Welcome to the November 2023 chapter newsletter. 

CHAPTER EVENTS

• AMWA Chapter Meetup

CHAPTER NEWS 

• Chapter Members Looking for Work

• Join our AMWA North Central LinkedIn Community! Link here. 

FEATURES 

• Managing Task Switching: not Letting It Stress You Out or Reduce Your Productivity

• Grammar Talk: When to Use the Oxford Comma

• Book Club Notes: Man’s 4th Best Hospital

CHAPTER EVENTS

AMWA Chapter Meetup

Please join us for an informal networking and social event with local chapter members.

Where: Urban Growler Brewing Company

2325 Endicott St, St Paul, MN 55114

When: November 16, 2023, at 5:30 pm

Website and parking: https://www.urbangrowlerbrewing.com/get-a-hold-of-us

Please join us for what should be an interesting discussion.

CHAPTER NEWS

Chapter members looking for work

The following AMWA North Central Chapter members are currently looking for work. See below for their names and details on what kinds of jobs they’re interested in. If you know of someone who’s hiring, please reach out!

• Sarah Kuyack (skuyack@gmail.com)

  • Looking for jobs in: patient education, public health communication, website content, mental health, veterinary or human medicine 

  • Job type: full or part time, contract, freelance 

• Kristen Hutchison (kristen.hutchison1@gmail.com)

  • Area of interest: continuing medical education (CME), clinical research work, literature reviews, patient advocacy, and healthcare policy work

  • Portfolio

  • LinkedIn

If you’d like to add your name to this list, please contact the Publications Committee Chair Michael Franklin at franklin.editing@gmail.com.

FEATURES

Managing Task Switching: Not Letting It Stress You Out or Reduce Your Productivity

By June Oshiro, PhD, ELS

Medical writers and editors often work on multiple projects with different timelines. As knowledge workers, we are expected to organize and prioritize our writing and editing projects and to manage administrative responsibilities. In addition to those tasks, we can have unscheduled external interruptions (e.g., instant messages from coworkers) and self-interruptions. To remain productive in these ordinary work settings, we must be able to effectively transition between numerous tasks (termed task switching) and to filter out thoughts unrelated to the work at hand.

Task switching involves mental and sometimes emotional transitions. With a mental transition, a person ideally stops thinking about the first task to fully focus on the second task. However, thoughts about the first task tend to persist. Dr. Sophie Leroy, a professor of management at the University of Washington, coined the phrase attention residue to describe this phenomenon [1], noting that attention residue is particularly pronounced if the first task remains unfinished when the second task begins. With an emotional transition, a person may resist moving from a pleasurable work activity to a mundane or stressful one [2]. This resistance can sometimes manifest as procrastination or avoidance.

Transitions can be planned (e.g., intentional work on multiple projects), but many are unplanned (e.g., interruptions). Unplanned transitions, particularly to unrelated topics, have clear costs in terms of time needed for reorientation back to the original task. Dr. Gloria Mark, a professor of informatics at the University of California, studied office workers and determined that they took an average of 23 minutes to resume work after being interrupted [3]. Interruptions also have an emotional cost. Dr. Mark reported that people who aimed to work faster to compensate for interruptions “experienced a higher workload, more stress, higher frustration, more time pressure, and effort.” [4]

If interruptions can be avoided, then a “deep immersion” approach may be particularly beneficial. Dr. Cal Newport, a professor of computer science at Georgetown University, posits that a single, long period of uninterrupted work may be more productive than multiple, shorter bursts because the mental overhead cost (e.g., the effort to remember where you left off, preparing to concentrate) is paid only once during a long work period [5]. However, if deep immersion with a singular focus is not professionally or personally feasible, then other strategies (detailed below) can be applied to protect productivity. Of note, multitasking should be avoided, particularly with complex tasks [6].

For some people, task switching is stressful. Whether a task switch is planned or imposed, allow time for a transition. A slow inhale (count to 4) followed by an even slower exhale (count to at least 6) helps activate the parasympathetic nervous system, which responds by slowing the heart rate and reducing blood pressure [7]. Consider breathing slowly for 1 minute while mentally preparing to set down the current task and pick up the next. Task transitions may also be a good time to stand up and to rest your eyes by looking at something that is not a screen.

