Episode #16 – GTD and the Medical Community

Date: Wednesday, May 25, 2016 by GTD Times Staff

This episode features two wonderful doctors and GTD enthusiasts in our GTD community: Dr. Julie Flagg and Dr. Julian Goldman. They join David Allen and Senior Coach Kelly Forrister in a lively and heartfelt discussion about how GTD has helped their stability, clarity, and focus.

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INTRODUCTION BY ANDREW J. MASON: You’re listening to Getting Things Done, the official podcast of the David Allen Company, with today’s conversation between David Allen and Kelly Forrister, chatting with Dr. Julie Flagg and Dr. Julian Goldman.
Welcome to another episode of Getting Things Done, GTD for shorthand. My name’s Andrew J. Mason and this podcast is all about helping you on your journey learning the art of stress-free productivity. Today we have David Allen and Kelly Forrister chatting with Dr. Julie Flagg and Dr. Julian Goldman, two incredible forces for good in the medical community, but first from time to time, we get GTD questions on certain subjects and if we think it’s a question that a lot of people would like the answer to, we’ll go ahead and pose it to David himself and let him answer it for us.
Today we’re asking him, is there ever a time that you look at everything on your lists and don’t feel okay or get overwhelmed. Here’s what David had to say:
DA: You know it’s funny, I don’t get overwhelmed looking at my list. I get overwhelmed when I’m not looking at my list. So the whole purpose of the list is to relieve that pressure, so it’s kind of funny as I think about it, ‘cause the truth is if people are not overwhelmed until they look at their list, I go, “Well they’re just unconscious”, or “They’ve got it on the wrong list, it should be Someday/Maybe.” If you have the commitment but only feel bad when you remember what the commitment is, I kind of don’t get that. I don’t get what that’s about.
For me, looking at the list and knowing that it’s not complete is probably what would create a sense of overwhelm. I think that’s true. If I look at the list and I go, “Oh, I don’t feel good because this is not really all of it”, and there’s more back, and it’s reminding me that I don’t have it all out because I’m looking at my list and my own methodology. I think that’s true and I think for that reason, that’s why some version of the weekly review is what I need to do. Some version of how I do that for myself.
I know there’ve been weeks where I’ve done versions of weekly review almost once or twice a day, simply because things were moving so fast and it was just nuts, or at least I was going nuts if I didn’t sit down and do that.
ANDREW J. MASON: That is awesome. Like we said, today we have Dr. Julie Flagg and Dr. Julian Goldman. The join David Allen and Kelly Forrister in a lively and heartfelt discussion about how GTD has helped their stability, clarity and focus. Now of course, this interview showed up first on GTD Connect, so if you want the latest bleeding edge of all things GDT, head on over to GettingThingsDone.com/podcast and click on GTD Connect to get started.
And now, here’s David Allen and Kelly Forrister, interviewing Dr. Julie Flagg and Dr. Julian Goldman.
KF: Hi there GTD Connect members, it’s Kelly Forrister. Well I am just thrilled today to bring you another slice of GTD Life. Many of you are familiar with this series, brings inside your fellow GTD practitioners and how they’re managing their GTD system, their world, what inspired them, what’s creative for them and today I invited two special guests. I have Dr. Julie Flagg. Hi there Julie.
DJF: Hi, how are you?
KF: Good. Welcome. And I also have Dr. Julian Goldman. Hi Julian.
DJG: Hi Kelly. Great to be here.
KF: And another special guest we have today is Mr. David Allen. Hi David.
DA: Hi Kelly, hi you guys. We’ve chatted. Delighted to be in conversation with all of you.
KF: Yeah, it’s gonna be great and probably will go something in the order of 30-45 minutes and I would say it probably took longer to coordinate the four schedules than it did to actually have this call, but I’m super excited to do this and before we dive in to our discussion, Julie I want to start with you and have you introduce yourself. You’ve been one of our In Conversation interviewees, as many people know. Wonderful interview. But for those who aren’t familiar with you and just a give a refresh of who you are, kind of work you do and uh what can you say to our members?
DJF: So, first of all, it’s great to be here. I have been a GTD member since uh 2001, when I stumbled on the David’s book and read the book and called and got some coaching and my life was really transformed from that moment on. And since then uh, I’ve been in touch with the GTD group probably several times a year. As a Connect member I log on a couple times a week probably and when I have a question I’ll call uh Kelly or contact Meg or talk to David or call Kam Ross or keep in touch with Kathryn, so it’s a very, very vibrant connection and it’s my background team that almost nobody knows about but it’s very much my working family and so GTD has been absolutely critical. When I try to put a number, I think it probably has increased my productivity, uh probably 25 to 30% from the get-go and that’s been consistent. Uh, it’s improved my sleep probably 100% and in the process I think it has made me a better physician and undoubtedly saved some lives and helped me produce some better work and better home life and more fun and – and uh – still have time for dinner with my 92 year-old mother and have a great partner, life-partner, so I simply couldn’t say enough for it. GTD is the skeleton of my work. There are people in the group that I try and meet up with. There are ideas that I try to talk to people about, so it’s just been – it’s been a really, really, fun thing and the power of picking up a book in the bookstore, probably never more powerful for me.
