Amanda: Hey guys. Welcome back to the podcast. I am Amanda.
Laura: I'm Laura.
Kendra: And I'm Kendra. Hi.
Amanda: And today we are so excited to welcome Dr. Christina Shenvi to the podcast. We heard her speak while we were at AAWEP in Washington DC and knew we needed to have her on the show to help all of us. She comes with an incredible academic pedigree including Princeton, Berkeley, Yale, and UNC. She's a mom of four, a practicing emergency physician educator, keynote speaker, and leader. She's going to talk with us about how she gets everything done with tips for time management. Welcome to the show, Dr. Shenvi.
Christina: Thank you. I'm excited to talk with all of you.
Amanda: Is it okay if we call you Christina or do you prefer Dr. Shenvi?
Christina: Please, please call me Christina.
Amanda: Okay, sounds good.
Laura: Christina, we're so excited to have you here with us. Would you mind just telling our audience a little bit about you?
Christina; Yes, I am an emergency medicine physician and mom of four, and I spend most of my time doing medical education. I'm also a coach, and a big part of my life is being a lifelong learner. And over the last five plus years, I've become really passionate about how we can help ourselves, help each other, help other busy professionals do more of what matters with less overwhelm. I feel like so many of us, I hear from my colleagues, go through life just trudging through in this constant state of overwhelm, feeling like they're up to their eyes with, you know, drowning in things. And we never are able to give ourselves that gift of time to come up from the water a little bit, look around, breathe, and ask, are we doing the things that matter most to us? So I have started teaching on this, lecturing, running workshops and faculty development retreats on the topic of time management. And sometimes I share what I do, but mostly I'm sharing ideas that are rooted in motivation, theory, and self-worth theory. I've read a lot from the psychology literature on procrastination and willpower, and at its core, managing our time is really. Not about changing time. We're not Dr. Strange from the Marvel Comic universe. We can't shift time. All we can do is change ourselves and change our own thoughts and feelings and our own actions. So it comes down to really being intentional with what we do with our brief wild ride on this planet.
Laura: It is awesome that you say “come up for air". Actually reminded me of the book I'm currently reading. Have you read “Come Up For Air" by Nick Sonnenberg.
Christina: I have not.
Laura: Okay. Well, I highly recommend it. It's basically he just goes through a variety of different methods to streamline our lives using current digital tools. But it's great.
Christina: Oh, I love that. That's, I'll have to add it to my list. The one that I finished most recently was Cal Newport's “Digital Minimalism”, which was also great. Similar ideas. And then Greg McKeown's, I'm not sure how you pronounce his last name. Yes. “Essentialism”. Essentialism is another big one that comes to mind.
Amanda: That's our book of the month. We're, we're all listening to it.
Christina: Oh, fantastic. I love it. Such a good one.
Amanda: We'll be doing a podcast on that one before too long.
Laura: So you're a time management coach in addition to everything else. How did that come to be?
Christina: Part of it was my own personal interest. I started just reading voraciously about how do people successfully manage things, how do we become more successful at doing what matters? And then also over the last five years, a big part of my job at work has been coaching medical students. To help them be academically successful. And what I found was that a lot of the challenges were rooted in how they planned their day, how they managed or didn't manage their time. So then I started getting more interested in that topic and spoke about it at a few different national conferences or grand rounds type things, and every time I would speak on it, people would come up to me afterwards and say, “wow, that really resonated”. That's a really different approach than what I've seen before. And so I started getting asked to create more, to create a lecture series. So I created an eight hour asynchronous series of material and created a workshop at the request of another institution. And so that's just kind of grown into lots of opportunities to teach thousands and work with thousands of high performing professionals, mostly physicians. And then also I teach regularly with the Executive MBA students at UNC.
Kendra: That's awesome. Yeah. I think as we evolve we just can't keep using the same techniques. I mean, I would've loved to have that in med school and residency. I think we had like one time management school in undergrad, but it was more like, “Hey, you need to see your advisor and you need to make sure you have books. And you need to make sure you go to class” It wasn’t any strategies. It wasn't really like a mindset.
Christina: Exactly Kendra, and it always seems to boil down to just do better. Like just do better. Right. You know, just buck up and do it. Which is not a strategy. In fact, that's kind of demotivating. And you know, you mentioned just the, we have to adapt with the change in technology, the change in our lifestyles. And back 50, 70 years ago when a lot of time saving devices were being popularized the washing machine, dishwashers. The question people had was, what will future women do with all their free time? Which seems laughable to us now. That's so funny. Right? But the idea is the treadmill just keeps going faster. So yes, we have these things, these apps, these technologies that will help us do things more efficiently. We don't have to hand wash our clothes. But that just means the treadmill speeds up.
