I used to think I was tired because I worked too much. Too many patients, too many charts, too much call. And those things genuinely matter. But lately, I've started noticing something else. I can finish a clinic day that wasn't particularly busy and still feel completely drained. Not necessarily physically tired, just mentally spent.

And sometimes, when I think back over the day, I realize it started way before I even saw my first patient. I woke up and checked social media. Something about the economy, something about healthcare, politics, a physician group arguing about reimbursement, a stock market update, another prediction about where medicine is headed.

None of it changed what I needed to do that morning, but somehow, all of it followed me into clinic. So, by the time I'm sitting across from my first patient trying to listen to what's going on with them, part of my attention is still somewhere else. And I've started to wonder how much of what I call being tired has nothing to do with how much I'm working or how much sleep I got last night. Maybe some of it is just the cost of having my attention pulled in way too many directions. 

Well, hey everyone, and welcome to another episode of the Better Physician Life podcast. Thank you so much for being here today. 

So I have been thinking a lot about attention lately. Not productivity, not efficiency, attention. Because attention is limited. 

We all get 24 hours, and none of us has an unlimited amount of mental bandwidth. So the question isn't how much information we can take in. It's where we allow our attention to go. Medicine has always required intense focus. We spend years learning how to notice subtle details, small changes in lab values, tiny findings on a physical exam, patterns that other people miss.

And that ability serves our patients incredibly well. But there's a downside. The same brain that's trained to detect risk also becomes incredibly good at finding problems everywhere else. You open your phone in the morning, one headline becomes another, then another. 

The healthcare system is collapsing. The economy is unstable. Artificial intelligence is replacing physicians. Reimbursement is changing. Private equity is buying another group. Someone is predicting a housing crash. Someone else says retirement won't be possible at all. Five minutes turns into 20. You haven't changed anything, but your brain is already thinking about six new things.

And then you walk into clinic carrying all of it. I have caught myself doing this more times than I'd like to admit. I'll be sitting in my office before clinic, coffee in one hand, Epic loading on the computer. Instead of reviewing my schedule, I'm reading another article about something I can't influence at all.

A few minutes later, my medical assistant knocks on the door. Your first patient is ready. Physically, I'm there, ready to go. Mentally, I'm still somewhere else. That's the hidden cost. Not the headline itself, but the attention it continues to occupy long after you've stopped reading. The truth is that most headlines are competing for one thing.

Not your agreement, your attention. Attention has become one of the most valuable commodities in the world. Entire industries exist to capture it. The longer they keep you engaged, the more valuable your attention becomes. The historian Yuval Noah Harari made an observation that has really stuck with me.

For most of human history, having power meant having access to information. But today, having power may be knowing what to ignore. Sit with that for a second, because it applies directly to you. You spent a decade plus training your brain to take in more information than almost anyone else in the room.

That training doesn't turn off when you leave the hospital. Your attention is your power. The question is whether you're spending it or it's being spent for you. And fear works exceptionally well. Conflict works even better. And uncertainty almost guarantees another click. Physicians are particularly vulnerable because we're conditioned to believe that staying informed is part of being responsible.

And to a point, that's true. We should understand what's happening in healthcare. We should know changes that affect our practices. We should stay educated. But there's a difference between being informed and being continuously immersed. Those are not the same thing. I've noticed something interesting in myself.

The more headlines I consume, the less present I become in the places that actually determine the quality of my life: my patients, my family, my own health. Those are the things I say matter most, but attention tells the truth. Attention reveals priorities better than intentions ever will. Think about how many times you've walked into your house after work while you're mentally replaying something you read online.

Maybe dinner is happening, your spouse is talking, your kids are telling you about their day. You're nodding, you're answering, but part of your brain is still thinking about some article predicting the future of medicine. Or you're lying in bed after everyone else has gone to sleep.

Instead of reading something enjoyable or maybe just going to sleep, you're scrolling through another discussion about physician compensation, another debate about burnout, another prediction about healthcare reform. You close your phone twenty minutes later. Nothing has improved, except now you are wide awake. 

There's another place I get stuck all the time: the productivity dashboard. Every physician knows that feeling. You log in; you weren't even planning to look, but there it is: your RVUs, your percentile, how you compare. And you look at it for maybe 30 seconds, and then spend the next three hours thinking about it. Again, attention. The numbers themselves aren't the problem. Sometimes they're important.