KF: Wow, what a great story Julie. Thank you.
And Julian, welcome on the line and tell us a little bit about yourself.
DJG: Well thank you and kind of exciting to have David join us. That was a pleasant surprise Kelly. I am an anesthesiologist. I’m a physician at Mass General Hospital in Boston and in addition to my clinical work, I have administrative roles. I’m a medical director of biomedical engineering for our organization at Partners Healthcare and I also run a research program, a federally funded research program that is trying to improve patient safety and innovation by improving the way our medical equipment can communicate, so that we can have the kind of standards in communication in healthcare that we have everywhere else, like in computers and electronics, and so on. So my work life is very diverse from intense clinical care in the operating room, taking care of patients, running around, being too busy to write almost anything down and certainly too busy to be distracted by mundane things that need to be remembered on a different day at a different time, to other days where I’m involved in back-to-back meetings and uh have a heavy travel schedule as well for the kind of work that I do.
And I think that I like the whole idea that has been expressed by David and taught that you know most of us who seek and use GTD methodology are people that you know are really excited and feel fortunate to do the work we do, uh but we want to be even better and more productive and I think it was – I guess probably, when was the book published, Getting – with that subtitle, Art of Stress-free Productivity? Was that 2001?
DA: 2000 – 2001, yeah, it was.
DJG: So I kind of stumbled upon it in an airport and uh I thought, “Gee, that sounds magical! Stress-free productivity.” Of course we’ve all learned a lot since then, but anyway that’s a big of my background and you know, very varied work life and the approach, the methodology and the notion of you know, really doing more and being effective has been very appealing to me and I’ve been grateful to have that education and teaching in my professional and personal life.
KF: Terrific. Thank you. And – and Mr. David Allen, what do you do as your day job these days?
DA: Ha, ha, ha, ha.
KF: What keeps you busy?
DA: You know, I take my puppy out for a walk and I’m designing the global education for taking GTD around the world, you know, in all the different languages that we’re now starting to distribute this and figuring how to leverage the heck out of the goldmine of resources, of Julie and Julian that we have in terms of how they’re applying this and how many other people they’re lives and conditions could be improved learning from them.
So Julie I have to say, you just gave me a fabulous image called me and Kelly and Kathryn and company are now the pit crew.
DJF: Ha, ha, ha, ha, ha.
DA: Ha, ha, ha, for these serious racers out there like you guys. And that’s really, I mean, I got to tell you that just so rang my bell. Believe me, I’m gonna get a lot of mileage out of that. So … ha, ha, ha. That’s enough for me Kelly.
KF: Yeah, that actually is a terrific visual, ‘cause I do get e-mails from you every once in a while Julie and it’s fun, ‘cause you’ll, “Kelly how do you do OmiFo? How do you do this in OmiFocus?” Or, “Kelly, what should I do in this …” and it does feel like you’ve been racing and I can imagine Julian your work style is like this as well or you’re busy, busy, busy and then you kind of pause and I love Julian when you pop up on the forums, ‘cause I think, “Oh good, he’s got some breathing time and he can …
DJG: Ha, ha, ha.
KF: …pop into the forums in the community.” But …
DJG: That’s pretty much it. That’s one way to tell, yep …
KF: Yeah.
DJG: … that’s exactly right.
KF: So what I’d love for this conversation to be framed around, of course it can take any direction it wants, but I thought it would be interesting to hear you both give your spots on the question, how has GTD helped you with stability, clarity and focus? And focus could also be presence or being present, but how – how do you think GTD has helped you in that? I’d love to hear your thoughts on that. How has it created stability with super busy, you know, highly successful careers and also give you clarity about the kind of work you’re doing and you’re saving lives and also the focus and the direction that you’re doing. I would love any input you – either one of you have on that. So, Julie, Julian; want to start, whoever?
DJF: I uh, being a very busy OB/GYN uh I sometimes have my days and weeks and years pockmarked by really good events and sometimes really catastrophic events and – and uh – we’re – we’re very much – I can’t wait to talk to Julian offline, because there’s a lot of safety stuff, uh ideas, that appeal to be to talk to him about, but the bottom line is and uh – I – some of my events, I have uh catastrophic events, have occurred after I’ve done my weekly review and some of them I have done, they have occurred when I have not done a weekly review and it is hugely, hugely, hugely, hugely different. Uh if I am – have a clear concept of my projects, uh, and my areas of focus, I really think that way. I visually – I have a visual structure in my mind of my areas of focus. Uh, I am always seeking OmniFocus how to uh – uh set up my projects and next actions and uh – it’s just for me, I honestly do not believe that I could be doing clinical medicine right now without GTD and I think probably in a much less level. I am very much involved in going to electronic medical records in our hospital and in our own practice and those transitions are monumental. They require tremendous focus and concentration, tremendous attention to what do we need to accomplish. Uh, I think very much the weekly review is critical, but also kind of – what can I do with these two minutes? Even the two minutes before the call came through – what can I constructively do in these couple of minutes that I have? What are my projects – uh – and then sort of what were my major goals. You know, I remember when I talked to David In Conversation, one of my major goals was to find another life partner. I mean that was a major goal and just focusing on it and it happened and it’s just hugely important and successful and in my mind, I – I honestly don’t think I could have done it without GTD. I think I just would have scattered and – and sort of fizzled. And – and GTD for me has been – has been sort of the anti-fizzle. Uh, it keeps me focused. I’ve had two very, very busy nights and the third time in my career, I cancelled patients today and I said, “I simply am in no condition to see patients”, and I took a long nap and then just sat at my desk and did my weekly review. And it just gives, it’s just a tool. I notice there are other people out there that are working really, really hard, much harder than I am, uh and it just gives me a lot more flexibility. It just is absolutely essential to my continuing to work and I think I’m gonna work for many years to come. It gives me the framework. It absolutely gives me the framework.