Kendra: Right? That's very, very true. Hashtag facts right there. So what are some of the recurring things that you do see in your physician and even MBA student clients?
Christina: A lot of similar themes. Probably the biggest one is the too much on my plate where people come to me saying, all right, I've done the math. I've got 24 hours in a day. And I've got, you know, 26 hours worth of stuff to do. And so really just trying to like continuously pack more and more in, and a lot of this will often come down to the achiever in us that keeps piling on more. That keeps saying yes. Or sometimes it's the people pleaser in us, or the part of us that's trying to prove other people wrong who said we'd never make it, or the part of us that really enjoys what we do and wants to do more of it. And all of those reasons together can often add up to the situation where we've just got too much on our plate. Another theme I see is not taking the time to slow down to speed up. If you think about effort, effort has three components, direction, intensity, and perseverance. And sometimes what we end up with is a lot of intensity, a lot of perseverance, like we've been working on this pathway really hard for a long time, but are we going in the right direction? And ironically, if we're not going the right direction, then that intensity and that perseverance are actually maladaptive. So taking the time to pause and say, let's do a retreat. Let's take time to coach or reflect on “are we going in the right direction?” so that we can course correct.
Kendra: So good point though that you said, you know, time for a pause because I think in the essentialist book by Greg McEwen, he, I mean, he talks about that a lot. It's like doing 15% of the work, but doing it. 90% well and putting out a product and it takes a lot of saying no, figuring out what's really important and being able to say no. Cuz Amanda said this before. I mean, when you keep saying yes, you are really in turn saying no to something else. And it may not line up with what your priority is or your value. So give us some tips on what our listeners could maybe start using today.
Christina: Almost all of the time management challenges that people have brought to me or have told me about on surveys and one-on-one interactions can fall into one of four areas that we can work through. And this is kind of my framework for how to approach most challenges. And those, the four parts are priority, strategy, efficiency, and reflection. So priority, starting with “are we doing the right thing?” “Are we going in the right direction?” And you know, we can always make more money. We can invest money, we can make a return or earn an interest, but we can never make more time. And yet many of us spend a lot of time thinking about where do we invest, where do we save, and how do we spend our budget with money? Then we just give our time away for free, or we fritter it away in things that are meaningless. So the first step with priority is getting really clear on our own personal priorities and our own big values. And there's lots of ways to do that. From just sitting and reflecting on what matters to you most, or reflecting on where did I get the most joy? Where did I get the most sense of meaning in the last five years? Another framework is the Japanese concept called Ikigai, which is if you think about a Venn diagram, you hold these bubbles in your head with the overlap of what you love doing, what you're good at, what the world needs, and ideally what you can be paid for. Although, you know, lots of us do things that are not paid and we do it cuz we love it and we get a lot of joy out of it. But if you look at, write down everything that you do, work things, home things, community, religion, community service, all of those things that you do. And see where there is overlap with those circles. It can be really helpful because you can start to see, oh, you know what? Yeah, this committee that I'm on, I just did it out of a sense of obligation. I don't like it. I'm not necessarily good at it. Maybe it's helpful. The world needs it. I'm not getting paid for it. Those are some of the easier things, the lower hanging fruit. Now you can still be strategic if you say, well, this committee isn't great, but it will lead me to something else that I love. But I think we need to be cautious with that. So, I think many of us who have gotten to where we are as physicians are the marshmallow delayers. So if you remember those tests from Stanford in the seventies where they gave kids a marshmallow and then said, Hey, you can eat this marshmallow now. Go ahead, or you can wait and then have two marshmallows. And what have we done all of our lives? Well, I'm not gonna go out. I'm not gonna go to that party. I'm not gonna watch tv. I'm gonna, you know, sit down with my books and study and that marshmallow is gonna come back to me later, right? I'm gonna get double the marshmallows in the end is what we tell ourselves. This delayed gratification, which can be very adaptive. That's how we've been successful. That's how we got into medical school, got into residency, did all these things. But then at a certain point it can become maladaptive because we're constantly pushing off that marshmallow. And then at some point, maybe it's early career, mid-career, we look around and we're like, where's my mountain of marshmallows? That I deserve from all the things that I have put off and, and it's not there. And maybe there, there's definitely rewards. It's rewarding to be a physician. It's rewarding to be, you know, compensated for what we do. It's rewarding to have those interactions. But those skills, those same skills that are adaptive, sometimes become maladaptive when we use them too much. So we can often find ourselves if our goals are not clear, if our values are not clear to us, someone else is gonna come put their goals on top of you. They're gonna come say, well, hey Kendra. Hey Amanda, Laura, why don't you go this direction? This would be really great for you, and maybe it would, but maybe that's not your goals. So taking the time to identify your priorities. The next step is strategy, and I think about this as working in the right way. Being intentional about how you architect your day and your time. Now, when I'm on shift in the ER, it's kind of eight hours of there I am. I'm trying to be as efficient as possible, make sure I take time to think about things. But then on other days when I have more autonomy over my day, I think about our time in terms of deep and shallow work. And this is very impacted by Cal Newport's work and his book Deep Work. Where some work we need to have a full focus on. So if I'm writing or you know, reading something or trying to write a paper or write a curriculum, that's deep work. I need to have allocated time. I need to focus, not try to task switch or multitask. I need to stow my devices so that I'm not distracted. But there, that's the digital minimalism that comes in and really need to focus on that work. Whereas other work is more shallow. Things like emails, tracking, sometimes charting. Charting can sometimes be deep, sometimes be shallow. So looking at your day and strategizing, all right, I'm gonna use these two hours for this deep work, then I'm gonna, you know, knock out my emails. Then I'm gonna do these meetings in the afternoon, cuz that's when I'm less focused and meetings work well then for me.
