Sarah Samaan, MD, a cardiologist, often opens an EKG only to get a deluge of other messages: test results, patient questions, refill requests, notifications — some urgent, many not. While trying to focus on one patient, “my mind would immediately get pulled into something else,” she said.

Sound familiar? Interruptions and attention breaks have always been a part of physician work, but there’s a distinct difference today.

Where once, “it was just a knock on the door, now the texts and EHR [electronic health record] patient messages are orders of magnitude far more than they used to be,” said Samaan, who retired from cardiology after nearly three decades and is currently a physician coach, working with clients who struggle with this very problem. “It’s impossible to escape.”

Put some numbers on it: What if, say, four interruptions coming close together made you twice as likely to make a mistake? What if you found out that you’d been interrupted 11 times per hour during a shift?

As you’ll see, data show this is more than a stress-and-burnout issue. Your focus deserves protection and you’re about to meet some doctors who have figured out ways to manage the deluge.

The Math Is Really Scary

Attention residue. It’s a term defined more than 15 years ago as “cognitions about Task A that persist even though one has stopped working on Task A, transitioned to Task B, and is now working on Task B.” Basically, as you switch tasks, some cognitive capacity stays tethered to the previous incomplete task.

“It’s like trying to read a book when someone is flipping pages back and forth,” said Angela Downey, MD, CFPC, family physician and host of the podcast The Codependent Doctor. “After switching tasks, the brain needs to reset, which slows us down and increases mental fatigue.”

Adding to the lost time? After an interruption, past research has found it takes 23 minutes to fully return to the original task, explained Elizabeth Harry, MD, SFHM, chief well-being officer for Michigan Medicine, University of Michigan Medical School, Ann Arbor, Michigan, and an expert in cognitive load and burnout. That effort to refocus further depletes your “attention bank.”

Now reconcile those statistics with these…

Emergency room physicians and nurses were interrupted an average of 11 times per hour in a 2020 study. High rates of interruption were found to degrade “situational awareness,” a cognitive process that is necessary for high performance in pressured, fast-paced settings.

Past research in JAMA analyzed medication administration among nurses and found that each interruption was associated with a 12% increase in procedural failures, like not checking patient identification or reading medication labels. It was also linked to a 13% increase in clinical errors, such as giving the wrong dose. Having four or more interruptions during medication administration doubled the risk of making a major error compared to working interruption-free.

Attention switching contributed to the cognitive load of clinicians involved in interhospital transfer cases, which naturally tend to be complex, according to recent studies in the British Journal of Anaesthesia and the Journal of Hospital Medicine. And among nurse practitioners (NPs) and physician assistants (PAs) in the ICU, it raised the likelihood for patient errors by 28%.

“Over the course of the day, this consistent shifting leaves you feeling scattered, falling behind, emotionally drained, and at an increased risk of mistakes or a reduced presence with your patients,” Downey said.

It Follows You Home, Too

One of Samaan’s clients routinely didn’t have time to complete one patient chart before having to see the next patient. “At the end of the day, she couldn’t really remember what was going on with that patient to finish the chart, and she’d call them to check-in and gain some clarification. She deeply cared about her patients, and it would lead to a 20-minute conversation.”

The sacrifice of personal time is something Annie Gallie, MD, a life coach who works with physicians, sees often. “Attention is the biggest commodity you have,” she said. When reserves get low, “we will sacrifice the back end — our time at home. So we open up our laptop after the kids go to bed or check the inbox when kids are at soccer practice. There’s an impending sense of always being behind and a perpetual state of living in survival mode,” she said.

The ‘Sterile Cockpit Rule’ and More Help at the Systemic Level

Several healthcare systems have made organizational changes to try to address the interruption problem and protect employee focus. “In medicine, our attention and focus is about performance and safety, but we haven’t framed it that way,” said Harry. Coming from an altruistic place, physicians often “try to pivot to meet everyone’s needs,” she said. “In doing so, that can put the people we care for at higher risk.”

One move toward protecting physician focus is instituting the “sterile cockpit rule” drawn from the aviation industry. In flight, there is to be no nonessential activity during critical phases. “In the OR [operating room] this has been done pretty well, when surgeons’ pagers are handed away, and there is an alignment between teams about what is critical and what is not,” said Harry.

This idea of “do not disturb” during cognitively demanding tasks has also emerged in nursing, though not all outcomes were positive. Various studies have analyzed what happens when a nurse wears a “do not disturb” vest, and some show that this tactic has no influence on errors and is off-putting to patients.

Some practices have attempted to triage patient communication, hiring a PA or NP to monitor the inbox and direct issues to physicians that need their attention.

AI transcription, which many hospital systems are using, can also be helpful for physicians to streamline their workflow, said Samaan.

But in general, no systemic solution has been found.

What You Can Do

Still, there are steps you can take to protect your attention span and reduce mental exhaustion:

Work the clock. Create focused blocks of time by batching similar tasks, such as reading all labs, suggested Samaan. When a new to-do pops into your head, write yourself a brief note, which can “signal to your mind that you’ve set it aside,” she said.

Enforce painful boundaries. Consider what you need to maintain focus from task to task, and then clearly communicate that with staff and patients, said Downey. For example, when your door is closed, that indicates that your staff should not knock. Or if you’re with a patient, tell your staff not to send through any phone calls. During appointments, tell patients that you are going to manage one issue per visit, and schedule follow-up visits for additional concerns. “This can be uncomfortable to set, but in the long run it’s worth it to protect patients and care,” she said.

Boundaries are critical for Joshua Gray, MD, an emergency physician and clinical consultant at Relias. “If my clinic staff have messaged more than three times with a patient about a topic, and we’re not getting to the answer we need, it’s time for the patient to come in for an appointment,” he said. Patient expectations for being able to message physicians has led to more complicated questions being sent through the portal, which can easily get out of hand. “Patients view this as text messaging,” he said, so create a rule that works for you and your colleagues.

Master the ‘microbreak.’ Jennifer Chung, MD, a functional and lifestyle medicine physician, has described her days as a “run on sentence.” To regain focus in between patients, she takes 1 minute in between each to breathe deeply. “This allowed me to be fully present with [the next patient] and focused,” she said. Harder days required pep talks — to the tune of “Jen, you got this.”

These moments aren’t merely symbolic. Microbreaks, as they are called, help restore working memory, said Harry. Research in PLoS One also shows that they preserve energy, alleviate fatigue, and enhance productivity. But watch what you do, Harry advised. “Often when we have a break, we get on our phone and scroll, but this does not provide the same cognitive restoration.”

Conspire with colleagues. During residency, Harry and another resident would switch off carrying the other’s pager for an hour, which allowed them to each sit down to finish their notes. “Patients got extra care and we could have more focused time,” she said. In her residency, this approach did not have to be approved, so keep in mind what your workplace allows and brainstorm from there.

Forgive yourself. If you think you’re the only one struggling with focus, think again. “I notice that physicians can carry shame that their colleagues can seemingly keep up with things that they can’t,” said Downey. “It can lead to feeling overwhelmed or seeing it as your own personal failure. It’s important to recognize that this is a systemic issue.”

Remind yourself that your mental well-being matters for your patients as well. “We often overlook the fact that this has an impact on patients,” said Samaan. “Protecting physician time and attention is about allowing them to do the work they’re trained to do.”

All experts declared having no competing interests.