KF: Awesome. I love that phrase, “GTD is the anti-fizzle”, ha, ha.
DA: You know, let me insert here, we were just having a conversation, actually with Todd Henry that I just did, a new In Conversation, so he’s the new one coming out and you know, a lot of what he has said about your energy …
DJF: Yeah.
DA: And he’s brought up a thing about energy that says, “Looking pruning is critical to manage your energy.” You know, the vine keeper prunes the most creative, cool new shoots that are coming out so that the old mature really high production things don’t get subsumed by all the new stuff and other things and stuff like that, so you’re just reinforcing that for me Julian and what a great, ha, ha, ha, I’m sorry – how impactful uh your testimony to that is. Thanks.
KF: Yeah, Julian what would you say about that GTD and stability, clarity, focus, anything around that?
DJG: Yeah, it’s really interesting listening to Julie, it’s stimulating some ideas as well and just the nature of the question. Your question Kelly is a very sophisticated one. You didn’t ask, “Well how did GTD help you remember your shopping list when you’re running around, or keep you from having to you know, not forget things?”
This is – this conversation we’re having now, all of us, is a much more sophisticated conversation. I think for people, for example who understand the value of a retreat. For people who understand the value of meditation, the ability to integrate and then work from a stable base. Uh, that seems to reflect the thinking here.
Um, I think of a lot of our work lives are kind of like, I think of it as skiing and I – boy I haven’t skied in a long time, but when I lived in Colorado I used to do that and you know, when you’re skiing on something, it’s really hard to stop. Basically you can pause at the beginning, you may select your line, you may select what you’re going to do, but once you’re going and it’s dynamic, if you try to stop, that’s when you fall, so you have to have a plan and you have to decide, this is the time for action and there’s another time when I stop and I make my plan for the next action.
In my – in my clinical world in anesthesia, it’s very similar. We see a patient before surgery, we take the time to understand all about their medical history, all about the needs of the surgeon, the peculiarities of their own disease interacting with whatever else is being planned, but then when it’s time to go and it’s time to start the anesthesia and start the surgery, that’s not the time when you stop and change your mind or go back and have another conversation. So there’s a time to pause and a time to plan and a time to go.
KF: Hmm.
DJG: And that’s in a sense what GTD, I find brings to a hectic busy life, because if you get – stuff gets thrown your way and you’re busy, you actually have a parking place for it, you know how to handle it.
I remember years ago, I – we were on a call and uh I asked at the time, I think David was leading the call and I asked uh, you know what do I do on my OR days? I can’t even carry things with me. I can’t carry a notebook. I can’t really process. And of course, he said, “Well you shouldn’t be processing. You shouldn’t even be thinking about what you’re gonna do with that. Just write it on a piece of paper and at the end – throw it in your in-box at the end of the day and you’ll deal with it later on when you’re not busy and – or the end of that day when you’re fatigued.”
So David that was a long time ago, it was great advice and it helps with that separation of having a – and that’s what the weekly review is, it’s that stable base, you know, return, retreat, stabilize and then go like crazy again if you have to. You know that’s kind of the way I think about how GTD brings stability or clarity and focus. It’s in that kind of general model of knowing how to get a stable platform so you could really be productive after that.
DA: You know, I have to – uh thanks Julian, that’s fabulous. I mean what a sophisticated way to reflect back on this stuff. We were just In Conversation today with somebody who said, “You know, when you’re riding a bicycle or you’re trying to sort of dynamically steer and stay on course, the fact that you, when something pops into your mind that might throw you off course, because of its distractibility or attraction, either way, as opposed to staying present with what the course is that you’re on, skiing downhill or in the OR, that the ability to write something down, that then took that distraction off that you could then trust would then put it in the appropriate process is a way to stay on course. And the most, you know, to me that’s I get inspired, get chills on my back, I go, “Yes!” The most mundane is the most sophisticated in terms of what we’re doing and what you guys are doing. So that’s a great frame of that and actually example of that, Julian, thanks.
KF: David I’m curious too in your thoughts, how do people know when they need to, when things are unstable when they are unclear and need more clarity or they’re out of focus, what are the signs that people need to go back and do more work at those three levels?
DA: They have stuff on their mind other than what they’re doing.
KF: Hmm.
