Why Doctors Procrastinate (And Why It Feels So Personal) | Ep45

Michael Hersh, MD

[00:00:00] 

You finished clinic a little after five. The last patient left 20 minutes ago. The hallway is quiet. Your inbox is mostly cleared. There are still six charts open. You tell yourself, you'll just check a message first, then maybe look at tomorrow's schedule. You answer a refill request, review a lab, click over to the productivity dashboard for a minute, then back to your inbox.

The charts are still sitting there. They're not difficult charts. You know exactly what happened in those visits. It would probably take about 15 minutes to finish them. For some reason, you keep pushing it off. You finally close the laptop around seven, you'll finish them in the morning, and on the drive home, there's this familiar thought sitting in the background.

Why didn't I just finish those charts? [00:01:00] Because this is the strange thing about procrastination. Physicians are incredibly good at doing hard things. Every physician has a few things they keep meaning to deal with and don't. And when physicians procrastinate, it doesn't just feel like delay. It feels inconsistent with the kind of person we think we are.

We know where responsible, dependable, the person, people count on. We make decisions all day long. We move things forward. So when something keeps getting postponed, especially something small, it's not just frustrating, it's personal because most physicians don't look at procrastination and think this is a normal human pattern.

They think I should be better at this, and that thought is exactly what keeps the whole cycle running.

Well, hey [00:02:00] everyone, and welcome to another episode of the Better Physician Life Podcast. Thank you so much for being here today. Okay, so that moment I just described, the charts sitting there waiting to be finished, the laptop closing the questions on the drive home, that's a version of something almost everyone experiences.

Procrastination is one of those things most people do from time to time. And almost everyone judges themselves for it, especially physicians, not because doctors procrastinate more than everyone else, but when physicians procrastinate, it runs straight into how they see themselves, and that's what makes it feel bigger than it actually is.

So today we're gonna talk about procrastination, not as laziness or lack of discipline. And not as some soft issue that only affects people who aren't used to responsibility. [00:03:00] Procrastination shows up in physicians all the time. The difference is that doctors are usually so competent in so many areas of life that when procrastination appears, they tend to be much harder on themselves about it.

We don't just put something off, we put something off, and then we notice, we put it off, and then the self-criticism starts. And that second part is what really makes the cycle stick, because procrastination usually isn't about the task itself; it's about what starts happening in your head once the task gets delayed.

Most physicians are used to being trusted by other people. Patients trust us. Our partners trust us. The staff trusts us. Our families trust us, but a lot of physicians struggle with trusting ourselves in certain parts of our own lives, [00:04:00] not because we're unreliable everywhere, because we've all had too many moments where we think I need to deal with that.

And then we don't. It might be something small, finishing charts the same day instead of carrying them over into the next, completing those annual compliance modules that have been sitting in your inbox for two weeks, booking the vacation you said you were going to take this year. Looking at the disability policy you haven't reviewed since residency, opening the spreadsheet where you meant to organize your finances.

Finally sitting down and deciding whether this job still makes sense. None of these things are impossible. Most of them would actually take less time than you think, but once something gets postponed a few times, a second problem shows up.

Now you still have the original [00:05:00] task, and you also have the knowledge that you've been avoiding it. That second part is usually the harder one, because the task itself might take 20 minutes, but the avoidance of the task can live in your head for months. You think about it in fragments, walking into clinic, driving home, lying in bed, standing in the shower.

I still haven't done that. I need to deal with that. Why haven't I just done that already? That is a surprisingly draining way to live. And a lot of physicians just normalize it because medicine trains us to carry a lot of unfinished things at the same time. There's always another chart, another message, another lab result, another patient question, another staffing problem, another metric to look at, another administrative task.[00:06:00] 

So adding one more unfinished thing to the list can feel minor, but it's rarely minor. Especially if it keeps repeating, because procrastination doesn't just delay action. It delays relief. It delays figuring out what you're actually going to do, and sometimes it delays decisions that would've improved the next five years of your life.

That's why it matters, not because procrastination means you lack discipline. Because it changes what's running in the background of your life. Background, pressure, background noise, mental bandwidth being used by things that haven't happened yet. Now, if you look closely at procrastination, the reason behind it is usually more understandable than people admit.

Most of the [00:07:00] time, you are not avoiding the task. You are avoiding what comes with the task. You're not avoiding the spreadsheet, you're avoiding the numbers inside it. You're not avoiding the conversation. You are avoiding what the conversation might lead to. You're not avoiding finishing the chart. You are avoiding reopening the entire visit in your head at the end of a long day.

You're not avoiding booking the vacation; you're avoiding the process of figuring out the dates, the coverage, the flights, and everything else that comes with it. That's usually where procrastination lives, not in laziness, in hesitation about what the next step might lead to. 

Now, there's another factor physicians run into pretty often. By the end of a typical workday, your brain has already made a huge number of [00:08:00] decisions, treatment plans, medication changes, patient expectations, workflow adjustments, messages, time pressure, carrying the emotional tone of the room. Even when everything runs smoothly, your brain has been working nonstop.

So when you finally sit down to do one more meaningful task, especially one that requires thinking, your brain just pushes back a little, not because the task isn't important, because there's just not much decision-making capacity left, and a lot of physicians just call that procrastination. 

Now, exhaustion isn't the only pattern physicians run into. There's also perfectionism. Medicine trains us to do things thoroughly, carefully, correctly. Those are phenomenally important [00:09:00] traits in patient care, but outside of patient care, that same standard can make it feel impossible to start new things. If I can't do this the right way, I'll wait until I have time to figure it out.