Mundane tasks can be incorporated into the day’s agenda through planned transitions. Dr. Adam Grant, a professor of management and psychology at the University of Pennsylvania, suggests a sandwich approach of starting with a relatively interesting task, followed by a boring task, and finishing with a highly rewarding task [8]. This pattern also is consistent with many workers’ natural rhythm of an afternoon lull [9]. Time blocking is a similar approach in which scheduled blocks of time are reserved for exclusive work on a prespecified task or group of tasks [10]. In this way, routine work such as checking email could be accomplished during periods when interruptions are more likely (e.g., at the beginning or end of the day).

If a task seems overwhelmingly large or difficult, then consider breaking it down into smaller pieces (chunking) [11]. Writing a 50-page document may feel daunting, but maybe writing 1 page seems feasible. If 1 page is still too much, then how about 1 paragraph? One sentence? Alternatively, try chunking by time. Can you focus for 25 minutes? Ten minutes? Two minutes? Although a single chunk may feel like a small accomplishment, chunks often snowball in a way that builds motivational momentum.

If distraction is a problem, then the Pomodoro technique is particularly powerful [12]. It incorporates time chunking (25 minutes of singular focus, 5 minutes of rest; repeat several cycles; then take a longer break) plus methods to manage distracting thoughts (record unrelated ideas elsewhere; address them during rest breaks or subsequent focus periods). In addition, website blockers such as BlockSite (https://blocksite.co/) can be used to stop access to user-specified sites, and nonessential phone apps can be temporarily disabled with an app blocker such as Forest (https://www.forestapp.cc/).

If a work transition is associated with resistance (i.e., procrastination, avoidance), then the first step is to identify the underlying feeling [13]. Dr. Daniel Siegel, a professor of psychiatry at the UCLA School of Medicine, developed the approach “Name it to tame it” [14], based on studies showing that the act of identifying a negative emotion reduces the stress and anxiety caused by the emotion. Second, validate strong emotions to defuse their intensity [15]. (For example, state “I feel dread [emotion] about calling Mr. X because he is so abrasive [validation].”) Third, nonjudgmentally accept that you are experiencing the emotion [16], which may help reduce task-associated resistance. Fourth, remember why you need to do the task [8] because deliberate attention to the link between your work and your values may provide the activation energy needed to get started.

I hope that the tips in this article help you better navigate the myriad task-switching demands that are common in modern work. Remember: plan for transitions; chunk big projects; remove distractions; name, validate, and accept your emotions; and remember your purpose.

References

1. Leroy, S., Why is it so hard to do my work? The challenge of attention residue when switching between work tasks. Organizational Behavior and Human Decision Processes, 2009. 109: p. 168-181.

2. Mahan, B. Why Task Switching is Difficult for ADHD Brains — and 7 Ways to Smooth Transitions. 4/25/2023; Available from: https://www.additudemag.com/task-switching-adhd-difficulty-transitions-teens/. [Accessed 9/19/2023]

3. Pattison, K. Worker, Interrupted: The Cost of Task Switching. 7/28/2008; Available from: https://www.fastcompany.com/944128/worker-interrupted-cost-task-switching. [Accessed 9/19/2023]

4. Mark, G., Gudith, D., and Klocke, U. The cost of interrupted work: more speed and stress. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems 2008; Available from: https://www.ics.uci.edu/~gmark/chi08-mark.pdf. [Accessed 9/19/2023]

5. Newport, C. How to Write Six Important Papers a Year without Breaking a Sweat: The Deep Immersion Approach to Deep Work. 3/24/2013; Available from: https://calnewport.com/how-to-write-six-important-papers-a-year-without-breaking-a-sweat-the-deep-immersion-approach-to-deep-work/. [Accessed 9/19/2023]

6. American Psychological Association. Multitasking: Switching costs. 3/20/2006; Available from: https://www.apa.org/topics/research/multitasking. [Accessed 9/19/2023]

7. Russo, M.A., Santarelli, D.M., and O’Rourke, D., The physiological effects of slow breathing in the healthy human. Breathe (Sheff), 2017. 13(4): p. 298-309.

8. Grant, A., Productivity Isn’t About Time Management. It’s About Attention Management., in The New York Times. 2019.

9. Northwestern Medicine. Quick Dose: Why Do I Feel Tired Mid-Afternoon? ; Available from: https://www.nm.org/healthbeat/healthy-tips/quick-dose-why-do-i-feel-tired-mid-afternoon. [Accessed 9/19/2023]

10. Todoist.com. Time Blocking…and its cousins task batching and day theming: Control your schedule so it doesn’t control you. Available from: https://todoist.com/productivity-methods/time-blocking. [Accessed 9/26/2023]

11. Perler, S. Habits & how to change them. Available from: https://sethperler.com/habits/. [Accessed 9/19/2023]

12. Todoist.com. The Pomodoro Technique: Beat procrastination and improve your focus one pomodoro at a time. Available from: https://todoist.com/productivity-methods/pomodoro-technique. [Accessed 9/19/2023]

13. Lieberman, M.D., Eisenberger, N.I., Crockett, M.J., et al., Putting feelings into words: affect labeling disrupts amygdala activity in response to affective stimuli. Psychol Sci, 2007. 18(5): p. 421-8.