DJG: Hmm, it’s funny you say that …
DJF: It’s almost like a palpable sensation.
DJG: Um hm.
DJG: It’s like a physical sensation that this does not seem right and I shouldn’t be continuing. I have to stop.
DJG: Yeah, I do that at the beginning. For example, my OR days start quite early of course, that’s the way surgery works, but I’ll still take 15 minutes and uh look at my calendar at home, before I go to work, look at my calendar, think about what my day is like, think about what do I have to address immediately that may slip through the cracks. Do I have to delegate some – something that’s really critical, or perhaps send a pre-emptive e-mail and let someone know they won’t be able to reach me today because I’m busy clinically and it’ll have to wait or who they could contact and by just partitioning things that way and planning accordingly and by having an up to date calendar, which I depend completely on my calendar being, you know, comprehensive and up to date, it changes how I could face the day. Now I can focus and put all of my attention, uh to where it needs to be, which of course is to take care of my patients.
DA: Well you guys are helping frame much more sophisticated sense of Gestalt of how we manage ourselves and our energy because in the old days, you know, yesterday and back …
KF: Ha, ha, ha, ha, ha.
DA: … you know, people would go and surgeons would go and believe you know, physicians who have that kind of drive, are gonna say, “That’s not life critical right now, forget it.” Or, “Maybe somebody will handle it, maybe something will show up and maybe it might be a part of later on, but it’s not the most important thing right now”, and then ignore that and then drop it out of their consciousness, or drop it out of their psyche at that point and then they get whipped back on the back end by that not being handled. And – and that, you know – it’s – it’s almost like understanding the whole Gestalt has to be handled immediately. You can’t, you know, if you’re jumped by four people in a dark alley, you can’t forget that there’s a fifth, and sixth person waiting in that other street, ready to jump you when you handle these four. You know, they are included in that situational awareness. So building a situational awareness and the things that then sensitize that so you know Julian and Julie you guys are absolutely fabulous demonstrations of the difference of taking that sort of responsibility to be accountable for the non-urgent critical – life-critical things in the moment that then if I don’t handle that will then distract me from my ability to handle those ongoing.
DJF: Well I think it’s that capacity that when you’re with your patient – I was with a resident, she said, “Oh it’s …” this kind of a night or that kind of a night.
And I said, “No, this is – we are with this patient right now and this is all that we are. There is nothing more. It doesn’t matter. We aren’t gonna make – she’s gonna get – at the end of the day, she’s gonna get the very best possible outcome.” And – and absolutely GTD enables me to go and I can have four patients that I’m dealing with, but when I’m with that patient, it absolutely lets me just drill right down to, “I am here for you.” That’s all that matters and that is – it just makes me at peace.
DJG: You know it’s interesting you say that Julie and I – I think there are two parts to this, in that there’s a way of thinking about things, in other words there’s a way of thinking and recognizing that one has to be focused on the issue at hand to do a good job. So that’s one aspect. And the other aspect is if you do have everything managed in terms of your information and reminders, it allows you to then practice that focus. And I have to say that certainly, uh – some of – managing all the bits and pieces of my life is an ideal. It’s an ongoing challenge to get to the place where I want to be. At the end of the day in the OR, or whatever else I might be doing, you know, getting home in the evening and having several hundred e-mails to process, I can’t necessarily do that and I certainly have things that slip through the cracks. However, so there’s that data part, but then there’s the – the general model of how to handle something and a problem and understanding – knowing that appropriate focus – or it gets focus that matches the need is to me, seems to be an essential part of the GTD approach to – to handling tasks and projects.
DJF: And actually developing tools that make it happen.
DJG: Yes.
DJF: What do you absolutely have to have? So she said, “Well how do you keep it?”
And I said, “Well here. And we’re totally electronic, but for the mission critical stuff, I still have a small white sheet of paper for each patient that’s got the scoop, because …”
DJG: Me too, same thing.
DJF: I have – I have – “I keep it very close to myself and I do not let anybody else see it, but I have to know that it’s there. And when I sign out the next morning, I can go, ding, ding, ding, ding, and …”
And she said, “Oh, that’s how you do it.” And so while we’re very electronic and very, very savvy, there’s still parts of me that there’s still 3 x 5 cards in my pocket.
DA: Well.
DJF: And I still have the note taker wallet in my back pocket.
DA: Well you …
DJF: You have to have that scoop.
DA: You know Julie, a lot of what I’m doing and we’re doing now to sort of reframe in a much larger scope and I – I think more critical scoping of GTD is creating the right maps.
DJF: Yeah.
DA: What map do you need to orient yourself, so you have your map to orient yourself for that patient? There’s in you pocket. You don’t use the map all the time. You don’t look at your GPS while you’re driving, you’d run into something, but it’s gotta be there and so you need to have that there. So I think that concept of ‘what do I need to do to make sure I’ve captured the appropriate data, clarified and processed it, so that then I can have the display I need where I need it, whether that’s a dashboard in your car or the dashboard you’re walking into doing your rounds. You know – that’s – it’s such a brilliant idea. I mean I keep thinking about Atul Gawande, who is a GTDer by the way.