Sometimes there's something we actually need to do about them. But frequently, they just take up space without actually changing what we do. We replay them, we compare ourselves, we carry them home. And meanwhile, our patients, our families, and the things we enjoy the most get whatever attention is left.

One of the biggest lessons I've learned over the years is that attention compounds, just like money. Small deposits made consistently become something significant, but so do small withdrawals. Five minutes here, ten minutes there, a dozen interruptions, constant checking, constant reacting. None of it feels particularly important by itself, but over time, you start noticing that more and more of your attention is being spent on things you never actually chose to give it to. The irony is that physicians understand this concept better than almost anyone else.

We tell patients that small habits matter. Blood pressure doesn't usually change overnight. Neither does diabetes; neither does cardiovascular disease. Small decisions accumulate, and attention works the same way. Where it goes today affects what gets more of you over time.

Not because attention magically changes your life, but because there's only so much of it available. And when more of it goes to the news, the market, the productivity numbers, or whatever argument is happening online, there's less available for everything else. I've become much more intentional about asking myself a simple question: Is this information useful or is it just interesting?

Because those two things are not the same. Interesting information often feels urgent. Useful information usually leads to action. If I can't do anything with it today, maybe it doesn't deserve another hour of my attention. Now, that does not mean ignoring the world. It means recognizing the difference between awareness and immersion. 

There's another question I've started asking: Who benefits from me continuing to pay attention to this? Sometimes the answer is pretty obvious. Not me, not my patients, not my family. Sometimes the only thing asking for more of my attention is a platform that's designed to keep me there. And physicians have our own version of this. There are online physician groups that I find myself checking because on the surface, it feels useful.

I'm staying informed. I'm seeing what other physicians are dealing with. Maybe I'll learn something about compensation or practice changes or what's actually happening in medicine. And occasionally, I do. But a lot of the time, I leave knowing more about what everyone else is angry about and no clearer about anything I actually need to do.

That's really important to notice. Something can be relevant to physicians without being useful to me right now. And I think that's harder to recognize than it sounds because as physicians, we like to believe we're pretty good at separating signal from noise. We're trained to evaluate evidence, to question assumptions, to make decisions with incomplete information, but we're still influenced by what we repeatedly expose ourselves to.

If I read enough posts about declining reimbursement, I start thinking about my own compensation differently. If I read enough physicians talking about getting out of medicine, I start wondering whether I'm missing something by staying. If I check the market every day, normal fluctuations start to feel like something I need to respond to.

Nothing actually changed in my life, but what I'm thinking about changed. And that's the part of attention I think we underestimate. It's not just what we see; it's what we continue thinking about after we've seen it. And eventually, some of that becomes the background noise of the day, which has made me think differently about what protecting my attention actually means.

It's not just about avoiding distractions. It's also about deciding what deserves my best thinking. My health is one of those things. And this is an easy one for physicians to keep pushing off. I'll exercise next week. I'll get back to it after vacation. I'll be more consistent when clinic settles down.

Except clinic doesn't really settle down. There's always another busy week, another call weekend, another staffing problem, another reason why now isn't a great time. Meanwhile, I can spend 20 minutes reading about something happening in medicine that I can't control and somehow convince myself I don't have 20 minutes to exercise.

I've caught myself doing exactly that. And when I see it that way, the issue isn't really whether I know exercise is important. Of course I know that. The question is whether the things I say matter to me are actually getting any of my attention. And family may be where I notice that gap the most.

Because it's entirely possible to be home and still be somewhere else. Sitting on the couch, phone in your hand, half listening to what your spouse is telling you while you're reading another headline or checking something from work. You're there, but not really. A physician once described this to me in a way I've never forgotten.

He said, "I give everything away at work, where half the time it isn't even deserved. Then I come home, and I'm frustrated with my kids and my spouse, and they didn't do anything." He called what was left the leftovers. "Everybody at home," he said, "gets the leftovers of you." And that one really stung because I think a lot of us know exactly what he's talking about.

