to do it, though? So the way it works in my brain is not finishing my chart is like eating cake. I want to eat cake. And it requires a certain amount of willpower to not eat that cake. So eventually that willpower is going to wear away, and I will eat my cake. I will not do my chart, I will let it go. And then it’ll accumulate and then it tends to snowball, right? You give yourself permission to skip one chart, you rationalize that, and then it’s just chart after chart. So how do you get yourself to really stick to that?
Junaid
Well, your analogy is on point because charting like most of these other things, you can say it’s easy, but it’s not simple. Just like dieting. We all know how to do it–
Brad
Just do it. Just chart. Yes, fine, easy. You just do it.
Delay that Cake-Eating Gratification
Junaid
But the execution, the discipline, the not succumbing to those urges, like you described, that’s the hard part. I figured out the strategy stuff first, and then I discovered coaching later. So a lot of the story I took you through about coaching, that’s all been the last probably 18 to 20 months. And that mindset aspect that I gained through coaching, really made things sort of fit within a system that made a lot more sense for me, and made it easier to teach people rather than just telling you, “Hey, do this thing. Why can’t you do it?”
But basically, to your question, if I want to actually get home to eat that cake with my kid, I know I need to finish my notes and finish my charts. So I know I’m making the decision now to deal with a little bit of discomfort because there’s all kinds of things clamoring for my attention in my time when I’m at work. Phone calls, messages, lab, radiology, my nurse, everything. So I know my priority is taking care of my patients, getting my charts closed so I can get home and spend time with my family, and you know, run a coaching business even.
If I did not have these efficiencies in place, I would not be able to have a business, right? Like, there’d be no time for that. I’d just be charting at all hours. So I developed the discipline because I knew decisions made while I’m seeing patients have an impact down the line, later in the day.
And I realized a little bit of discomfort, which is now not discomfort for me, after you get used to it you get over the hump. Just like if you decide I’m not gonna eat after 8pm, and you’re somebody who usually has a snack before you go to bed, right, you’re going to feel hungry for the first week or two. After you get over that discomfort, you won’t feel it at all. It’s similar to that. So now it’s not even a thing.
And even if I’m running behind—our staff has been cut due to COVID, and in medicine stuff flows uphill to a physician, unfortunately—there’s been a lot more on my plate to get done. So there are some days especially if I’m on call, and we’ve had physicians who are out on extended leave for one reason or another, so now when you’re on call, there’s a lot more to deal with. And there’s some days where I’m running, you know, 30-40 minutes behind. And that’s unusual for me.
But I know even if I’m running behind, all my prior work is done! If I’m seeing patient number 15 of the day, my 14 other notes and charts are completely closed. Their meds are ordered, referrals are in, everything’s done. I’m not worrying about any of that! I’m not juggling in my brain: who had that murmur, gosh, did we repeat that blood pressure on that one patient before they left because it’s a little bit high? I’m not worried about any of that. That’s all taken care of.
So I can focus on the patient in front of me. So even if I’m running late, I go in and see the patient, they know they have my undivided attention. I’m able to give that to them because I’m not distracted by all these—I describe them as barnacles that are just, you know, clutching onto your mental bandwidth.
Brad
But when you do start running behind, don’t you have that pull to stop finishing your charts? You get hungrier and that cake starts to look more delicious!
Junaid
I mean, I think initially yeah. But I think now having built up that discipline, that doesn’t happen as much. And I think about people who are successful at dieting, right, they’re able to surf that urge. They’re able to sit with that discomfort and realize one person’s in the waiting room, the next one is already roomed. We build up that anxiety within ourselves. If you sit and recognize most patients don’t mind waiting, you know? They probably spent a couple minutes in the waiting room. We try to move as fast as possible just because of COVID to get them out of the waiting room. They don’t mind spending 10 minutes, 15 minutes, a little bit longer in the waiting or exam room.
And as long as I can sit with that discomfort, I’m okay with that. That’s the discipline. Everyone has those patients that get upset with them for running late. Prior to COVID, I had one patient who came like an hour early for her appointment. After sitting in the exam room for 45 minutes, was just storming the hallways livid that I hadn’t come to see her. Her appointment time hadn’t even started! It was still 15 minutes before her appointment time. You know, people are going to people.