DJF: Oh, I know, aw.
DA: The whole idea of what map do you need in the OR when you’re taking out of a heart or you’re doing whatever.
DJG: Well we’re doing – you know, interestingly enough we’re – in – in my research lab, we’re working on, on context sensitive check lists that update dynamically.
DJF: Yeah.
DJG: Because it’s the same idea. I mean, if I can, I’ll ask – I’m gonna play Kelly for a minute and ask you a question Julie. On those – on your index cards or on your paper …
DJF: Yeah.
DJG: … you know, I’m assuming that you don’t write everything down about the patient, you just write down those things that you might forget and …
DJF: What we did is when we went to our electronic medical record at the hospital two years ago, before then we had our paper system and we basically did not, you know, maybe one in ten thousand times we would forget a blood clot or something, but – and then when we went to electronic, we went down to pretty much one in one hundred errors, very, very frightening time. So then I started to have a hidden paper sheet and then I started to tape my check-list to the white board in the OR and uh so – and it became a useful tool.
But it is in part to make sure that we don’t forget to get an informed consent, that we don’t forget that she has a clotting problem, that we don’t forget she’s HIV positive and …
DJG: So it takes it off your mind. I think that – what I was aiming at is I think is that the idea is you write things down to make sure they’re not on your mind because they’re on the paper.
DJF: Right. I do not want to be thinking, “Did I get – do I – do I have a blood clot here?” when I’m in up to my elbows in blood. I – I just – I can’t – I can’t do that. Um, I – I have to have everything – I – if I’m gonna be able to say at the end of the day, “I got the best possible result”, I cannot be worrying you know, do I have a blood clot? I just can’t so that’s where we developed this hybrid system and I probably will go to my grave with a 3 x 5 card in my pocket …
KF: Ha, ha, ha, ha, ha.
DJG: Yeah, we all go …
DJF: Because you never know when you’re gonna need it.
DJG: So David, how – how do you envision the – the notion of contextually relevant data is something that uh, you know a lot of people are thinking about, especially health care, but in many areas of course, and we’ve been working on that as a – as a way for example to, you know, why have a check list that tell you, for example, um, to check the patient’s allergies, if you’ve already checked the patient’s allergies and the electronic system knows that it’s been done? Or why have the check list remind you to get informed consent from the patient, if it’s already been done and it’s documented electronically? So why waste, you know, everyone’s time with steps that are unnecessary because they’re already documented somewhere?
DA: Yeah, yeah …
DJG: So how – how are you thinking about that?
DA: Well Julian actually it’s a great question and these are – this is really um, sort of framing the new frontier, because uh – to Julie’s point and Julie I hadn’t heard that before but as soon as you start to go to “Let’s trust the system to do this”, because the system is not nearly as sophisticated as all the variables and subtleties that we don’t really realize are involved in our decision making and critical decision making that – that you can’t trust that system to be able to make that decision for you.
So – the – the two ways to answer that. One is um, I highly distrust contextural stuff simply because of all those variables. You know, some of the early uh stuff they’re doing right now to say, “Well when I get home, show me all the home calls I need to make or show me all the things.” Yeah, but come on, that’s a pretty arbitrary way to try to describe the different categories. You know, I’m sure there’s lots of ways in your context that that would get much more subtle and much more critical that says, “Wait a minute! I still need to know this, even though I’ve checked that off, that’s still something I personally want to know about …” x, y and z. And so …
DJF: I think – especially with electronically you say, “Well electronically we check it, but we have to be really honest with ourselves.” There’s a lot of stuff that’s done electronically that’s frankly not done. It’s checked off, so you know, we’re in this horrible transition period, but we have – you know, we have to be completely effective and truthful and so …
DA: Well …
DJF: … we have to know it’s there.
DJG: That’s my experience too.
KF: And it seems like the theme here too is um, systems are great and of course check lists and getting all that documented, but don’t check your intuition at the door. I would imagine Julie and Julian, you both call on your …
DJG: I like that Kelly.
KF: … intuition quite a bit. Yes?
DJG: That’s great. You hit the nail on the head.
KF: Yeah.
DJG: It can’t be taken away. Exactly.
DA: The key is – what do you need to do to get this off my mind, so I can be present with what I’m challenged to do? So you know, all of you have been speaking to that point, you know and that’s the sort of underlying principle, the GTD principle that says, “Wait a minute! If it’s on your mind, aside from developmental constructive thinking about it, it’s on your mind called – oh that’s a distraction.” And the worst part of it is the subliminal stuff on your mind because it’s not on your conscious mind but you didn’t handle it consciously when it showed up and is still there resident internally and then sucking wind out of your sails when you’re trying to do your top work, so that’s the martial art of all of this and to be able to say, “What is it that’s on my mind when I walk into this person, and when I do my rounds, what do I want to know, what do I want to see?” And I think that’s a very individual call. I don’t see anybody being able to really template that yet, other than how do we build a template that just sort of a template that manages your own template?
