# DTD 184
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This is the Drive Time Debrief, episode 184. Hey guys, welcome to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And today is inspired by my home—it's basically about how tiny signs of neglect, for what we're gonna call on this podcast [00:01:00] "broken windows," can silently erode our sense of control and wellbeing. We're gonna first talk about the origins and psychology of this principle, then we'll talk about at-home and at-clinic scenarios. And then what you might wanna do about it if you choose.
So the first part is, what the heck is the broken window metaphor? And the core idea is the broken windows theory states that visible signs of disorder and misbehavior in an environment encourage further disorder and misbehavior, ultimately leading to more serious problems. This was originally a theory in criminology and we're not gonna talk about criminology because there are some people that feel like this idea, first of all, is false in criminology. And then secondly, like used not for good reasons, but in our personal lives—that's what we're talking about. At least in my personal life, this does hold up.
So the idea behind it, Wilson and Kelling, in 1982, I believe the magazine was The Atlantic, where they talked about it and the idea was one unrepaired window in a neighborhood signals neglect and then [00:02:00] leads to other disrepair and other people also not repairing their windows, et cetera, et cetera.
Zimbardo in 1969 had done a car experiment where they would leave an abandoned car. Now in a particularly awful neighborhood, the car got vandalized regardless. But in your average neighborhood, an abandoned car would just sit there completely abandoned and untouched until he broke one window. And as soon as he would break one window, then all of a sudden, for whatever reason, the car would get trashed after that.
And so it is just an interesting idea of how one little small act of disrepair can lead to bigger problems. And this is an example of what happens on my kitchen counter when I don't separate the mail, it is an example of when I don't have my kids put their shoes away—it's like a moth to the flame for whatever reason.
This would be also what my uncle described in the [00:03:00] lawn mowing area. He would get so bent out of shape 'cause he is like "one bad lawn means the whole neighborhood has bad lawns" and he was very uptight about keeping the lawn mowed.
Yeah. Yeah. All of a sudden like, the peer pressure isn't there anymore, I guess. I don't know. I don't know why it is, but we're just discussing this idea and how we can use it in our own life. Whenever we have visible disorder, it functions as a cue. There's a perceived stress and I don't think I'm as honest with myself as how much it does affect me, but unintended mess does heighten perceived stress in some sort of way, and the more mess there is the less I'm interested in fixing it.
Oh yeah. You know what I mean? Oh true. Yep. And for me too, I do get stuck in my perfectionism where if it's a big enough task, I don't even wanna start it 'cause it's gonna take me forever. So that's something that has been really useful for me. Like I don't have to tackle the whole thing. I [00:04:00] just need to do like five minutes. But your motivation does drain, ignoring these minor issues. And then to me, it just, it turns into a bigger challenge the second you start letting things go, and I don't know if you've ever noticed this, but this happens all the time in multiple areas of my life, so let's dig into it.
Yeah. I feel like though some people aren't bothered by this at all. I just happen to maybe cohabitate with these people. Yeah. I feel like the level of stress in my soul is disproportional to those that I cohabitate with.
Well, for sure. There's gonna be different levels and different people for sure. I feel like that's—that's true. Yeah, I will talk about this first one hits home with me, but if you come home after a long shift or a long workday and there's a sink full of dishes—trigger warning, I'm sorry. Some of you, this will be a trigger warning—but it can automatically feel, you just feel overwhelmed. And [00:05:00] I testify, I will preach all day about this and I never really noticed it. What it really triggered, because I guess it was so minimized in my environment, like it's just a sink of dishes. But I think more than anything it was that it just added to coming home after an overwhelming day to like face more overwhelm. I just didn't have the energy.
Yeah. Especially with the monitors beeping all day, like I had some serious like sensitivities coming home after a shift like that, where normal things were much bigger because I was already just sensitized. Mm-hmm. Mm-hmm. Yeah. It's interesting, you know? Looking back, I can see why sometimes I would walk into the dark house, not turn on one single light, just sit there in the dark with no TV, no radio, I mean, nothing. Just like, mm-hmm. Okay.