14. Mindfulness.com. Name It to Tame It: Label Your Emotions to Overcome Negative Thoughts. Available from: https://mindfulness.com/mindful-living/name-it-to-tame-it. [Accessed 9/19/2023]

15. Salamon, M. Validation: Defusing intense emotions. 8/14/2023; Available from: https://www.health.harvard.edu/blog/validation-defusing-intense-emotions-202308142961. [Accessed 9/19/2023]

16. Cuncic, A. How to Embrace Radical Acceptance. 11/3/2022; Available from: https://www.verywellmind.com/what-is-radical-acceptance-5120614. [Accessed 9/19/2023]

Grammar Talk: When to Use the Oxford Comma

By Tess Van Ee

The Oxford comma is one of the greatest grammar debates of all time. Proponents say the little mark in a list of three or more words brings clarity. Opponents say it slows down a sentence, adding unnecessary bulk.

Which is it?

The answer depends first on your style guide. AMA, APA, MLA, and other major guides recommend using the Oxford comma. AP, the guide used mostly by journalists and news writers, leaves it out. 

If your company or client doesn’t use a style guide, the choice to use the Oxford comma belongs to the writer. Just remember to stick with the same decision throughout the piece. 

In some cases, an Oxford comma is necessary. For example, “I love my in-laws, Steve Martin and Gillian Anderson.” Does the author love her spouse’s parents and a famous comedian and actress, or are her in-laws an unlikely but equally loveable duo?

This sentence needs an Oxford comma.

Because the healthcare community generally follows AMA and APA style guides, medical writers often use the Oxford comma. However, some situations, like a boss or client’s preference or when pitching an article to a magazine, may require you to leave that comma out.

In these cases, writers can find ways to restructure sentences. Here’s a restructured version of the earlier sentence: “I love Steve Martin, Gillian Anderson and my in-laws.” Rearranging the words from specific to vague brings clarity.

Sources: APA Style Guide, Bartleby, GrammarBook, Grammarly, Proofed

Book Club Notes: Man’s 4th Best Hospital

By Paul W. Mamula, PhD

Our book club met virtually on September 25, 2023, to discuss Man’s 4th Best Hospital by Samuel Shem. Shem is the pen name of Stephen Bergman, a psychiatrist who wrote the book as a sequel to his 1978 classic novel, House of God, a fictional account of the stresses of medical residency. One need not have read House of God to follow Man’s 4th Best Hospital. The books have recently been discussed on the author’s website and in JAMA (1). We had a good turnout and a lively conversation.

The Book

Man’s 4th Best Hospital‘s plot revolves around restoring a fictional hospital—based on Beth Israel Hospital—to its number one national ranking. The corporate director, an old classmate of the “Fat Man” (one of the protagonists in House of God as well) gives him a large budget and the task of restoring the hospital’s ranking. The Fat Man reassembles his former interns (Chuck, Eat My Dust Eddie, the Runt, Hyper Hooper [2]), now established in their practices, and they get busy. They circumvent the hospital’s policies and disable the notorious electronic health system, HEAL (Healthy Electronic Assistance Link) to address the problems corporate policies have caused. HEAL’s emphasis is on billing and administration, and patients get lost in the shuffle, frustrating the physicians who must slog through computer screen after computer screen to complete patient visits. HEAL, they estimate, consumes about 80% of staff time, time better used for seeing and treating patients. One of the novel’s physicians mentions wryly that the words “patient” and “care” do not appear in the electronic health system’s name.

The team generates a system that provides more patient-friendly care. After dismantling HEAL, they implement their own system, one less computer-screen driven. They also address familiar problems—corporate oversight, electronic patient records, pharmaceutical industry ties, and rigid rules. The novel has multiple ethnic characters who populate the physicians’ world and fill their waiting rooms with medical problems that the avant-guard team successfully addresses. The workarounds are eventually found out and lead to a confrontation with a corporate computer expert and the CEO, culminating in a brutal crime (interestingly depicted by a blank page in the novel).