DJF: Yeah, it’s just such a very – even since I was a resident, I had templates in my clipboard that I was sort of always evolving and I feel like – I feel the templates on my clipboard, out on a clipboard, I’m still sort of looking for that magic. You know this is really gonna hit the nail on the head, uh to get it just right, so that we can do superb, superb work.
KF: Well Julie – consolation Julie for you on your index cards, one of my favorites uh tools that sits on my desk is actually a stack of index cards and I’ve all my systems and they’re pristine most of the time and all my projects and all my lists and even this morning I was just starting to feel like the wheels on the bus were wobbling a bit with just how much is on my plate at the moment and I pulled out one of my cards and I wrote my punch list, “Here’s what has to happen today. Here’s what has to happen this week.” And it was really just my little mini 3-1/2 x 5 card map that I had next to me and immediately I calmed down, I went – got it. It’s – I’m covered. So even those of us that are super electronic nerds as myself …
DJG: Um hm.
KF: … those cards are just – there’s something about being able to create that kind of ad hoc map as David calls it, just right on the fly, “Show me what I need to know.”
DJG: And Kelly it’s funny you brought up the – you just partitioned something into “It has to happen today – it has to happen this week”, and I – way back when, I guess around 2001, where we started this – this journey, uh, I – I – I really was frustrated at how difficult it was to use a regular electronic device or calendar to put something in that kind of parking spot. It’s either for the week – you know, any time this week is okay, but is has to get done this week, and I think back then what I used were post-it notes on plastic dividers and a loose leaf and so one of them was for the week and one of them was for the day and I could move things back and forth and uh – it’s – it’s funny how hard it is to – to make that happen electronically.
KF: Um hm.
DJG: And uh …
KF: Yeah.
DJG: Yeah, a simple thing like that and yet, that’s how we really work and live and – and the electronic tools don’t map very well. I’m pretty comfortable with these different tools. I think I’ve tried, I – I don’t know, probably 80 or 90% of any product that’s been discussed, at least if it’s Mac compatible or web based, I probably tried it. If it’s discussed on the forums or elsewhere and … I’m still a little frustrated.
DA: Well to validate all of you guys, you know, several of the serious GTDers that I’ve come across fairly recently, you know, what they do is the night before or early in the morning just glance through all their systems and take a 3 x 5 card and say, “Okay, if I get any windows today, here are the three or four things I need to handle”, and they – they really go at a low tech to be able to make that work. You were working technologically – I understand that, so I think that can be supported and supported in spades technologically once you get what this is about. So …
DJG: Um hm.
DA: … it’s coming but no promises how soon.
DJG: Well the problem David is that I – I have to stop using an index card for my daily list because I can’t read my handwriting. Only a pharmacist can read it.
KF: Ha, ha, ha, ha.
DJF: Ha, ha, ha, ha.
DA: Got it.
DJG: Yeah, yeah.
DJF: There’s another secret that you have talked about that’s a really cool in terms of just getting things done, ‘cause alternately you know that’s the part – big part of the beauty of your system is just do that bitchin’ thing that you don’t want to do and do it first thing in the morning.
DA: Ha, ha, ha, ha. Yeah.
DJF: Now I will give you one of the things that torments physicians is that we’re required to be board recertified and you’ll get this e-mail that says, “In three days, if you do not do this, it’s going – you’re going to implode and your – your license will be taken …” You just have this horrible sense that the license will be taken. It’s obviously ridiculous, but you know you’re in for a couple of hours of talking to this lady in Dallas about what you need to do. But because of David like I have this funny – I just took off. I said, “Dammit, I’m gonna do this!” And so the first thing I did and it kind of gave me this boost all day long and so it was this goofy thing, but you – somehow in your litany of advice you said, “Do the thing that’s just got that thorn in your side that’s driving you crazy, do it first thing in the morning and you get this sort of lift all day long” which is very nice. It’s like a bonus, it’s a GTD bonus and that’s a nice little thing.
KF: Ha, ha, ha.
DA: And let me graduate that Julie, thank you, and I – me too. I mean I’m talking to myself when I say all that ‘cause I have to deal with the same thing. It’s really about: I need clear space. And I think you know, a lot of my message going forward for the rest of the years of my life, I’m sure, was gonna be, “Come on folks, clear space is where you want to get to, because that gives you the ability to be present for the meaningful things in your life.” So what’s most in the way of clear space? The thorniest things. Right? The things that are distracting and pulling on you and every time I do this I’m going, “Yeah but, oh my God, I should be …” You know, it’s quieting that noise is the critical factor.
DJG: Well David, if I may say that I think in a sense your emphasizing the roots of your work. That’s full circle back to the beginning which is as I’ve heard you say many times, the reason you focus on – on the runway is to allow people to move to the higher level.
DA: Yeah.
DJG: And I think you know that’s – and in a sense that’s what we’ve been talking about during this – this whole conversation.
DA: Exactly.
DJG: Using examples of that.
DA: And you guys are such brilliant examples of your operating from a higher space and you know that. You look around your colleagues, you know you can probably, you know, I’ll – I’ll tell you ‘cause you probably won’t self profess it, but I’ll bet you know, you’re standing out in the crowd.
DJG: In a good way or a bad way, when you say – you know?