But we'll talk about some of these examples, but psychologist Gretchen Rubin, she identifies cluttered counters and dirty dishes as classic [00:06:00] personal broken windows—they elevate stress for high pressure professionals and obviously these are just examples, but you can think of something that if you were to walk in after a busy day even, or just a stressful day, or like Amanda said, a sensory overload day 'cause Lord knows we get interrupted a million times and I mean, our brains are literally going so many different directions for a prolonged period of time that I feel like system breakdown, system failure, system breakdown, system failure, like alert, alert every day going down.
But this could be also unsorted mail or paper, like Amanda said, like if you just keep checking the mail and bringing it home and setting it down on the counter, you know, we have a certain place that I like to put mail. Unfortunately, that region is the only place I put mail. My cohabitants don't seem to [00:07:00] appreciate the designated mail space and that's okay. But then it gets on the counter and then I'm trying to cook dinner, you know, so trigger warning. But what it can create is just feeling always behind. It's some kind of narrative that you make up in your brain like "I'm behind." You know? It gets, that stack gets more elevated and thicker and deeper, and you're just constantly subtly increasing that anxiety.
Like Amanda said, if you look at it long enough, at some point it just becomes overwhelming to where like, I don't even wanna tackle this because the perfectionist in all of us is like, if I start this, I have to finish it, meaning complete too, like all done, and that takes a little bit of work and intentionality. But individuals who tackle small tasks immediately, like sorting the mail or just taking a handful of the papers right away, report lower stress levels. Gretchen recommends that if something takes less than a minute to complete, don't write it down or try to remember it for later. Just do it. Just do it now, and I am trying to subtly train my 15-year-old son that he has way too many distractions [00:08:00] that down the line, if I have to ask him three times, that does not help either of our anxieties.
And then, you know, the old unmade bed, right? Leaving the bed unmade—a task that can take seconds unless you're in my house and then my husband's like, "what are all these pillows we don't sleep on?" And that, you know, obviously takes 30 minutes—can undermine a sense of order and negatively affect the mood. But studies say, and we've talked about this before, that references such as the National Sleep Foundation found that people who actually make their bed every day do report better sleep quality and better wake up time, morning wellbeing.
I can't say that I do this making of the bed on the regular, I just don't. But there has been many articles that I've read about, and also there are quite a few podcasts I listen to, leaders that I listen to that say sometimes in order to get out of a funk, do one thing. And that might just be making your bed for the day, because that right there just gave you purpose, right? [00:09:00] Mm-hmm. And so if you find yourself kind of in a funk or just a little bit of a spiral, or a couple of days are just off, sometimes it's what you can do. Make your bed every morning, you've just done something, it gave you purpose and move on.
There's some other potential broken windows, like the shoes, the shoes everywhere. And I live, I, we've talked about this before. Thankfully, I live on a cattle ranch, so we have regular shoes and we have farm shoes, farm boots, all the things. So it gets a little chaotic here, but staying in the pajamas all day, this is, sometimes you just need a pajama day, but sometimes for people that, that's a trigger. Eating food straight from the container, you know, wearing stained or ripped clothes. This happens to be one of my broken windows. Unless it's ranch clothes, we don't wanna go out in public in the ripped clothes, piles of laundry or trash.
So you can see these aren't things that overwhelm. We're not talking about an episode of Hoarders. We're just talking about the fact that there are just small things that end up creating a low level anxiety that really, if you take a step back, could be [00:10:00] taken care of. And why not? We have enough to be anxious for. We have enough to worry about. We're in the business of lowering chaos or at least organizing the chaos till it's manageable, so why not?
But at work, this could also look like backlog charting inbox. Oh, right. When you preach about the inbox, it can really nag at you when it's just constant, when it's just never zero or never cleared out. It can just be a constant nagging reminder. If you don't answer your pages right away, I'm not sure if that lands, but unreviewed labs or just messages unanswered. That's just a bunch of digital clutter. It's real every time you sign into your EHR, and this just creates more and more cognitive overload.