But being intentional about it for you. The third component is efficiency. So all those things like emails, other shallow work scheduling, man scheduling is like the bane of our existence, trying to get two or more people together. It's like solving the three body problem in physics. So anything that you do frequently or that takes little brain power, finding ways to either outsource it if you can, delegate it or make it more efficient. And this is where some of the shortcuts or other things come in handy. But time management is not about life hacks. It's not about, oh, if I only had the right app or the right to-do list or the right calendar, suddenly it would work. If it were that easy, none of us would have any difficulties. So it has to come after the priority and strategy steps. But then some of my favorite efficiency tools are things, you know, in charting, like dot phrases, that's an obvious one. But then one of my newer favorite ones is essentially a way to make dot phrases for your life. This is Magic Text Expander, which, and there's others that just happens to be the one I use, which is an add-on to Chrome. So then anytime I'm in Chrome, whether it's a Google sheet, whether it's an email, emails where I use it most, you can make your own dot phrases. So I have whole dot phrases for emails that I send frequently. If you send an email to me and say, “Hey, can I meet with you?” I will reply and type in the phrase “meeting” and it will populate with, “Thanks for reaching out about this. I would be happy to meet with you. Here's a link to sign up for a spot with me. Can't wait to talk soon.” So all of those things that I was typing out over and over. If you're typing something more than three times, automate it. Make a dot phrase. The other part that I love for scheduling is programs like Calendly or there are others that you can use where people can just sign up for a meeting with you. You don't have to email back and forth and say, would 9:00 PM work? Would you know, 9:00 AM work? What time zone are you in? Just automate all of that. And then the final step, so priority strategy, efficiency. The final step is reflection. A lot of procrastination. A lot of the, too much on my plate comes down to our self identity. How we think about ourselves, how we think about the things that we're doing. And if you, maybe you can relate to this. Think back to some task that you just dreaded. You put it off. You're like, I'm too busy. I'm gonna do it later. I just don't wanna do it. I hate this. You put it off for weeks, months, maybe years. Then you sit down to do it. What? It takes you one hour, two hours, and by the end you're like, you know what? That felt good. That doesn't feel bad. And then we wash, rinse, repeat. So it's those emotions that we want to avoid. We procrastinate for many reasons, but a major archetype is we're avoiding feeling those negative emotions, whether it's boredom, don't like this task, or self-doubt. What if I fail, or insecurity or all of those emotions come into it. So taking time to really reflect. To identify your thoughts and the feelings that those thoughts are creating and seeing how they're serving you or not serving you. Are they adaptive or maladaptive? That's my framework.
Amanda: Oh my gosh, that is so good. I have had decades of procrastination and you think you're escaping the difficult thing, but there's this thing over your shoulder looming, so that's been eye opening for me. Like I'm not escaping anything and I'm just making it much more miserable than it should be. So let's dial down into something that is the bane of many of our existence in medicine, charting and the EHR is a frequent complaint with our physician clients. Do you have any advice that you'd give people who have challenges staying caught up?