Brad
I actually had a patient recently who who was upset about the wait time. It was last patient of the day. It happens. I apologize, as I do. I said, but this is going to happen with me from time to time. If you want someone who’s going to run more on time than me, I can refer you to another doctor. I know this doctor tends to run more on time than me, which is great. Yeah, I don’t have to deal with that anymore.
Junaid
You know, patients tend to self select for providers who practice a certain way or whose attitudes match. And that might be the right thing for that patient, right?
Brad
Yeah.
Junaid
That’s a better fit.
What Else You Got?
Brad
So what about some other charting techniques? Right? Like, what about the importance of dictation, carry forward comments, templates, scribes, like some of the other tricks and tools and things like that? Is that part of your philosophy, your management style?
Junaid
All of these things are tools that you may or may not have in your arsenal. Some people don’t have scribes available to them. We don’t. A lot of people think scribes are going to be that silver bullet that fix everything for them. But really it depends on how you use your scribe, right? They can create a lot more work for you that all gets dropped on you at the end of the day, for example, when you need to get home. So then you’re actually delaying closing your charts for 24 hours or whatever, until you come back the next day. And that might not work for you, right?
They also require training. Everyone has a unique practice style, unique clinic workflow, so that you have to train them to get them to work within your own workflow. And then there can be a relatively high turnover of scribes.
But you can train a scribe and you can use them very efficiently. I still encourage people and I’ve had actually good success with some of the physicians I’ve coached who have scribes by getting them to again finish that visit right after they step out of the room. Finish that entire note and chart with the scribe for several reasons, right? A) Everything’s fresh in both of your guys’ minds. B) You can give them direct feedback as you guys are going through the note and everything. Say, “Hey, you wrote it like this” or “no, this is what I meant when I say this.” You can give that direct feedback, which maybe if you’re reviewing late at night, you’re thinking oh, I need to tell the scribe to do X, Y, or Z. And then the next day, you’ve forgotten already.
So I helped one academic endocrinologist who has a scribe who had a backlog of 400+ charts. And within eight weeks, which was actually the length of the program, she completed that entire backlog! Her scribe and her actually got her MA on board with a lot of this stuff, too. She could only see 12 patients a day prior to that. Now she is seeing 16 to 18 patients a day and finishing all her work! Because she realized she had to work on herself, and she had to work on her team, including her scribe. Just charting as you go was one of the pivotal things that made a big difference for them!
Brad
Yeah, you mentioned the scribe being the silver bullet that solves everything—that’s what I was gonna rely on! Because I have this problem: I get behind, I don’t do my charts. I don’t walk in the room and get on the computer sometimes. And just because I, you know, it’s easier for me to then just chat and build rapport without the computer as the barrier. So a lot of this may or may not be true, or may just be me rationalizing. And then I do it at the end of the day, and I screw around. I’ll scroll on Twitter or whatever. So “No, once I get that scribe, then none of that will happen!” So what you’re saying really speaks—I feel like you’ve been watching me and know how you come up with your commentary. So I’m sure this applies to a ton of our listeners.
Junaid
Well, you just have to make sure the issues that were keeping you from getting your work done, you know, you actually are intentional in addressing them in working with the scribe, and that way you’ll knock them out hopefully.
You mentioned a couple other things. Dictation is a similar thing. So we have dictation available in my institution. I tried it for a while. It made my notes longer and less useful, frankly, because I don’t know why I guess I felt compelled to talk in full sentences. So I actually stopped dictating, because in my EHR, I can track the length of my notes. And the length of my note went up about 30 to 40%. And the content I don’t think was any better. So I said I’m making my notes trimmer. And again, you know, I do most of my typing in the room, so it just didn’t work for my workflow. Some physicians, especially surgeons, really like dictating, and a lot of them have really good workflows for during the visit or immediately after the visit, hammering out their dictation and they’re golden. So dictation can work really well for charting as you go.
You mentioned carrying forward comments, I assume you mean like copying forward your last note?