DJF: Ha, ha, ha, ha.
DA: A good way to keep assessing your capabilities and attraction and a bad way to all the people around you that – that you then become the result of them having to then manage themselves.
DJG: You see in our profession we’re all used to left-handed complements, we have to be careful.
DJF: Ha, ha, ha. Well with that list, you keep coming back and it drives ‘em nuts, ‘cause you know you remember ‘cause it’s on – it’s on – that accountability list that we all – it all ultimately to be effective, which is what Julian said was, you know, you have to do what you say you’re gonna do and you really need the list to remember what on earth it was you said that you were gonna do last Friday night uh just before you went to sleep. And if you don’t have it written down, you aren’t gonna remember what you said to that person that you love so much and you thought it was related to travel, but you have no idea if it was.
KF: Ha, ha, ha, ha. Um …
DJG: But it’s like in a sense Kelly, if I can share a thought which is – we have it a little bit easier than some people do in terms of prioritizing what we have to get done. When – I – I think and of course I don’t want to speak for Julie, but I’ll give it a try and then Julie, just correct me, but – I – I think we – you know all of us who care for patients make that our priority, when that’s – if it – if there’s a list of things to do, a list of things to focus on or be concerned about, that always becomes number one, so in a sense, it’s almost like cheating. You know our prioritizing – our number one item is the easiest thing we do. Now the rest of the stuff can be a little more difficult. Uh, but at least we have one area where we can easily, you know, it bubbles to the top all the time.
Now that’s a double edged sword, because it’s – it’s easy to – if we didn’t have uh a good system and a methodology it would be easy to lose those other things to that highest priority all the time.
So Julie do you – does that – is that similar or I’m …
DJF: I have always actually thought that in fact being in medicine that is a huge simplifier. I don’t know how people don’t work in medicine. And I think that I absolutely agree. It’s – it’s we are spoiled.
DJG: Yeah.
DJF: We wake up in the middle of the – I – I wake up, they tell me where to go, I go, I smile, I do my work, I do my operations and – and then I go to the next thing that’s on my list. So it’s actually – it’s wonderful. I – I feel I know that I could not do anything else. And I feel really, really, really fortunate and honestly if it were not for GTD, the rest of my life would be a shambles …
DA: You know guys …
DJG: … unequivocally.
DA: I probably told this story somewhere before but you know an old client and friend of mine Erich Rose, who you know ran surgery at Columbia Presbyterian, I think he’s still there and he said, I had dinner with him in New York and he said, “You know David, uh transplanting hearts …” and he was the first guy to transplant a – a – a kid’s heart successfully, he said, “transplanting hearts – that’s easy.” Ha, ha, ha. “That’s no big deal, but now I’m responsible for integrating a surgical department from New Jersey, the hospital that we just bought ….” Or whatever, he said, “I have no idea what to do about any of that.” He said, “Can you just get me the OR?” Ha, ha, ha.
KF: Ha, ha, ha.
DJG: Yeah, that rings true. But uh you know, it’s an interesting way we look at life, I suppose.
KF: Well guys, we’re coming to our end here. As much as I have loved this conversation and I would love to hear some final words from all of you on your focus and what’s coming – what’s on the horizon for you that’s fun, exciting, creative, in any – inspiring for you in your work or personal life, what’s – what’s your focus? Julian what would you say to that?
DA: Uh, I’m gonna hijack this Kelly for a second. Because I’m gonna challenge uh both of you, of something and just gonna ask a favor of you.
DJG: I knew there would be a test. I knew it!
DA: There is a test. If you didn’t have stability and uh clarity and focus that GTD gave you, what’s the price you pay? Because you know, we’re – we’re going out to a much larger world right now and there are a lot of people that think our stuff is really about getting lists and corporate and you know whatever, but when you really get down to, wait a minute, what’s the improvement of the conversation – what’s the improvement of your conversation with yourself and if you didn’t do this, what’s the price you’ll pay? So it may be a tough question in a short period, but I – I couldn’t resist tossing because of what you guys have contributed so far.
DJF: Julian you go first.
DA: Ha, ha, ha, ha.
DJG: I was gonna say, Julie you go first. Okay, I’ll go. Uh, David it’s a great question. Uh, so I in all modesty I’m a little uncomfortable saying just the number of active projects I have that are work-related. I’m – I have a large uh research lab that’s uh – had the opportunity to positively influence health care policy and health care technology and I’m also building out some other – other things within the hospital and have – I wear other hats that relate to uh standards development for medical equipment internationally and my point in mentioning these things is just how diverse they are and I’ve a lot of balls in the air and it’s pretty hard to keep them all up at the same time and manage them and certainly they do drop and I can’t always keep them going, but what gets me out of bed every morning and what gets me excited is the fact that in all the areas of my professional life, these activities are synergistic. The technology, the patient care, health care policy, whatever they are, they’re all synergistic and I feel like one of the luckiest people in the world to do what I do and I couldn’t do it if I didn’t have an approach that would let me – and to the best of my ability, manage what I’m doing for the sake of – of the best possible outcomes uh to influence health care in a positive way.