Christina: Absolutely, man, this is such a thorn in our side. Absolutely comes up very frequently and it can come up in many different forms, just getting the charts done day to day or I've worked with several clients who come to me not emergency medicine physicians so much cuz we don't have the in-basket messages from patients. But primary care or other folks who say I have 400 in basket messages and that same procrastination of every time I think about it. It's just this horrible specter looming over my shoulder. So then I put it off more and now it's 450. And how do I even start to think about tackling that? Well, let's use the framework that I gave above. So first priority, why do we chart? You don't have to chart. No one can make you chart, right? You don't have to. Why do you do it? I do it to keep my job. I do it because taking good care of my patients means I need to document. So that's, you know, coming back to what are your vision and values, what's your mission? Well, one of my values is being a good physician. So in order to do that, I'm gonna do my charts. Part of it is I’m the sole financial provider for a family of six. Part of one of my big values is to keep my job, to have a paycheck, to keep the lights on. So in order to do that, I need to do my charts. So tying it first into your priorities and your mission, and what that does is helps bring the locus of control back internally. We have a lot of learned helplessness. We have a lot of emotions about charts and things like this, but one of them is often learned helplessness. They're forcing me to do this. I have no control. So bringing that locus of control back internally. So that's the priority. Then strategy, how do we want to chart. Sometimes charting is deep work. If I really need to just sit there, think about it, and think critically about what I'm doing. Sometimes it's shallow work. I just have to like knock through all those automated dot phrases and knock it out. So thinking about how you need to chart and whether, you know, in the example of the buildup of in baskets, sometimes you need to just allocate two hours of time, two hours of time a day for a week to get that done and plan ahead for it, and plan ahead for the emotions that are gonna come up too. Other times it's just time confetti. During a shift, I'm gonna sprinkle my charting throughout the day so that then I'm not having a ton of work to finish up in the evenings. And also sometimes B minus work is okay. If I try to make every chart an A plus. I read it four times through before I sign it. There's a few charts where I wanna make sure that that's the case, but most of the time it just needs to adequately tell the story and communicate what we did to the next physician. So, sometimes B minus work is okay. So priority, strategy, and then third, efficiency. Take a couple hours and get somebody to help you. If you need to create your dot phrases, create your shortcuts, your order sets, dictation, anything that you type more than three times, make it a dot phrase that will speed things up. And think about charting. Let's say you had, you know, an hour of charting to do, if you could do that same amount of charting in 45 minutes. Not a big change, just drop 15 minutes from that. And this holds true for any shallow work, emails, other things, meetings. If you could take 60 minutes worth of work and drop it just down to 45 over the course of eight hours in a day, that's two hours that you've saved. So those small changes can add up.
And then probably the most important one though, is the reflection. When we look at the emotions that charting evokes, there's some big capital B, emotions, frustration, opportunity costs. Where, well, if I'm charting at night, I'm missing time with my family, I'm missing the opportunity to go to the gym. Also, sometimes institutional betrayal. I thought medicine was gonna be about helping people. And actually it's about clicking boxes for coding and billing, right? And that sense of institutional betrayal. Sometimes its shame. Why can't I figure out how to do this? How come my partners at my work don't seem to have the same struggles as I do? I'm so ashamed I've let it get to this, you know, 400 messages and now I keep getting, you know, nasty grams, reminders that I'm late and that learned helplessness. So just separating ourselves from those thoughts and emotions enough to look at them and say, wow, you know, some of those emotions are actually getting in my way, or I'm avoiding feeling them by putting off the task and just how many big emotions come up for relatively mundane tasks. So looking at them, identifying them and then thinking about how we want to feel about our charts. And now I don't think it's realistic to try to conjure up these positive emotions of, you know, I just love charting. Charting's the best. Right? That's not gonna ring true for anyone, but maybe we can aim for neutrality or what the stoics call a studied indifference where this has no emotion for me, I'm just indifferent about it, I'm gonna do it. And all of a sudden those emotions kind of lose their power. One of the frameworks that I love comes from Byron Katie, who conceptualized it as the work in her book, “The Work” where we think about how are you feeling about this task? What are your thoughts about this task? And if we look at those feelings of frustration, Betrayal, shame, learned helplessness. And we think about what is the thought that is creating those negative emotions. And it can be things like, I hate that I have to do this. This is the worst. This is so frustrating. This is not what I wanted to do as a doctor. Whatever those thoughts are, and, and just try to isolate the thought and then ask yourself, how do I feel with that thought? Now I feel miserable. I feel frustrated. I feel helpless. And then think about, just experiment with, let's imagine your brain could not compute those thoughts. Your brain just cannot think, I hate charting. Charting's the worst. This is gonna be terrible. You just can't think that. And sometimes if you allow yourself to explore that space of my brain just can't think that thought. All of a sudden you're like, “Whoa! How do you feel now? I just feel free. I feel so much lighter. I feel. more neutral. And how would you act with that thought? I would just do it. I would just do my charts. I would just sit there and knock 'em out. It just wouldn't be a thing. It wouldn't have all that emotional baggage and layering. So there's a lot of different ways we can explore from the efficiency, from the operations, all the way down to like, who are we as a person? What are our goals?