Brad
Yeah, exactly. Or like using the previous physical exam that’s sometimes a part of an EHR.
Junaid
No, I actually think that’s great. The first thing I do after I copy forward a note though is I go and put in you know, we use Epic and we can use a little wildcard, meaning something that just stands in like a placeholder where I can’t sign the note or close the chart unless it’s addressed. So I just put that in every section–subjective, objective, assessment and plan–forcing me to actually review those sections, right? Because if my last note on the patient was a pre-op for an amputation or something and then suddenly they’re down a limb and I’m saying, “normal extremity exam,” you know, that’s poor form and a poor showing on my part.
So putting in those wildcards forces me to review, but I love copying forward notes because I just look at my last assessment and plan, update my HPI based on that, and I can set my agenda way better for the upcoming visit of that day. And especially with you know, a lot of the the new E&M coding changes where all the time on that day spent on the encounter counts towards the new time limits, a couple of minutes pre-charting, you know, can help take you to a level 4, potentially even a level 5, just depending on the nature of the visit, and how much time you’re spending. So I think copying forward notes is a great way to amplify your pre-charting
It’s like pumping up your Reebok Pumps! Now you’re ready to ball!
Work Will Expand...
Brad
Is there anything else that you want to mention about charting? Because you had spoken about just efficiency in general, like life efficiency, so I want to get to that just just a little bit. So is there anything else you want to mention about charting?
Junaid
You know, just a plug for something called Parkinson’s Law. This guy was a naval officer in the British Navy and then he was a sort of a civil servant afterward. And he was one of those people that actually hated being a civil servant, and just, you know, bashed it constantly and wrote satire about it.
He came up with several things. The funniest one was he actually created a very complex mathematical formula, which showed you that if the number of civil servants goes up in a government, efficiency will drop. And he was very proud of his official formula!
But the law that’s best ascribed to him that is most useful says that basically work expands so as to fill the time available for its completion. So think about your work day, right. So if you can confine all of your work between whatever your hours are 7am to 5:30pm, or whatever, look at that, as your timeframe for getting work done. If you go home with the expectation that you’re gonna just do your charts after the kids go to bed or whatever, you’re going to wake up early to do your charting, you’ve now opened up the entire rest of your day, to getting that work done, which is a big part of the reason you work so much slower when you’re at home.
One client I worked with, we calculated the time she spent on a chart and it was 48 minutes per chart when she was at home. What would probably take her five, maybe 10 minutes at work was taking her 48 minutes at home! Because subconsciously, you know, you’re like, “I have all this time, I can just stay up later, I can just wake up earlier.” I’ve had one person who was in one of my trainings, who basically said they were sleeping 45 minutes a night, because they were staying up late to chart, they’re waking up early to chart. And I mean, clearly, how long can you function on 45 minutes of sleep? I can’t. So…
Brad
It sounds like there’s an impending seizure there!
Junaid
Badness will ensue. So I really encourage physicians to find ways to constrain your work to work. Otherwise, it’s going to eat up all the rest of your time. And that’s your, you know, time is a nonrenewable resource. It’s our most valuable resource. You deserve to have a life outside of medicine. Find a way to constrain your work to your work.
Brad
It’s like when I wrote papers in school, right? You save it for the last minute, and then you get super efficient when it’s that last night. But if the deadline had been different then you would have gotten it done sooner. You just have to give yourself that deadline and then you will be more efficient. Like those days that you need to pick up your kids from school, or daycare, are the days that you’re going to be super efficient about making sure that you get it all done, if you say that I have to get it done.
Because at least for me, it’s harder to use my EHR from home. So I’m significantly more inefficient. So I really don’t want to do it. So I don’t leave until all is done. Which you know, she just started working part time again, but she’s home at bedtime every night. So I don’t have to be there. But…like you had said, the cake is not screwing around on Twitter instead of finishing my charts. The cake is bedtime with the kids.
Junaid
Exactly.
Brad
So you have to be that to marshmallow kid. Right? The one that that delayed gratification, you get one marshmallow. Yeah?
Junaid
Haha, yeah.
