The Distracted Physician: How to Be More Present When It Counts | Ep23

Michael Hersh, MD

[00:00:00] 

Dad, why aren't you playing? I'm sure this scene feels familiar. You're on the floor, toys in hand, doing your best to be present, but your mind. It's somewhere else entirely. Bills that need to be paid. Your call schedule this afternoon's clinic, tomorrow's procedures, unanswered emails, planning your next vacation.

Even the dog's heartworm pill. You're physically there, but your mind, it's a million miles away. If you've ever felt that split, finally home, but unable to focus on the people who matter most, you're in the right place. This episode is just for you.

Well, hey everyone, and welcome back to the Better Physician Life Podcast. I am Dr. Michael Hersh, and I'm so glad you're here today. So we are talking about something that comes up. All the time for physicians, you finally get [00:01:00] home. You are surrounded by the people you love the most, but you just can't focus.

You're distracted. There's that constant background hum of unfinished charts, labs, messages, and the ever-growing to-do list, all stealing your attention from the people who matter the most. Even though this is supposed to be the time you've been waiting for all day, maybe even all week, your brain just won't shut off.

We spend all day helping other people and then we come home to realize we've got nothing left for the people who matter the most to us. Being fully present at home sounds simple, but in real life it's one of the hardest skills to master. Yet, it's also the one that changes everything, your relationships, your focus, and how you actually experience your own life.

[00:02:00] So in this episode, we're gonna talk about why it's so hard to turn our doctor brains off and what you can actually do about it, because this isn't only about being calmer or more mindful, it's about taking control of your time. Your attention and your energy so that when you're home, you're really home.

All right, let's get into it. So when I first started paying attention to this in my own life, I realized something. It wasn't that I didn't want to be present, it was that I didn't know how. Medicine trains us to live in constant motion. We're wired to think ahead, to anticipate, to plan, to problem solve, and we do all of that because we're trying to prevent things from going wrong.

And you're talking about patient A while. You're mentally ordering labs [00:03:00] for patient B, you're documenting today's clinic visits, fielding calls from the emergency room, responding to patient messages, and simultaneously prepping for tomorrow. That kind of mental multitasking is part of the job we were all trained to do, and it becomes second nature.

But at home, it's brutal because the moment we sit down with our kids, our spouses, or even just trying to have a quiet moment to ourselves, our brains just don't stop. It keeps running the list. Did I finish the note? Did I message that patient back? Did I pay the bills? Did I book that flight for our upcoming vacation?

And before you know it, that one quiet moment turns into a planning session with yourself. Then later that night, the guilt sets in. Everyone's asleep, [00:04:00] and you're lying there replaying the day, realizing you were physically there, but mentally somewhere else. If that sounds familiar, you are not alone.

You're conditioned. We've all been conditioned. We've been rewarded for juggling, praised for our speed and our efficiency, and taught to wear busyness like a badge of honor. But at home, those learned and earned behaviors don't quite serve us the same way. For me, presence became one of the hardest skills to learn.

Not because I didn't care, but because I didn't have a system for it. And that really is what this is all about. Learning a better system for being present when it matters most. For a long time, I thought multitasking was one of my strengths. If I could chart, answer [00:05:00] messages, throw in a load of laundry and help with bedtime all at once, that meant I was winning the day because I was efficient and productive.

And maybe I was even a little proud of how much I could get done in such a short period of time. But over time, I started to notice the cracks. More distraction, more mental clutter, more of those moments where I'd stop and think, wait, did I already do that ? I don't remember. My evenings felt like a total blur.

I'd move from one thing to the next, checking boxes, but never really remembering where I'd been for any of it. And here's the part that finally clicked because the problem wasn't my focus. It was my complete and total lack of a plan. Every free moment turned into a free-for-all. Playing with the kids was interrupted by bills.

Bills were interrupted by laundry. Laundry [00:06:00] was interrupted by text messages. Nothing got my full attention, and everything felt half done. And that's not a personality flaw, that's a system problem. And here's the most important lesson I learned. Present isn't just a nice-to-have. It's actually productive, like a lot more productive.

When I'm fully present, I make fewer mistakes. My kids get a dad who's actually there, not just in the room with them. My brain finally gets to rest instead of running constant loops of what's next. But maybe the hardest realization was this. Sometimes the things my kids love, I just don't enjoy that much, and that used to make me feel guilty.