Amanda: Oh my gosh, I love that so much. First of all, I love that you mentioned not gaslighting yourself into trying to pretend that you love something that you don't. It just doesn't resonate in your body, like your body knows you're lying. Yeah. Like, yes, just completely rejects it. The other thing is, I noticed you're kind of famous. Al’ai dropped your name, Al’ai Alvarez. You're kind of famous for your word pairings. I love your idea of time confetti. I'm totally stealing that and using that in my own life. That's a super fun idea. So, I'm kind of thinking that I need to get a home consult from you, but I'm doubting that that's available. What sorts of things could an institution hire you to do a workshop or how do people get in touch with you and what are your offerings?
Christina: Yes. Lots of different options and you can get in touch with me on my website, which is timeforyourlife.org or by email [email protected]. And my hope is really to bring some of these ideas and bring this time freedom or time empowerment to as many people as possible. So if you're an institution, I'm happy to come speak to your group, your department. I do a lot of work with women's organizations or emerging leaders, young leaders, et cetera. All the way to a more intensive three hour faculty retreat. I love doing those. I've flown up to Brown to McMasters in the last year to do those three hour retreats where people can really sit down, interact. And one of the great things that happens when you have a group in a department sitting down and doing this together is they start to develop a shared language around deep work, or they develop some shared ideas around. How do we email as a group? what are our expectations about when we send emails? or how do we do these tasks? So all the way from one hour lectures, three hour faculty retreats to four week more intensive workshops, and then of course a lot of one-on-one coaching, which is a great way to take the time to reflect and think through some of these things.
Amanda: Oh, I hope so many people reach out to you cuz it's such a help to be in control of your time. As we close out, do you have any closing thoughts?
Christina: I would love to leave people with hope. Hope that change is possible. We don't have to live in this constant state of frenetic, shallowness and overwhelm, but change requires a lot of intention and sometimes we have to change our own self identity or our own self narrative. I've worked with a number of people who have this narrative of, I'm just a disorganized person, or I just work better at the last minute, or at their core, they feel they need to stay busy to be important or to be relevant or to prove themselves. And so this process of reflecting on our priorities, our strategies, and how we work efficiently is kind of like a continuous quality improvement process for our life. And it's something that we're never done at. We're always striving to improve and sometimes we grow best through a metamorphosis. So I love to think about my role as a coach, as a thought partner, and as someone who can help catalyze that change, catalyze that growth, and sometimes that change or metamorphosis requires us to shed an old part of ourselves, those things that might've served us saying yes, always being the person who does everything. That those things no longer serve us. And so we have to shed that identity. I think about it kind of like how lobsters grow, where you know that the exoskeleton helps them, protects them, serves them, and then as they grow, it no longer fits them. And in order to grow, they need to scuttle under a rock where it's safe, shed that exoskeleton and then form a new exoskeleton that's bigger so that they can grow into it. So I think about coaching is that time under the rock where it's a safe space to shed that constricting, whether it's limiting beliefs or thought patterns or just habits, shed those and then take on a new identity as we grow. So I would love to leave people with that final word of hope.
Laura: I love that. We love the lobster.
Amanda: We are obsessed with lobsters and just the fact that it requires you becoming uncomfortable to take the steps to grow. Otherwise you wouldn't ever grow if everything was always pleasant and, and there wasn't a little bit of pain involved.
Kendra: I love that you said that sometimes those labels or that identity, some people call it labels, you know, it's basically your identity gets wrapped up in like, “oh, I'm just a procrastinator” or, “oh, I'm just better in the two minute warning”. Are you though? Because maybe that was okay in high school and college, but now you have a different identity of multiple roles. You need to get your stuff in gear. And so I just love how some people just wanna cling to those labels or that identity and like you said, it just is not serving you in this season. So thank you so much Dr. Shenvi for being here today. You have given our audience amazing tips and tricks, but also just the realization that it's not just about trying to hack into our schedule, hack the hours, the minutes, or the days, but it's really just you know, that mind, body, brain connection, that's the most important. So thank you for listening today. And if you want to claim CME for listening to this episode, scroll down to the bottom of the show notes and click the link. So until next time, you are whole, you are a gift to medicine and the work you do matters.