How about your workstation? Right. I definitely can tell who I follow when I come on shift because it is clearly, like, I just think of Pigpen from Charlie Brown. I'm like, oh, I think to myself, well, Pigpen's here. You know? So I've learned that I need to get there, you know, 10, 15 minutes early, not just to like focus, but also I'm not [00:11:00] sure what I'm gonna walk into. And I do need a workstation that doesn't have crumbs and squatted up papers and everything because it does, it does help you focus to know that everything has order and a place and whatever clarity you can find during a chaotic shift, this is helpful.
And procrastination of minor tasks, this is that thing, like just ignoring the small tasks like filing things away or putting things away, or restocking whatever you need in your office or your clinic or the ED even. These minor tasks that go uncompleted really consume some working memory resources. And once again, it just raises the stress 'cause if you're spending an extra minute or two trying to find gloves or trying to find the curette, or trying to find whatever that is, it's just gonna allow that anxiety or that baseline stress, you know, that chronic stress we were never meant to sit at, just to continue to simmer. And that will just keep you at that level 10 stress response and it [00:12:00] does not help focus.
So just think about it. Notice what small tasks are the most dangerous for you, or what broken windows increase that anxiety or just get you out of focus. And it's different for different people. Like for instance, the dishes thing. Gretchen says as long as the dishes are in the sink, she stays good. But her husband, that is really bothersome for him. He needs it in the dishwasher. But like, none of this are hard and fast rules, but just noticing which things are dangerous for you. They're different for other people, but like those are the ones that you would wanna focus on.
Yeah. I just wanna put my testimonial behind all of these things. I just see such a huge improvement in my mood and my energy level when these things are attended to, and there's a couple of resources that I have found really helpful in helping me develop like a routine. [00:13:00] Years and years ago, I've followed the Fly Lady. If you don't know who she is, her name is Marla Cilley and she is this really fabulous lady who lives in Brevard, North Carolina. And she has built a business on helping people who may struggle with taking care of these little broken windows. She helps you develop routines and her website and resources are awesome. She's got a book.
One of the things that helped me was developing a morning routine, and that is always making my bed always, I call it starting the machines if you know, I usually start the dishwasher the night before, even if it's not full. I run that thing every night, so in the morning it takes like four minutes to empty the dishwasher, and then I have an empty dishwasher to put stuff in during the day so I don't get the pile up in the sink, start the laundry every morning. I just reboot it and do, you know, move the thing, move the stuff to the dryer and fold and put away the other stuff at each one of these things takes just a few minutes to do and they [00:14:00] make such a difference in your peace of mind.
So that's a great resource. There was a book called, it's an old book, I think it was from like the eighties, called Sidetracked Home Executives, and it's kind of, it's a cute little book about these two sisters who were homemakers and who sounded like they had ADHD, but they just got kind of overwhelmed by things and they created some systems to help them. So the creating a routine or a system that you do that becomes a habit helps it frees up some of that cognitive bandwidth as well. So you're not trying to have to remember, it's just kind of what you do.
Just like all the things we are supposed to do to take care of ourselves, we dread it and then we're so glad I got a house cleaner how long ago? I've tried house cleaners here and there over the years, and then they would do something that my OCD couldn't take. Like one set the used bathroom rags on my [00:15:00] white bed. And I wish I was like, I can't, I lost my mind, but I found a really amazing one. And she helps. That's accountability. You know, like we have to have our crap together for her to be able to come clean. And it helps her, like it's a blessing to her. We can afford it and it provides that accountability that things never get completely out of control, which they would.
So make some decisions ahead of time that will help you. What cues do you have that are helping you or harming you and keeping things under control? So an example we've used a lot is from, well, we use Tiny Habits and Atomic Habits. Those two books are so helpful and some of this behavioral change, the techniques they describe include stacking something with either a cue or a habit that you already do like while your shower is warming up. Like mine, it takes two minutes to get the cold water gone, and yeah, maybe I should just stand in that cold water, but I'm not [00:16:00] there yet. I'll make my bed during that time. Or if there's an inspirational talk that I wanna listen to, I'll listen to it while I'm in the shower.