We spend all day being patient with patients. We deal with the late arrival, the patient who didn't take the medication, the complaint in the inbox, the administrator asking for one more thing, the schedule that's already behind, and we hold it all together. And then we get home, and someone asks us a completely reasonable question while we're looking at our phone, and somehow that's the thing that irritates us.

Not because the question was the problem. We're just out of bandwidth. And I think work can suffer from the same divided attention. I've certainly had moments sitting with a patient when I realized part of my mind was still on the previous patient, or the inbox, or something I read that morning. I'm listening, but part of me is somewhere else.

And I've also had visits where I wasn't thinking about any of that. I was just in the room. There's a difference. I've been both physicians, and increasingly, I think that's what I'm trying to protect. Not some perfect state of focus, just enough attention to be where I actually am. One of the physicians I work with, an anesthesiologist, gave me a good example of what that can look like.

In the middle of a code, she's completely locked in. No checking, no wondering what else is happening. The situation in front of her gets all of her attention because it has to. But she started noticing that once the shift ended, that boundary completely disappeared. Her phone kept going. Messages, notifications, people expecting a response.

So she made a pretty simple decision. When she's off, her phone is off. She described it to me this way: "It feels good to reclaim me." And I knew what she meant. Not that the phone had somehow taken something from her. She had just gotten used to being available all the time 

I think that's what I've started paying more attention to in my own life. Not eliminating information, not ignoring what's happening, just creating some boundaries around when I take it in. The news will still be there after clinic. The market will still be there tomorrow. The argument in the physician group will probably still be going on too.

Most of it doesn't require anything from me right now, and that's been useful for me to remember because healthcare will keep changing. Reimbursement will change. The markets will move. There will always be another headline telling us something important just happened. But important doesn't always mean I need to give it my attention right now.

Meanwhile, your daughter only tells you about her school day once. Your son only asks you to throw the baseball for so many years. Your spouse only gets whatever version of you walks through the door tonight. And none of those things are particularly good at demanding your attention. They don't send notifications.

They don't have breaking news banners. They don't refresh every thirty seconds with something new to react to. They're just there. And if we're not paying attention, they can lose out to things that a week later we won't even remember. Now, I'm not suggesting we disconnect completely.

I'm certainly not doing that. I'm just starting to question how easily I hand over my attention without deciding whether something actually deserves it. Because once I've spent twenty minutes on something, those twenty minutes are gone. The same is true of an evening or a Saturday morning. No amount of income, RVUs, or investment returns buys that time back, and maybe that's the part I've underestimated for a long time.

Attention has a cost, even when whatever we're paying attention to is free. As physicians, we already know how to guard things carefully: medications, controlled substances, protected health information, patient safety. We've built entire systems around protecting things that matter. I'm starting to think our attention deserves some protection too.

Not from everything, and not all the time, just from the things that keep taking it without giving much back. So here's something simple you can try this week. At the end of the day, maybe when you're plugging in your phone or setting your alarm, ask yourself one question: Did the things that got most of my attention today actually deserve it?

That's it. You don't need to track anything. You don't need another app, and you don't necessarily need to change anything. Just notice. Some days the answer will be yes. A difficult patient needed you. Your family needed you. Something happened at work that genuinely required your attention. And some days, you may realize you gave forty-five minutes to a news story you couldn't do anything about, or checked the market six times, or spent half the evening thinking about an RVU number that wasn't going to change before morning.

That's useful information too because once you start noticing where your attention is actually going, it becomes a little easier to decide where you want it to go. One thing I've learned from working with physicians is that these patterns can be really difficult to see when you're in the middle of them.

We get so used to our own routines: checking the phone before clinic, opening the productivity dashboard when we didn't need to, reading one more physician thread before bed, thinking about something for three hours that only required thirty seconds of our time. Sometimes another set of eyes helps you notice what you've stopped noticing for yourself.

If you've been trying to figure out where your time and attention are going and what you might want to do differently, there's a link in the show notes where you can learn more about working with me. Or you can head over to my website at betterphysicianlife.com and schedule a time to chat.

Because tomorrow morning, you'll wake up with the same amount of attention you have today, and someone will ask for it. The news will ask for it. Your inbox will ask for it. Your patients will ask for it. Your family will ask for it. And somewhere in there, you get to decide what actually deserves it. 

Thank you so much for listening, and I'll see you next time on the Better Physician Life podcast.