August 14, 2026 |
Categories:Opinion.
On any given day I could be in the Multi-Disciplinary Team(MDT), running a specialist clinic, out on home visits, ringing patients back, taking advice calls from other clinicians. Some of those visits mean an ultrasound scan to assess ascites, in clinic or at the bedside at home. And around all that: GP trainees to supervise, medical students and sixth formers, a palliative care trainee I’m the educational supervisor for, a quality-improvement project, a corneal donation policy in the background. None of it turns up in a sensible order. The policy gets a bit further along in the gaps, a few minutes at a time, and that’s enough.
Take last week. I’d set aside time to prepare some teaching when a call came in about a patient at home, and I needed to judge whether they really needed a hospital admission or could be managed where they were. So, I went. The teaching prep didn’t happen that day, and that was fine; it got done the next. The visit couldn’t wait. The preparation easily could. And as it turned out, the visit itself became the teaching, a real case of weighing up an admission, worth more to the trainees than anything I’d have prepared at my desk.
So the job isn’t a system, just a handful of habits that keep everything in the air.
It starts before any of that, with getting into the right frame. I’ll put music on in the car on the way in, or do some small thing I enjoy first, just enough for a bit of charge. It sounds trivial, but the day goes better for it.
Then there’s triage, done on the move. When three things land at once, I ask which genuinely can’t wait, and it’s usually obvious: the patient who’s going off, the urgent call. The report and the policy can wait; they always can. Earlier on, that was the hard part. I felt everything had to be finished then and there and couldn’t settle until it was. Learning that some of it can safely wait, and letting it, took time, but it’s where a lot of the calm comes from.
“No plan” doesn’t mean no shape, though. I keep a few things nailed down, the MDT and the supervision meetings, and let everything else flex around them. The MDT is usually where the day’s shape shows itself; I come out with a feel for how busy it’ll be.
I’ve learned to take that as it is rather than dread it: accept the busy day, jot the tasks down on paper, and split it into three blocks, the morning after the nine o’clock MDT, midday from twelve, and three o’clock for wrapping up.
There’s something about writing it down by hand, rather than on a screen, that helps me hold it all and lets me tick things off as they’re done. The rest, calls and notes and feedback and admin, I batch rather than handle piecemeal. Whatever I sketch out at half past eight looks nothing like the day by ten, but that stopped bothering me long ago. By the afternoon the day that looked impossible at nine has usually smoothed itself out.
The hardest part is switching cleanly. Moving from a call to a patient to a trainee inside an hour, I try to be fully there for each and not carry the last conversation into the next. I don’t always manage it, but a few minutes of proper attention is better for everyone. The drive between visits helps: ten minutes in the car is where I set one patient down before the next.
And then there’s the uncertainty, which organisation can’t make go away. When families ask how long, I don’t just say “I don’t know.” I can rarely give an exact figure, but I can usually say whether we’re looking at days, weeks or months, what to watch for, and how we’ll adjust as things change. That informed read is the specialist’s job, and far more use to a family than a shrug. Early on, not knowing for certain felt like a failing I should be able to fix. It isn’t; it’s a skill in itself, and learning to work calmly without certainty is a lot of what keeps this job doable.
None of this works single-handed, of course. There are colleagues who’ll pick up an advice call when I’m tied up, cover a visit I can’t reach, or talk a hard decision through with me. And a good medical secretary controls the traffic, in the best sense: fielding calls and steering requests my way in some order rather than all at once. The juggling only works because mine aren’t the only hands in the air.
People assume a week with no plan must be exhausting. For me it’s the opposite. The variety is the bit I love, and once you get the knack, it’s genuinely good fun.
For a long time, I thought good time management meant getting on top of the day. I don’t think that anymore. It means making peace with the fact that you never quite will, and doing good work anyway, calmly, one thing at a time. There’s no set plan. The juggling is the plan, and most weeks I wouldn’t swap it
Dr Ramesh Thulavavenkateswaran
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