So I – without it – without – without it – I would just be confused all day long. I’d be trying to remember things, trying to continue to forget things and I – I still do. I’m so far from perfect, I’m almost embarrassed to say that I’m modestly successful in some of these things, but I know how pitiful I would be if I didn’t have the approach that I use, and also the help. I, you know, Julie mentioned the help she gets and I’ve had coaching with uh Julie Ireland and it’s been, you know, magnificently helpful to me. So uh, I just basically wouldn’t be nearly as effective as I am, even though I’m still not as effective as I wish I could be.
DA: Wow, thanks.
KF: Julie, you’re up.
DJF: Yeah, I think that for me, it’s really – it’s everything. I have uh I have kind of envisioned that for the last sort of 30 or 40% of my career that I would be just safety oriented in OB/GYN, that would be my main focus and then the computer systems came in and – and then I realized that I was gonna be much more involved in the IT aspects of safety and so I really had to modify what I was gonna be doing. It wasn’t gonna be how quickly can I deliver a baby, uh but you know how was I gonna incorporate the – the computer and really make as fine a medical record as I made way back in 1987, uh that we could make as really superb medical record. So I had – because of the areas of focus, I had to kind of like shift my – that area of focus from pure safety to – I had to modify it and so GTD let me modify it.
Um, with my personal life, just staying committed to rowing every day, to you know, taking care of my mother so then I can just go quickly and go see her uh before this evening and then – but on the way I could pick up my trousers at the dry cleaner so that I could get everything done in a seamless way – it’s really helped me to get it all done and – and not be crazy.
I see so many people leaving medicine because of the changes because they haven’t been able to adapt and they just go, “Forget it!” And I’m seeing great, great, great clinicians leaving medicine and I so miss them. These are superb people but they just didn’t want to make that adaptation and I think honestly that with GTD it kind of makes you say, “Oh you can do this. You know, just take it down into a little bite. You know, call up somebody, get some tutoring. You know, meet them next Friday, you can figure this out. There’s just really this one problem that’s really bugging you.” And so to me that’s what the beauty of GTD is, is that it makes you go, oh this is a big project, but my daddy was a builder. You know he used to take us when we were very little to look at the George Washington bridge and he said, “This is just a million little steps that made this beautiful bridge”, and I think that GTD kind of goes, it really is just a matter of picking up your trousers so that you can go to the meeting after work tomorrow, so you’d have something to wear and you’re not worried about – are you gonna have clean trousers tomorrow.
DA: This is mission critical stuff absolutely.
DJF: Mission critical, so to me, GTD it makes me and it was very important for me to find a partner and I found this most incredible person in the world and it’s just such an amazing thing and I honestly think that without GTD – I – I honestly think that – this – you know, I decided this was damned important and so I made it happen. And – and I just benefit from that every single time. So I feel like it’s kept me – it’s kept my world really fun. It’s let me tend to the other stuff and by God, I’ll have clean trousers for this thing after work tomorrow and you know, and then I get to talk to people like you guys – just unbelievable. It’s an unbelievable thing.
DA: Thanks guys.
KF: Great stuff. I’m so appreciative of all of you for doing this, because it was just such a great, rich conversation. I love the different analogies that – Julian I love the – the image of the skier, it was really interesting just picturing a skier and the elegance of that and you have times where you stop, or in my case you fall, and you just – it’s a really interesting analogy. Yeah.
And Julie, you just make me laugh. You’re just such a delight and I welcome your e-mails and thank you – I’m so glad to be considered your pit-crew, and Julian you can ask the same of us as well.
DJG: I certainly will.
DJF: I will just tell you one other thing, meaning Julian. I had this anesthesia idea and now after this conversation, I know I can call him and …
DJG: Oh yes, we started e-mailing each other right before the call too. It’s kind of cool. It’s good to be chatting.
DJF: Yeah, so it’s been wonderful connections and that’s another richness that is – it’s simply fabulous and I can’t thank you guys enough. That’s really what I would say.
KF: Awesome.
DJG: Indeed. Thank you, I’d like to express my thanks as well and Kelly boy you work, you’re flat out always pulling the community together, answering questions, giving it your all. It’s not unnoticed, very appreciated and David, uh – you’re still expanding the thinking and revisiting and refining which is, you know, is exciting. I’m really eager to see what else you have to bring us.
DA: And your Formula One racers are what keep me in the pit. You know.
DJF: Ha, ha, ha, ha.
DJG: Ha, ha, ha.
DA: Good work.
DJF: Okay, we send our love. You guys are awesome. Thank you.
KF: Thank you all. Alright. Take good care.
DJF: Bye, bye, be safe.
DJG: Bye, bye.
DJF: Bye, bye.
CONCLUSION BY ANDREW J. MASON: Love that conversation. If you’re interested in experiencing so many more resources and interviews like this, head on over to GettingThingsDone/podcast and click on GTD Connect. Well if you’ve enjoyed this episode, there’s no better complement you could give us than a review and rating in ITunes. We have some awesome episodes in the works. We can’t wait to share them with you, but now that you’ve listened to this podcast, what’s your next action?

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