Dr Koshy Jacob held an Achievers' Web Meet on 15 November 2022 on strategies for Radiologists to get more done in less time. This article is a transcript of the web meet which has been edited for clarity.

A man who dares to waste 1 hour of life has not discovered the value of life - Charles Darwin

Time Management

There are a number of great benefits of having good time management, including greater productivity and efficiency. As a radiologist, there's a lot less stress when you've managed your time and, potentially, a much better professional reputation. All of us only have 24 hours. So why do some people seem to achieve more with their time than others? Really, the answer is time management.

Strategies for getting more done

Setting up your workspace

Set up an ergonomically correct workspace, reducing background noise. The more comfortable you are for long periods of time, the longer you can focus. If you've got a chair or a workspace that is not ergonomically suitable, you won't be able to stay on that seat for long. Make sure that your workstation is well-lit. Even as a radiologist, one often finds themselves much more relaxed when there’s good lighting. It's difficult to report in bright ambient light with most monitors, but it comes down to what you're reporting. For example for MRI reporting, you don't need to have a dark room, you can work with ambient light. A useful thing to have in the office is a dimmer.

When you're in a shared workspace, you could have either earplugs or headphones and listen to something that doesn't distract you. That can improve your work performance and contribute to higher productivity. But, if you work in an office, it might not be as appropriate to be listening to something. You have to work out on your own what is acceptable.

You’ve also got to minimise distractions and interruptions. I came across a study that said that it's not speed that causes errors, but interruptions and distractions. When someone comes into your workspace and distracts you, it usually causes more mistakes while reporting. Its the same with revising for the FRCR exam rapid reporting or long cases, for instance. It also increases your stress level because you can't just continue from where you left off, you've got to start again. For example, you might be looking at a knee MRI scan and then get interrupted. You can't necessarily remember what you looked at. Say you looked at the meniscus, the next thing to look at is the ACL and PCL, the crucial ligaments, but you forget to look at that. So when you continue, you start with the collateral ligaments and you completely forget that you hadn't looked at the ACL and PCL. You could end up making a clinically serious mistake, so it's quite important to restart. 

Lastly, a clean desk is really important. It's also good to have access to whatever resources you need within a hand's reach.

Workspace Stress

In order to manage workspace stress, you've got to reduce your office noise. You've got to create a healthy workstation, and clean and organise your office. If you can, reduce your commuting time or do something productive during your commute that might help you with stress.

Scheduling your task to match your energy flow

The secret to your future is hidden in your daily routine. You have to be self-disciplined to spend your time wisely. - Michelle Moose

The other thing to think about is your energy levels. The big benefit of waking up early is the fact that you are fresh. You also don't have the normal distractions of phone calls or people wanting your attention. Find out if your energy level is more in the morning, afternoon or evening. Then try and schedule in the different tasks that require a lot of focus, like your FRCR exam preparation, when you know your energy level is up.

However, if you’ve had a chance to take a short power nap in the afternoon, of between 20 and 30 minutes, it will drastically increase your productivity. Researchers found that short sleep helps fight fatigue and improves memory. Also, it’s recommended to have certain foods, drink lots of water, and maybe take a brisk walk or meditate, if necessary.

Eliminating unimportant work

Keep an activity log. Look at the things that you seem to be doing and then review your tasks to understand which of them are important to achieve your goals. Then sort through your tasks and decide your most important tasks. Delegate or outsource the unimportant things that need to be done. Avoid multitasking when working on important tasks. Multitasking is just doing things very fast and it can make you quite tired.

Activity Log

Look at what you were doing, how you felt when you were doing it, how long it took and how much value it has. Nothing done over two days is similar. There are things that always come in, but there are certain things that are routine that you do repeatedly. Write down these tasks, look at how much time you take, and don't rely on your memory because having a lot of to-do lists in your brain can get you stressed. 

You will also be able to understand whether or not you're doing your most important task during the right time. This also helps you to identify the non-core and non-urgent activities you might be doing. And especially when you see for yourself how much time you're wasting, you can change the way you work to eliminate those problems.

Action Priority Matrix

Most of us have many more activities on our to-do lists than we have time available to work on them. By choosing activities intelligently, we can make use of our time. But, if we choose poorly, we can bog ourselves down into time-depleting tasks or low-yield projects that can stop us from moving forward. This is where the action priority matrix is very helpful. We divide the matrix into four things:

• Quick wins are attractive projects because they give you a good return from relatively little effort. You can focus as much as you like on these things.

• Major projects are high-impact and high-effort projects. They give good returns, but they are time-consuming. They can crowd out those quick-win projects. 

• Fill-in things are the low-impact and low-effort projects. Don't worry about doing these activities if you don't have spare time. Drop them or delegate them if something better comes along.

• Thankless tasks are low-impact but high-effort tasks. You've got to try and avoid these activities because they give you a very low return, and also soak up your time. 

Checklists are invaluable. You could have different checklists for different activities or occasions. All you need to do is just go and check whether you done all those things, and they save you so much time. In radiology, you should be using checklists when you're reporting, it will help you incredibly to take away stress. You can make reports that have a checklist built into them, and then you just read through the report and check off everything that you’re doing.

Create a checklist for athropathies, how you look at the chest X ray, the skull X ray, abdominal X rays. What are the things that you're going to look at, or shouldn't miss, and so on. You could have a checklist for the chest with the usual, heart size, lungs, hyla, APCs. Behind the heart, bones, soft tissues, and then have a negative checklist. Pneumothorax, rib fracture, soft tissue mass.

You can probably finish one rapid reporting case in 30 seconds if you have a checklist. Most of the time you're going to pick it up straight away. When you're reporting CT abdomen, do a checklist for liver, pancreas, spleen, kidneys, gallbladder, bowel, small bowel, duodenum, ileum, stomach, and then do a negative free air. Check if there is any medias mesenteric stuff, metastases, pelvic masses, little renal lesions because those are the things we miss. Make a checklist, it will reduce your stress. 

Leverage Time Management Strategies

Work expands to fill the time available for its completion. - Parkinson's law. 

If you schedule 2 hours for an activity, you'll often find that it takes that much time. But if you schedule half an hour, you probably will find yourself squeezing it and finishing it within half an hour. Try to challenge yourself on how quickly you can do things. When you're in a flow, you operate at maximal capacity and you also feel much better.

The Pomodoro Technique

Use a timer and work in 25-minute blocks, then take a five to seven-minute break and work again for 25 minutes. It's very simple, but surprisingly effective. For example, when you're doing rapid reporting, it's a 35-minute exam. Do it in 20 minutes and check your answers, then stop and take a break. Finish your task in 25 minutes and take a proper break, maybe get a coffee or something.

Setting deadlines and being accountable is quite important. After one Pomodoro, record what you've completed, enjoy your five-minute break, and then repeat that four times. It’s also a good idea to use to-do lists. If you get an idea, don't try and keep it in your brain, put it into the to-do list, transfer what's in your brain to paper or some kind of device. You should not allow yourself to get distracted with emails, team chats, text messages or anything during these 25 minutes.

Have Efficient Meetings

What's a bad meeting? One that doesn't have a clear start or end time, has too many people and doesn't have any clear action list. In the end, all you're doing is discussing ideas where you have a few people who don't say anything. It's much better if you have the meeting, discuss your stuff and then feedback to the people who need to know the ideas behind the meeting. 

A good meeting is one that has a good meeting agenda and you know exactly who needs to attend it. Everyone has a chance to contribute and thus provides feedback. It's efficiently run and fulfils the meeting's objectives.