Playing Barbies, not really my thing. Video games, I am [00:07:00] in taking walks with my family, playing Legos, even doing math homework. I can do that stuff all day. And it took me a while to realize that presence doesn't mean forcing myself to enjoy something I don't. It means showing up with genuine attention, even if it's just for 10 minutes, and finding connection in ways that we both actually enjoy.

Because when there's genuine connection, presence stops feeling like another thing on the to-do list, and it starts feeling like a choice. And that's when things really started to change for me, because I realized something really important. Presence isn't about willpower, it's about structure. For years, I thought I just needed to try harder.

In order to stay focused, I needed to force myself to stop letting my mind wander. In reality, [00:08:00] focus follows clarity, and clarity comes from a plan. So I started treating my time outside of work with the same level of respect. I gave my time at work. If something matters, it gets a place on my schedule and when everything has a spot, my brain doesn't have to keep track of all of it.

And here's what that looks like in real practice. So step one, you need to sit down and get everything out of your head. Write it down, type it out, use an app. Whatever works for you, but don't let your brain be your inbox. You need to actually figure out what are the things that need to get done. Then split that list into two this week for things that need to get done in the near term.

Projects for anything [00:09:00] longer term. That's it. Two lists, nothing more. First, you'll be amazed at how much quieter your brain feels just by externalizing the noise, just by giving those things a place to live on a piece of paper or in an app or on an actual list. Now step two is prioritizing. You have to prioritize what actually matters.

And I use a simple four-box system called the Eisenhower Box. And yes, it is named after that. Eisenhower. President Dwight D. Eisenhower actually used this framework to make decisions about what got his attention as the leader of the free world. And if it worked for the Oval Office, it can probably help us manage our inboxes and to-do lists, call schedules, and our home life.

So here's how it works. There are [00:10:00] four quadrants. Box one is the urgent and important stuff. It's in the left upper quadrant. These are the things that truly can't wait, both in medicine and at home. The patient with chest pain, the case you need to review before tomorrow's OR at home. It might be paying the mortgage, fixing a leak, or showing up for your kid's game tonight.

These are your must-dos and non-negotiables. Schedule them first and make sure they actually get done. Box two is for the non-urgent but important tasks. This is where real life happens. These are the things that build stability, not just momentum. So things like family time, exercise, sleep, catching up with a friend, planning the week ahead, and even doing nothing for a few minutes.

These are [00:11:00] the blocks that are easy to skip when you're tired, but they're the exact ones that make you feel grounded. And if you don't schedule them, they'll never happen. Box three are the urgent but not important jobs. This is the trap box. This is false urgency. Things that feel urgent because they're noisy, but they don't actually move anything forward.

Answering the text that could wait, or the email that doesn't really need your response. The committee meeting that doesn't really require your expertise. These are tasks to batch together or, even better, delegate to someone else. And remember, delegation is a leadership skill, not a weakness. And then lastly, we have box four, and this is for the non-urgent, non-important [00:12:00] tasks.

And this is the easiest box to spot. And the hardest to let go of. It's the doom scrolling on social media. It's refreshing your inbox to make sure you didn't miss something, even though you just checked it five minutes ago. It's reading that group text thread about the next call schedule swap. That doesn't even involve you.

These things feel like tiny breaks, but they quietly drain your focus. Delete these. Proudly. You are not being lazy. You are reclaiming your attention for the things that actually matter. And if you take one thing from this part, let it be this: that last box, it doesn't get done ever. That's by design, because once you learn to separate urgency from importance, you start spending your time on the things that make your [00:13:00] life, not just your checklist, actually work.

Okay? Now step three is to take a look at those things that you just listed out and put them on your calendar. Be realistic because if it's not on your schedule, it's not real. 10 minutes to tidy up the kitchen. 45 minutes for paying bills, 90 minutes for family play, label it clearly. Play with the kids, work out, call mom.

These aren't fillers, they're priorities. And yes, I even schedule rest because our physician brains don't rest unless they're told to. We need the fence to feel the freedom. Now I can already predict what some of you might be thinking here, which is there's no way I can schedule this stuff. I have no idea how long any of this stuff is actually going to take.[00:14:00] 

And you're right, you don't. But as you fall into a rhythm with your schedule, you'll learn. but here's another thing. Constraint works. Ever notice how productive you are when you have a hard deadline? How much studying you can accomplish when the test is tomorrow? When I give myself 45 minutes for bills, that's how long it takes.

When I give myself the whole afternoon to pay bills. That's how long it takes. It's not magic. It's Parkinson's law. Work expands to fill the time we give it. Another key to optimizing our calendar and time is finding ways to tame our devices. Your phone is a slot machine in your pocket. There's so much to see, so much entertainment, so much to explore.