Brad
If you eat it now, you only get one. If you eat it later. I’ll give you a second one. So you got to just change your perspective on what cake is, why am I doing this, change your your why a little bit.
Why Are You To Doing It to Yourself?
Junaid
Absolutely. So you know, you mentioned productivity in general, and one of the things I’m a big fan of is showing people how their to do lists are actually one of the biggest problems to them getting stuff done in general.
Brad
I don’t believe it. I don’t believe it, because I wouldn’t remember what I need to do without said list.
Junaid
Yeah, so to do lists have two functions. One of them one of them you just described, right? It’s to do that brain dump, to capture all the tasks you need to get done and get them out of your working memory. That’s one.
Number two is sort of as a safety net to just make sure you don’t miss any major or urgent tasks. Those are really the two functions of a to do list.
You might notice I didn’t state anywhere that the point of a to do list is to actually get those things done, right? So that requires building a system around your to do list, which most people don’t do or don’t do effectively. You know, expecting your to do list to help you get things done is grabbing a screwdriver to hammer in a nail. And sure you might flip the screwdriver around and try to bash the nail in with the handle, but it’s not the right tool for the job.
Brad
Or it’s like a vision board: this is where I want my life to be. And I’m just gonna hope that it gets there.
Junaid
I would argue that to do lists actually have a deleterious effect on people that rely on them because they bias you towards tackling the easy stuff, the quick tasks, which you get a quick win and you get a hit of dopamine every time you can check something off. I mean, that’s why people go back and add things that they’ve done for the day already, just to check them off, literally because their brain wants that hit of dopamine.
But that keeps you from making progress on the big goals that will truly move you forward. And that makes you feel kind of like a failure at times. That’s when people say, “I’m so busy, I’m so overwhelmed. I never make headway on any of these things. I can’t keep up!” You know, we all have the same 24 hours in a day. So why can some people get a lot of stuff done, while others sort of languish just staring at their to do list that keeps growing and growing. And you know, sometimes we stare at the to do list or sometimes we avoid it altogether by scrolling social media or eating that pint of ice cream on the couch watching Netflix.
A Better Way
Junaid
So to do lists are fine, as long as they’re part of a larger system. In fact, I’d argue that they’re the first step in the system, and that’s capturing all the tasks that need to be done. But from there, they’ve outlived their use. You take everything from your to do list, and you need to get it on your calendar. If you do that, you’ve now committed to getting it done. And you’ve allocated sort of your time and attention to that task, which is the only way that that task is really going to get done. So this goes by many names, one is called time boxing because you’re literally putting boxes on your Google Calendar scheduling your time to do something. Some people call it calendaring. I’ve heard a lot of different terminology for it.
But you’re assigning everything a time and a place. This plays into Parkinson’s Law. You’re constraining your time available to get something done. So you will as long as you then commit to honoring your calendar, which again takes some discipline. You’ll figure out how to get whatever done in that time you’ve assigned it
Brad
A huge source of stress in my life is when I’ve got to do these CMEs, I’ve got to do this course or that course for the hospital, and they start accumulating, but I haven’t allocated time for them. And so it’s there in my mind bogging me down, and it becomes a source of stress, stress that comes out in other points in my life. And you know, that’s where my wife asks me, “What’s wrong.?” And it’s usually because so many of those things have accumulated, that it’s really starting to weigh me down.
Whereas if I had put them on a calendar with a specific time and place, and even if I said, “You know what, I can’t do bedtime tonight, because tonight I have to dedicate to, you know, or x night.” Give her some advanced notice so she knows I’m not gonna be around. Now, I’m more pleasant. Why? Because I’ve got a time and a place for it. And I have to get it done in the time that I’ve allocated for it. I love it, I love it! Now I just have to execute on it.
Junaid
I have an accountability partner, and it’s–
Brad
Who’s not your wife?
Junaid
Who’s not my wife. It’s another physician coach. And we just hop on a Zoom call just to keep each other accountable. On the Zoom call, we’re filling out our calendars and taking our to do list, which, you know, I just use the Notes app on my phone to capture what I need to do, and I just transfer it to a planner like page I made where I can track things. I do it on my iPad, which makes it super easy for me to track and then you can put it on Google Calendar as well.