If I can't finish it completely right now, I'll do it later. If I don't have enough time to do it, well, I just won't start at all, and later becomes next week, then next month, then eventually it just becomes one more thing you keep meaning to get to. Perfectionism sounds like high standards, but a lot of the time it functions more like hesitation. You can't just start. It has to be done well, thoughtfully, completely in one clean pass. That's a great way to keep postponing things. 

Now, there's another factor here that physicians don't always notice right away. [00:10:00] Medicine provides an enormous external structure. Clinic starts when it starts, the OR starts when it starts. The consult has to be answered. The chart has to be signed. Someone is always waiting for you, and there's an urgency that is built into that system. That kind of environment produces action, but most of your personal life has none of that structure. No one is paging you to review your retirement plan. No one is rooming your decision about whether to leave your group.

No one is scheduling the conversation about your workload. No one is sending reminders to ask whether this pace of practice still makes sense for the next decade. Without external structure, things start to drift, not because physicians are incapable of doing these things, but because we've spent our entire training becoming [00:11:00] excellent in systems where urgency is built in.

A lot of personal decisions don't feel urgent until they start becoming expensive, and that's where procrastination slowly traps people. The thing doesn't feel urgent today, so it moves to tomorrow, then next month, then next year, and over time, the task changes. It becomes more personal, more loaded. And harder to face, and eventually judgment enters the picture.

You start telling yourself, you should have handled this already. You start attaching meaning to the delay itself. Now it's not just a postponed task, now it's a character flaw. That's where things start to get stuck, because shame doesn't usually lead to action. [00:12:00] It makes you want relief. It makes you want distraction.

It makes you want something easier to work on. And physicians are really good at finding those. You answer a few quick inbox messages, clear a couple of refill requests, check a few labs, look at tomorrow's schedule, maybe glance at the RVU dashboard. That's all still productive. You're still working. Not touching the one thing you sat down to do.

From the outside, it looks like efficiency, but internally, you know what's happening. You're circling the real task. That version of procrastination is so common amongst physicians, not doing nothing but doing a lot of smaller things, so you don't have to touch the one thing that actually matters.

At some point, most physicians start noticing the pattern. You delay something, then you judge yourself for [00:13:00] delaying it. Then the task gets bigger in your head. Now you're avoiding both the task and the judgment attached to it. That combination can run for a really long time because judgment feels like accountability, but it rarely produces action.

Most of the time, it just makes the whole thing harder to sit down and do. A helpful place to start is asking the hard question, what exactly am I avoiding here? Sometimes the answer is uncertainty. Sometimes you don't want to see the numbers. Sometimes you already know what the conversation needs to be, and saying it out loud would make it feel real.

Sometimes starting means giving up the version you've been imagining and replacing it with a real version that might not go perfectly. That's where procrastination [00:14:00] sits. In the hesitation about what the next step might lead to. Another pattern, physicians notice over time, is that most postponed tasks have grown way larger in their heads.

The task stops being review the numbers and becomes figure out my entire financial plan. It stops being send the email and becomes make the right career decision. It stops being schedule the trip and becomes figure out the time off, the coverage, and the whole vacation. That kind of scale makes it so much harder to start.

What usually works better is shrinking the task back down to something small enough to begin. Open the file, read the first page, spend 20 minutes with the spreadsheet, schedule the meeting, finish one chart. [00:15:00] None of those solve the entire situation, but they end the avoidance. And once the avoidance ends, the next step usually becomes a lot clearer.

There's another shift that tends to help physicians too. Doctors function extremely well in structured environments. Clinic blocks, call schedules, OR times, deadlines. Those systems remove negotiation. But outside of work, many physicians wait until they feel like doing something, and that usually doesn't work, especially for decisions that actually matter.

Most important things in adult life don't come with a deadline, so it's easy to wait. But physicians usually do much better when there is some structure, a time on the calendar, a specific task, a short block to work on it. [00:16:00] Not solving the whole problem, just starting. That tends to work well for physicians because it looks a lot like how medicine already works.

Clinic starts at a certain time, the OR starts at a certain time, and when that time arrives, you show up and begin. And the last piece here is repetition. Not intensity, not a grand reset, not a weekend where you try to organize your entire life. Just repetition, small follow-through again and again, because procrastination slowly changes how much you trust your own follow-through.

Every time you tell yourself you'll do something and then don't. That trust slips a little. But the reverse is also true. Every time you do something small, you said you would do, a little bit of [00:17:00] that. Trust comes back gradually, and that matters more than people think. Because over time, the small things you deal with and the ones you keep postponing start shaping the direction of your life.

And a lot of those decisions in a physician's life happen in places where no one is waiting. Because physicians are incredibly reliable when someone else is waiting a patient in the room, the consult that needs to be seen, the order that needs to be signed, clinic starts at eight and physicians show up.

Even when we're tired, even when we don't feel like it, even when the day is already full, but the parts of life where no one is waiting, those are much easier to postpone. No pager goes off reminding you to review your retirement plan. No nurse knocks on the door asking whether you've [00:18:00] updated your will.

No one schedules the conversation about whether this pace of work still makes sense for your life. And the question of whether you wanna keep practicing the way you are for the next 10 years, that one can sit there for a really long time. So it gets delayed. Not because it doesn't matter, but because nothing is forcing the decision today.

And the strange thing about procrastination is that it rarely explodes into a crisis. It just slowly decides things for you. The job you meant to reevaluate becomes the career you stay in. The financial plan you meant to organize becomes the retirement you drift into, the life you assumed you would eventually shape, starts taking shape on its own, and sometimes physicians don't notice it until years have already gone by.

Thank you so much for being here today and for listening. [00:19:00] And I'll see you next time on the Better Physician Life Podcast.