It steals your attention [00:15:00] and your focus without you even realizing it. Turn off the sounds, use Do Not Disturb. That is like one of my favorite features and I use it all the time when I want to be more present at home. And no need to worry if something is truly urgent. People will find you. They do know how to reach you.

And finally, step four, and this can be a huge struggle for doctors, delegate, delegate. Delegate. Urgent but not important is delegation territory at work. That might mean letting your MA or your nurse handle something. At home, it might mean grocery delivery or hiring help once in a while, you're not buying luxury, you're buying back your time and your presence.

The point of all of this isn't to become more efficient for efficiency's sake. [00:16:00] It's to make space, space for rest, space for connection, space to actually enjoy what you've built. Because presence isn't a feeling that just shows up. It's a system. You create one intentional block of time at a time, and once you've got your priorities and your calendar set, here's the key.

Make it real. Give your plan a home before the week begins. For me, that happens on Sunday afternoon. I sit down, I look at my work schedule, block the essential family activities, and make sure the people who matter most already have time reserved. I also take the time to discuss the schedule with my wife to ensure we're both on the same page.

Look, this isn't perfect. Life happens. I've learned to slide the time blocks, not the values. [00:17:00] And that simple shift, treating my calendar at home with the same respect I give my work schedule, has really changed everything because now when I'm with my family, I can actually be there. The rest is handled. I know exactly when it's all gonna get done.

So that's the structure. It's fairly simple, clear, and absolutely repeatable. But the truth is that having a system only works if you keep the right mindset around it. Because even with the best plan, life still happens. The pager goes off, the cases run long. You need to see an extra patient, the kids melt down.

The goal isn't perfection. It's traction. It's spending more of your time in alignment with your priorities. And to build traction, there are a few mindset shifts that make all the [00:18:00] difference. First, it's really important to remember that presence is productive, not in the check more boxes kind of way, but in the build, something that lasts kind of way.

When you give your full attention to your kids, to your spouse, or even to a single task, you make fewer mistakes. You build trust with the people you actually love, and you create memories you'll actually remember. And then it's important to remember that planning is respect. When you put something on the calendar, you're saying it matters.

You're not taking the warmth out of it. You are protecting it. Third, remember that emotions are data points. That guilt you feel when you drift off during playtime or check your phone at dinner. That's not a failure. It's feedback. It's your brain saying something's off [00:19:00] and use that signal, adjust the system, and then move forward.

Fourth, perfection is the trap. You are going to mess up. You're gonna check your email when you're meant to be listening. You'll blow up a calendar block because something else comes up. It doesn't mean you failed, it means you're human. Presence isn't a final exam. It's a practice, and the goal is just to have more good days, not all perfect ones.

And finally. Boundaries build trust. When you protect your focus at work or at home, you're showing people what they can count on you for. That's leadership. Without saying a word, whether it's turning off notifications, leaving your phone in another room, or saying no to something that doesn't fit your values or priorities.

You're modeling what real leadership looks like. At home, [00:20:00] at work, everywhere, because your family and your team are watching how you manage your attention. And when they see you holding those boundaries, it gives them permission to do the same. I'll end where we started. My daughter once looked up at me and asked Dad, why aren't you playing?

And that moment hit hard because she was right. I was in the room, but I wasn't really there. Today, I still get distracted, but now I have a system to bring myself back. I'm not chasing perfection. I just keep building more moments that matter. And that's what I want for you to, because being more present isn't about adding one more thing to your list.

It's about clearing the noise, creating space, and showing up where it counts. So as you head into your week, here's a simple [00:21:00] question to ask yourself. When you walk through the door tonight, are you really home? And if not, what's one small shift that would bring you back? And if you are ready to take the next step, I've created a quick tool to help.

It's called the 5-minute Commute Reset for physicians. It's a short guided exercise and worksheet that you can use on your way home to leave work at work, and walk through the door, ready to connect with your family and the priorities that matter most. You get a downloadable audio file, a simple worksheet, and a lock screen reminder of the model, so it's always within reach and you can grab it for free at betterphysicianlife.com/commutereset.

I'll make sure there's a link in the show notes because presence doesn't happen by accident. It grows from small, deliberate choices, and this reset gives you a great place to start . And remember, [00:22:00] you don't have to be perfect. You just have to be present. Thank you so much for listening, and I'll see you next time on the Better Physician Life Podcast.