When I was trying to develop my identity as an exerciser, I stacked it with being in the shower 'cause I will take a shower every day, at least once a day. I get in a crazy funk if I haven't had a shower. So I know that I'm gonna do that and I know that I can tell myself, well, I'm gonna do a couple of pushups in the shower, I'm gonna do a couple of squats. And that helped me create that identity as someone who exercises every day. So little things like that. If you're a coffee drinker, that's one that you can tie a cue to—while your coffee is being made, you empty the dishwasher. So those are some ideas of things that you can do to use cues and habit stacking to keep those things from getting out of control.
Placing sticky notes on your chart screen, or a sticky note at your desk. [00:17:00] Don't see more than two patients without completing a chart. Another tool that you might use is linking a repair task to a habitual action. Like after I log off, I'm gonna straighten up my desk. After I come home, I'm gonna empty and sort the mail. Just take the mail over to the garbage can and sort it right there before you sit down on the couch.
There's some window repairs we can do on our mindset and our cognitive world. We can draw a parallel between physical and mental windows. So when we notice self-critical or catastrophic thoughts, like, "I'll never catch up," or "this is just who I am, I'm always gonna be behind"—reframe it. "I've managed 10 charts. I can manage one more." We can think about when we were, you know, if we get overwhelmed in clinic or in whatever environment we're working in. Think about back when you were a resident and how you could only, you know, like a baby intern or even a med student. How seeing [00:18:00] you know, five patients an hour would like, it was mind boggling. You could never do that. It took you like two hours to see one patient, do all the things you needed to do and chart, so you can increase your speed. You can become more efficient. You've got evidence that you have already done that. So look to the past to see where you've ramped up. You can do it. You can do it again. You can find ways to streamline. You just have to believe that you can and overcome some of the discomfort that comes from doing things a little bit differently.
Breathe. Use a three step pause—that inhale, hold, exhale to neutralize stress that we've talked about it over and over again. That really helps reengage our parasympathetics so that we're not in fight or flight as we can be. When some of these things are stressing us out, when we're in fight or flight, our prefrontal cortex is offline, that's the best part of our brain [00:19:00] for executive functioning, we need it to be able to stay on top of stuff. So if we find that we're getting stressed, really taking that time to relax is gonna be very well invested. It's going to help us get back into our prefrontal cortex so that we can use that good planning part of our brain to move things forward in a more efficient way.
So we know that you all are used to dealing with all kinds of stress. What is your go-to method or do you have a mental reframing that you use when you notice that there is a little internal window starting to crack? You hear that inner critic starting to pipe up, or you start feeling despair or start complaining in your brain. How do you redirect that and get yourself back on track? We'd love to hear the ways that you fix the broken windows before they widen in your life. Be sure to just send us all that. We'd love to hear it. [email protected] is where you can send that information. [00:20:00] And we just want you to know that attending to these windows, it's always gonna be time well spent.
That old proverb "a stitch in time saves nine." If you notice a stitch popped on your seam, if you put that thing back in, then you'll save yourself nine stitches down the road. If you chart immediately after seeing the patient, while that information's fresh in your brain, it will take you, I need somebody to do a study on this because I think it probably takes you less than half the time to chart immediately after you see the patient versus putting it off till the end of the day just because it's fresh and you're less tired. So use that "stitch in time saves nine." Fix the broken windows and you're gonna save yourself a lot of time, effort, and energy.
Yep. So we hope we've inspired you today, or at least created an awareness around your broken windows and what may be triggering you and maybe some hacks that you can use and implement today to help, you know, reduce that [00:21:00] anxiety and stress level.
So anything we can do to lower that or inspire you to make a change, we hope we've done that today. And don't forget to follow us on the socials. We are on the Gram. We're on Facebook, Twitter, and YouTube. Of course, if you're watching us on YouTube, you know that. So until next time, you are whole. You are a gift to medicine and the work you do matters.
