Distractions and interruptions are actively stressful, and impact your ability to focus.[1] The nature of the interruptions vary depending on whether you are at home trying to write a paper, or in theatre trying to operate, and I have included some thoughts and resources for both, below.

Our phones and browsers are designed to be compelling, as is the content beamed in on them. Randomly timed visual and audible notifications, are distracting and make it difficult to focus. Even the mere presence of a face down, silenced smartphone reduces our ability to connect.[2]

Ways to limit the involvement of your technical devices can be as simple as closing all browsers other than those you’re working on, putting your phone on silent and out of sight, or on airplane mode (IoS, Android, while making sure that anyone who needs to contact you knows how to do it), or turning your phone display to greyscale to make it less compelling. 

There are also apps which can block notifications during specified time periods, such as Freedom. You might consider removing notifications for, or deleting work email or social media accounts entirely from your phone, allowing you to opt in rather than opt out of checking them. This feels radical, but you'd be surprised how helpful it can be!

Digging out or buying a manual clock and having it visible can also be helpful, since a common reason for getting sucked into our devices is checking the time. 

Clinically, some of these techniques may also apply, depending on the context, plus you could physically remove distractors such as bleeps where appropriate, by asking someone to cover it while, e.g. you’re doing a difficult operation. 

[1] Becker L et al. Psychoneuroendocrinology 2023;156:106358
[2] Dwyer R et al. J Exp Soc Psych. 2018;78:233-9

Two other simple and effective practices to help manage distractions are single tasking and scheduling. 

Humans don't multitask, rather we task or context switch. Switching context is hard work for our brains, so carries a high cognitive load, and can increase cortisol levels. It also reduces the efficiency with which we complete the task.[1] So both chopping up our time into little pieces of ‘time confetti’,[2] or trying to multitask, are both stressful and inefficient. 

Scheduling tasks to specific time slots (also known as using implementation intentions, or time-blocking) helps to support focussed single tasking.[3] Allocating a time slot of an appropriate length further supports efficiency, according to Parkinson's Law, which states that a task will take as long as you give it, within reason.[4]

An alternative to scheduling a single task into your calendar is to 'batch' smaller tasks into one time slot, e.g. allocating 30 minutes every lunchtime to check emails (and not looking at them at any other time). This can reduce the cognitive load of the multiple context switches that we usually exhibit when we check into our emails constantly. It also reduces the likelihood of stress resulting from checking a stressful email just before starting a case.

You can use your normal digital or paper calendar to support scheduling, or specific tools like the Time Block planner or Productive, below. Single tasking is enhanced by the previously described ways to reduce technical interruption.

You can keep track of the time during a scheduled appointment without checking your digital devices in various ways. You could use a manual clock, a timer or you could set a specific length of sound track.
 
While you're at it, why not go for the timer option and try out the Pomodoro technique? Here, a timer is set for e.g. 25 minutes (feel free to tweak the length depending on what works for your brain, body and schedule), during which time you may not check your devices.

[1] Murty et al. Harvard Business Review 2022, available here
[2] Brigid Schulte in Overwhelmed: How to Work, Love & Play When No One has the Time

[3] Gollwitzer and Sheeran. Adv Exp Soc Psych. 2006;38:69-119
[4] Cyril Northcote Parkinson, The Economist, 1955: “It is a commonplace observation that work expands so as to fill the time available for its completion.”

Sometimes it is impossible to avoid people sticking their heads around the door, but there are structures, props or clues that can be put in place, that can help.

Scheduling, for instance, a 90 minute appointment with yourself for a study session, particularly with a shared calendar, can be a good signal to yourself, and others, that time is protected.

Visual aids such as noise-cancelling headphones can also be useful in demonstrating that you are concentrating. They can also help to reduce external auditory distractions, and there are soundtracks aiming to support focus, like brain.fm below, that they can deliver.

Physically finding a place discrete from the action is helpful, rather than trying to do work in the ward office for kitchen, for example. Admittedly, this can be difficult where space is scarce, but there may be ways that this can be designed, or times where there are less likely to be people around. 

Certain physiological states are stressors, like fatigue, or calls to action, like hunger. 

Stressors accumulate, so reducing the number in the background is useful in defining where we start on our arousal curve. Some stressors are difficult to modify, for example fighting an illness; others you have more control over, such as optimising sleep, hydration and nutrition.

These will all be covered in their own right in due course, and feel free to email me directly for recommendations in the meantime.

Our lives, and the surgical workplace, are full of stressors. Having said that, the way that we interpret stressors can change our experience of, and response to, them. After all, within reason, different people can find the same situation interesting, fun or very stressful. 

Think, for example, of being close to a spider. One person may find it fascinating and exciting, while the next might be completely terrified, and their physiological response will reflect those two interpretations. 

Another example is that of being physically alone. One person may revel in it and find it deeply restorative, while another feels lonely, a subjective experience which can be worse for your health than smoking 15 cigarettes per day.[1]

Considering our perspectives on certain stressors, and changing the way that we view them, can be powerful ways to alter our experience.

A second way that we can alter our psychological stress load is through the way that we talk to ourselves. Negative self-talk and criticism are stressful, and self-compassion practices can mitigate this. Kristen Neff is very experienced here, and I have included one of Rangan Chatterjee's podcasts interviewing her, below. 

There are many ways to develop awareness around how, and why, you criticise yourself the way that you do, and techniques to mitigate it, including self-assessment tools such as the PQ score, coaching and counselling. 

[1] Holt-Lunstad J, Robles TF, Sbarra DA. Advancing social connection as a public health priority in the United States. Am Psychol. 2017;72(6):517-530.