The Good Stuff

The writing style is witty and contemporary. Mary Knatterud said, “I relished Shem’s wry, dark humor, e.g., his main character’s reference to ‘my parents doing better as my parents, dead’ (page 7).” Many of Shem’s scenarios ring true, much as in his earlier novels. He paints a contemporary take on the problems facing current health care practices. As other readers noted, electronic health records, formulary limitations, and clinic issues pose familiar problems for patients (and physicians).

Of particular interest was the animosity toward HEAL and the corporate overseers. Both brought unnecessary complexity and hindered care. Knatterud added, “I loved the characters’ clearly justified resentment of ‘being called analog interfaces’ (page 136), and this nugget about the need for two-way human bonds: ‘Good relations are mutual; if they’re not mutual, they’re not all that good’ (page 161).

The underlying relationship between big pharma and hospital administrations also is prominent, and those familiar with drug marketing can relate. Knatterud emphasized, “I especially appreciated Shem’s calling out of pharmaceutical companies and physicians that push harmful drugs, e.g., ‘Merck, of the billion-dollar drugs Vioxx for arthritic pain—which causes heart attacks—and Fosamax for women’s osteoporotic bones—that can lead to broken bones’ (page 83). Later in the novel, he indicts the much-prescribed statins. He says, ‘Statins, like Pfizer’s Lipitor, can eat away muscles so your triceps hang down like wet noodles—irreversibly’ (page 169).”

Story Line Quibbles

Although the novel takes place in an urban medical center, portrayals of the Fat Man’s assistant Humberto, of the Irish policemen who help keep order in the clinic, and of other ethnic characters were flat and stereotypic. The book has many instances of stilted dialect, e.g., “Sí, sí. Merck Vioxx kill my madre! (p 83).”

Women characters are nearly absent. None of the main characters were women, which is strange given how common women physicians now are in medicine. The only women are Roy Bash’s wife, Berry, an old flame from his intern days who resurfaces briefly, and a couple of female MDs. Only Berry appears fully characterized; the others have fleeting appearances. The women all have subservient roles more typical of the 1950s than the 2020s. Basch’s anachronistic sexism begins early: His leering at the Costa Rican doctor who treats him after a fall is dated: “When she bent over to examine me, I could not help notice that her purple blouse was—to use a line from House—’unbuttoned down past Thursday,’ breasts cradled in the lace palms of a pink bra (p 6).” Wow. A female physician has recently provided some excellent criticisms of both books (3).

Basch’s financial problems didn’t win much sympathy from our group, either. The book opens with him and Berry at their Costa Rican finca (small estate) and sets the stage for later disclosures of financial stress. His huge mortgage and the need to rent out his house and live in its carriage house to make ends meet, his very young daughter’s expensive private school education ($15,000 per year), and his overwhelmingly busy medical practice create tension that grow as the novel progresses. Perhaps some of Basch’s stress might have been lessened with better financial choices.

No article would be complete without some editorial comments. I noticed a few typographical errors, as did other readers. Knatterud said, “I found a few irksome typos: heirarchical for hierarchical (page 18); verses for versus (page 297); and minues for minutes (page 309).” It’s strange that these should get missed, although having also worked as an editor, I can understand how a few mistakes might creep in.

In sum, the book is a worthwhile read. If you have had a recent hospital or clinic visit, particularly one with a physician typing away while you try to enumerate medical problems, this novel will resonate with you (and your physician).

A Little More About the Author

Samuel Shem has a website featuring podcasts and interviews about Man’s 4th Best Hospital and his other books (1). He has also just published another book, Our Hospital, a novel about the experiences of medical personnel during the beginning of the COVID pandemic.

Our Next Book

Our next book club meeting will be on January 29, 2024, when we will discuss Exercised: Why Something We Never Evolved to Do Is Healthy by Daniel E. Lieberman. For those with questions about exercise, this might be the book for you. Please join us, even if you have not read or finished the book.

References

1. Shem S. Man’s 4th Best Hospital website (Writing | SAMUEL SHEM ). [Accessed September 29, 2023]

2. The House of God at 40: The Characters Speak | Humanities | JN Learning | AMA Ed Hub [Accessed September 29, 2023]

3. Pearson R. “The House of God,” A Book as Sexist as It Was Influential, Gets a Sequel. The New Yorker, Dec 25, 2019. “The House of God,” a Book as Sexist as It Was Influential, Gets a Sequel | The New Yorker [Accessed September 29, 2023]

Questions, comments or new additions to the newsletter? Please contact the Publications Committee Chair.