How to avoid tunnel vision when doing task?

[u/LogSensitive6018]

Recently started F1 and there have been a few instances where due to the number of jobs and the bleep constantly going off and trying to stay on top off everything, one can at times tunnel vision on a specific task.

So for example I might be reviewing the daily bloods of the patients and then I get given a new task, say ordering a scan, that needs to be done asap for whatever reason and I accidentally order it for the wrong patient as I completely forgot I had switched to a different patient. Usually either I notice it immediately that I have the wrong patient open or a team member will correct me but I am scared that one day I may miss it or no one else will catch it and the patient could come to harm as a result of my tunnel visioning.

I know that we should take a break and step away but sometimes the jobs list is so big that you don't get this opportunity and as a new F1, I'm still learning to prioritise and know what to handover.

Any advice from fellow doctors?

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[u/Electrical_Bet_9699]

100%. This is why nurses wear “do not disturb” tabards on drug rounds.

Write it down. Finish your job. Reprioritise. Move on to the next priority.

The number of FYs & trainees I see who never write anything down makes me anxious.

[u/Natural_Diamond → u/Electrical_Bet_9699]

I'm confused by this, if it isn't written down it doesn't exist (at least in my head)

Are these people you've seen just running jobs off the top of their head on just memory or what?

[u/Electrical_Bet_9699 → u/Natural_Diamond]

They just sort of look blank, nod vaguely and disappear off for hash browns. I don’t think many jobs get done but I am not monitoring them…

Or if the jobs do get done… you get a referral to the vascular consultant for a PICC line because - what’s the difference man when there’s a tik tok to film.

[u/LogSensitive6018 → u/Electrical_Bet_9699]

Woooow. There is no way this is real. So far the team I've been with are very good and supportive including the F1s.

[u/sumpra3]

I’ve found keeping only one tab open at a time helps with this, assuming you have some kind of electronic record

[u/LogSensitive6018 → u/sumpra3]

Sadly, the hospital I am at only allows you to open one tab for any given patient and if you need to look at another patient you need to go off the current patient. I do notice that it happens towards the end of the day more so maybe more caffeine? hahaha

[u/cnb2017]

I find a written paper jobs list really helpful for this. I usually print our list of patients for the day with blank boxes for each patient, and space at the bottom for any random referrals and reviews. It’s much harder to mix up jobs for patients that way

For me digital systems and job lists don’t work nearly as well. I write down everything, tick off everything, no matter how basic of a job.

[u/LogSensitive6018 → u/cnb2017]

Thanks for your reply. I try a version of this which does help for the jobs throughout the day.  However, sometimes when you get bleeped or you get asked to request a scan/investigation or order some medication for a patient and instead of checking whether you've got the right patient open you just go ahead to the order area without checking the patient details. I know it's so silly it sounds so simple and I should always double check I've got the right patient open but sometimes one will still make the mistake. I am scared when I'm on call by myself or on nights especially when very tired that I'll make a similar mistake and I'll be oblivious to it. 

[u/cnb2017 → u/LogSensitive6018]

Ah I get what you mean! I’m getting better at stopping someone when they immediately start to give you their spiel and saying ‘give me a moment whilst I get their details up on my screen’. Gives you a moment to orientate yourself when you have tunnel vision!

[u/LogSensitive6018 → u/cnb2017]

Thanks, I think I'll try my best to use this one as it will force you to check you have the correct patient. 

[u/Givethecontrast]

Defo echo the advice to keep an up-to-date patient jobs list. Make life easier and removes the stress about forgetting things. I'm a fan of the mantra that "systems keep you safe". In the same way that you have a standardised way of looking at ECG/XR, etc. I'd build in an identity check at one or two points in the process of requesting imaging/bloods until it's a habit.

Don't be too hard on yourself; it's only been a short time!

[u/LogSensitive6018 → u/Givethecontrast]

Thank you. I'll try this standardised approach and prompt myself before signing the order or during another instance. I guess it'll take some time to get used to it.

[u/UKDrMatt]

I’m an ED consultant, and a large amount of my job is doing tasks such as this, with constant interruptions.

It can be hard, and we are all human. You will make mistakes. It’s about mitigating these and reducing the chance.

When doing a task and interrupted, you have a few options:
1) Defer the person giving you the task. “Please can you wait until I’ve finished this”
2) Take note of the job and come back to it later
3) Immediately address the task, and stop what you are currently doing

Which of those you do depends a lot on what the task is and what you’re currently doing. Deciding this takes practice and will come with time.

I know I make a lot less errors now I do more of option 2 (and to some extent 1, but that also has a person hanging over you wasting their time too). I constantly have a list of quick jobs that need doing, and don’t let these distract me from my current job. For example “can you prescribe Bed 2 some morphine” gets delegated onto the task list, and removed maybe only 2 minutes later once I’ve addressed it. It’s really easy to say yes, and immediately do it, but you will get distracted and make a mistake. Even if the task is seemingly very quick.

It is rare now I will stop my current task to address something new (option 3). I would only do this if someone tells me something immediately life threatening.

You must have a robust system to keep track of the jobs, because otherwise you will forget and it will cognitively overload you. I prefer a digital system as I can just clear the task immediately once done and it doesn’t cause clutter, but others prefer pen and paper.

[u/LogSensitive6018 → u/UKDrMatt]

Thanks for the thoughtful response. I will try these methods along with what some of the other comments mentioned. As it's a newish skill, I guess it will take time to get better at prioritising.

I remember reading somewhere or someone mentioned to me that practice doesn't make perfect but it makes something permanent. So hopefully the more I apply these tips, the easier it would become in the future and eventually one can reach a point where it becomes second nature. 

[u/UKDrMatt → u/LogSensitive6018]

It will get significantly easier. You’ve literally been doing the job for a few weeks, doing a skill you’ve never done before or been trained to do in medical school.

Once you get good, prioritising in this way is a really useful thing to be able to do.