But you know, the important thing isn’t actually necessarily finishing your task in that time that you allotted because that takes time to figure out how long things are going to take. But what’s actually really key is that you are honoring that commitment you made to work on that thing. Because like I said, those folks who operate just off of a to do list, they may not think of it, but they’re generating the subconscious narrative that they are a failure, that “why am I always running behind” that weighs on people. That is a heaviness.
Whereas if you can tell yourself, “Hey, I just said I’m going to spend an hour working on X, Y, or Z,” and I spent that whole time even if I didn’t finish it, like that’s still a win! So you’re almost like building up your credibility with yourself. So you start to then get that reward, and that positive feedback is a more sustaining kind of reward than that quick hit of dopamine from just crossing something off your list. And that’s what makes these things sustainable for the long term.
Say that to yourself. Seriously!
The Common Thread
Brad
It sounds like exercise and dieting the way that you’re describing, right? Like that cookie is that quick hit of dopamine, but the exercise is more fulfilling and more sustaining. But you can’t just exercise once, and then it just happens from there. It needs to be a commitment. An accountability partner helps. If you want to listen to one of my past episodes, you can go to the episodes with BJ Fogg, where he talks about tiny habits. Incorporate some of those ideas. So yeah, but I love that it applies so exactly to my life, which I’m sure is happening with 99% of the listeners right now.
Junaid
Yeah, and you know, that common thread between diet, exercise, charting—all these things—that common thread is our mindset and how we approach these things. And this is why coaching is powerful. This is why at the beginning when I said I was working on self coaching on certain things and I had all these sort of ancillary benefits, it’s because if I fixed this one thing, a pattern of thought that wasn’t serving me, there’ll often be all these downstream benefits that didn’t even relate to working on my burnout or working on scarcity and things like that. It’s because I’m working on my mindset and again that has such diffuse and prolific benefits that it’s not like a one to one. So that common thread through all of this is mindset, and again that’s why coaching is so powerful.
Brad
Are you still part of the FIRE movement?
Junaid
I subscribe to financial independence because that helps give you autonomy. And you know if at some point decisions at work are made that completely run counter to the other priorities I have in life and if you’ve hit a certain number where you’re comfortable saying you know what, “I’ve set a boundary, you have now crossed that boundary, I will now take the action that I said I was going to take.”
I used to be like, “Oh gosh, you have to stay at work until loans are paid off or we’ve qualified for Public Service Loan Forgiveness or this, that, and the other.” You know, in the midst of COVID, we were unsure if my wife—if her job was still gonna exist. Her clinic was really struggling. I was so unusually calm during all that. I’m like, “That’s fine, you know, we’ll be fine. We’ll figure stuff out, we’ll be fine.” Whereas I think a year prior, I would have been running around with my hair on fire—well, what little hair I have left on fire—and you know, contributing more to the stress in the family. But I think I was able to make it less of a stressful issue even for my wife just based on how I was reacting.
Hit Me Up
Brad
So where can people find you? You have a charting course coming up, and you also have a blog, so tell us where can people find you. Where can people find the course and the blog?
Junaid
I run an online course with group coaching called Charting Conquered. Second cohort is running currently. It will next be available early 2022. It is CME eligible so that is a nice perk for folks who need help with charting as you can use your organization’s CME to help defray the costs. In that program I’ll help you finish your work at work so you can reclaim your time. Try to make medicine work around your life instead of the other way around.
If you want to get on the waitlist for that you can go to www.chartingconquered.com and click on the “Join Waitlist” button.
My main website is Prosperous Life MD and that’s where I house my blog, my one on one coaching. You can just go to www.prosperouslifemd.com and you can find a lot of posts that pertain to the material we’ve discussed today.
Brad
Junaid Niazi, thank you so much for your time!
Junaid
Thanks for having me on as a guest. It’s been a lot of fun!
I hope you found this podcast interview entertaining and helpful! Let me know in the comments section below if anything in particular stood out to you. Also, anyone count how many times I said, “You know?”
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