The myth of multitasking: Costs, dangers, and consequences

Neil Baum, MD

"To do two things at once is to do neither." Publius Syrus

We have placed an emphasis on enhancing efficiency in our medical practices. There are so many intrusions on our time that it is necessary to find methods, techniques, and technologies that will make us more efficient. One that won’t work is multitasking and this blog will discuss why we must bury the myth of multitasking.

I have bought into the lie that trying to do many things at once enhances productivity. This lie became apparent when I answered a cell phone call in the exam room with a patient in the room, and the patient asked for his records and left. This myth is perpetuated when more than 6 million websites offer advice on multitasking, and employers look to find staff who claim they are proficient at multitasking. The reality is that if you try to do two things at the same time, you won't do either well. It's a trajectory to get less done.

History of multitasking

Humans have existed because we are wired to do many tasks simultaneously. Our ancient ancestors wouldn't have lasted very long if they couldn't scan for predators while gathering berries or hunting for food. This ability to perform two functions at the same time was a necessity for survival.

The concept of humans doing more than one thing at a time became part of the vernacular in the 1960s. The term describes a computer's ability to perform many tasks. Multitasking alternates multiple tasks by sharing one source, the computer processing unit (CPU).

The term was then used to mean multiple tasks performed simultaneously by one resource (a person). This is a confusing concept because computers can process only one piece of code at a time. The speed at which computers tackle multiple tasks gives the illusion that everything happens simultaneously.

Humans can do two or more things simultaneously, such as walk and chew gum. However, we can't focus on two things at once. Our attention bounces back and forth. This works for computers but not for medical office workers and physicians. That’s why it is unlawful to text and drive at the same time. Thus, we have created an atmosphere where we feel the need to do too many things in our allotted time.

The modern medical office has an abundance of distracting demands. An example is the receptionist in a small office who answers the phone, schedules patients, makes follow-up appointments, and collects payments. Therefore, it is not a surprise that costly mistakes occur. Research shows that employees are interrupted every eleven minutes and spend nearly one-third of the day recovering from these distractions.

We receive more than 6000 thoughts daily and are tempted to do too many things at once. Some call this jumping between tasks task switching. This occurs when you start one task, get interrupted, switch to another, and then redirect back to the first task. There is a cost in terms of extra time from task switching from 25% to 100% depending on the complexity of the tasks. Employees who use computers at work change screens or check emails 37 times an hour. The average desk job employee loses 2.1 hours a day to interruptions or distractions. It is easy to see why multitaskers are less productive than those who do not.

Think of the cost we spend on multitasking. If we lose a third of our workday to distractions, what is the economic cost over a physician's forty-year career? Just calculate your hourly rate and deduct a third for each day, week, month, or year, and you quickly see the economic impact for a practicing physician.

The neurophysiology of multitasking

We can process different kinds of cerebral input. When we walk and talk at the same time, there is neuronal interference. However, you are not focused on both activities. One activity is in the foreground, and the other is in the background. For example, if you are attending to a code blue patient with a cardiac arrest, you can't take a phone call from the office. Many of our essential functions, like breathing, come from a different part of the brain than where focus comes from. This part of the brain, or brainstem, is responsible for essential life functions like breathing, heart rate, and balance. It is in the prefrontal cortex of the brain where the focus occurs. When you try to focus on two activities, your attention gets divided, and we have a term for that, "divided attention." When you take on more than one task, something will receive short shrift.

This is an explanation for how media multitaskers and screen switchers become addicted to the process. They may experience a thrill when they receive a burst of dopamine that keeps them repeating the process.

Why multitasking won't work

When we try to do two things at once, we divide our focus. This is why multitasking will not work. Let me summarize why.

• We have only a limited amount of brain capability. Dividing that brain activity results in a price in productivity.
• The more time you spend switching tasks, the less likely you are to regain focus on your initial task.
• If you bounce between two or more activities, you will waste time, as you will spend valuable time refocusing on the original task. The experts report that we lose 28% of an average day to multitasking inefficiency.
• Repeated multitaskers have a distorted sense of how long it takes to do things. They almost always have a distorted concept of time and believe tasks take longer than required.
• Multitaskers make more mistakes than those who focus on one task at a time.
• Multitaskers have less happiness and more stress than those who are more focused.

In addition to a decrease in efficiency and productivity, there are dangers associated with multitasking. We all have heard about the dangers of driving while texting or using cell phones. An article appearing in the New York Times found that distracted driving is responsible for 16% of all traffic accidents and nearly half a million injuries each year. Even hands-free phone conversations have a 40% decrease in your focusing ability or about the same impact as drunk driving. I would never condone this behavior for my teenagers and the airline pilot taking off or landing the plane. Just remember that a text message can turn your SUV into a deadly weapon.

Let's make this more pertinent to the medical profession. Multitasking can cause serious consequences for surgeons at the operating table when they take or place calls during surgery. Our patients have no tolerance for anything from their surgeon but total concentration. When we are with a patient, they demand our undivided attention. (I learned this painfully when I took a phone call in the exam while I was with a patient.) My take-home message is that there is no tolerance for multitasking when we are involved in patient care.

Suggestions for mono-tasking

• Make a to-do list at night for the next day or first thing in the morning. Prioritize your tasks based on their importance and urgency. For example, use the acronym NLF or now, later, or in the future. N tasks are to be completed today. Later ones will be accomplished soon. Future tasks are done when time allows. Focus on completing one task at a time, first with the new ones.
• Turn off notifications, close unnecessary tabs, and avoid checking your email or social media while working on a task. For example, set aside a 30-45-minute slot each day to return phone calls. Have your staff let patients know approximately the time you will be calling so you avoid playing the wasteful game of phone tag.
• Schedule short breaks between tasks to recharge and refocus. Try the Pomodoro Technique, where you work for a set amount of time, like 50 minutes with patients, and then take a short, 10-minute break.
• If possible, delegate or outsource tasks that others can do, freeing up your time to focus on the most important tasks. A physician should only do what can't be done by others.

Bottom Line: Multitasking is a myth and leads to decreased efficiency and productivity. Attempting multiple tasks simultaneously can increase the likelihood of costly and dangerous errors. Instead of multitasking, physicians should prioritize tasks, minimize distractions, and focus on completing one task at a time. By embracing a more focused approach to their medical practice, doctors can improve their productivity, creativity, and overall enjoyment of our medical practices.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.