Living Like a Resident: A Guest Post for Your Financial Pharmacist

A couple of months ago, Tim Ulbrich over at Your Financial Pharmacist asked me to author a guest post about my journey to becoming free from student loan debt. Like many of today’s pharmacy graduates, I faced a distressing amount of student loan debt — just over $100,000 by the time I was finished with residency training. Despite earning less than a third of an entry-level salary during my two years of residency training, it was that experience that taught me some of the strategies necessary for climbing my way out of debt in half the time.

Head on over to Tim’s website to learn more about my story or those of other pharmacy professionals who are now proudly debt-free. Even if you’re not a pharmacy professional, there’s still plenty to learn!

Is Disconnecting from Social Media an Answer to the Productivity Dilemma?

I recently finished Deep Work, a book in which author Cal Newport contends that professional success in the future will be characterized by those individuals who can still accomplish deep work despite the world of distractions competing for their attention. According to Newport, deep work represents those arduous tasks that require working at our peak mental capacity (e.g., brainstorming, critical thinking). Shallow work, on the other hand, represents those activities that tend to fill up our days but rarely move us forward on our professional goals (e.g., email, meetings). A consistent theme throughout Newport’s book is his excoriating commentary on social media, which he also highlights in Quit Social Media, his third of four rules for working deeply.

In a blog post earlier this month, Joey Mattingly and I explored some of the advantages and disadvantages of social media for pharmacy professionals. Social media has democratized and accelerated the dissemination of health information, and has facilitated communication among patients and providers alike. Conversely, its widespread use has raised concerns regarding patient privacy, as well as the validity and reliability of health information shared online. Although we did not address the risks highlighted in Newport’s book, I agree that the tendency for social media to interrupt even the most cognitively demanding tasks has important implications for health care professionals, especially since distractions of only a few seconds can significantly increase the risk of errors. However, I dispute his assertion that social media has minimal benefit and that quitting it is the most optimal strategy for working deeply.

First, I think it is important to point out that we have a finite capacity for completing the difficult tasks that Newport characterizes as deep work, a fact he also acknowledges in his book. Individuals who are unaccustomed to the focus necessary for working deeply may only be able to do so for an hour whereas even experts are limited to a maximum of three to four hours per day. Either way, considerable time is left over for social media and other activities.

Second, as I discussed in a previous post, evidence also suggests that focused work is optimally done in much smaller increments, with periods of mental rest in between. Otherwise, diminishing returns should be expected. Although a strategy consisting of 52 minutes of work followed by 17 minutes of rest has been posited as an optimal balance for productivity, a breakdown of 45-50 minutes of focused work followed by a 10-15 minute break is probably more practical to implement. Either way, breaks for social media and other activities can be utilized as a reward for productive work.

Normally I put my mobile devices away when I need to focus on challenging work, but there are times when they must be kept nearby (e.g., when I am on service and someone may need to reach me about a patient-related issue). However, after realizing how frequently my workflow was also being interrupted by social media and other distractions, I recently made the decision to turn off all notifications (including push alerts and badge app icons) except for phone calls, text messages, and the applications we use at the medical center for secure text messaging. Doing so has filtered out all non-urgent communication and has helped restore my willpower for choosing when to engage in social media rather than avoiding it altogether, as Newport suggests.

Admittedly, the tactic outlined above is just a trial-and-error approach to improving focus, and there are probably more comprehensive strategies out there. For those of you who must get deep work done while also maintaining an active social media presence, what are some strategies you have found helpful? I would love to hear your thoughts in the comments section below.


Image credits: adapted from “switch” by Arend (CC BY 2.0)

What Troubled Me Most About the Election

Last week as I was getting ready for work, there was a news story covering Donald Trump’s criticism of the recount efforts being led by former Green Party presidential candidate Jill Stein. In a series of several tweets in particular, Trump alleged that millions of fraudulent votes had been cast in Virginia, New Hampshire, and California, a claim that had no basis in fact whatsoever. Despite being unequivocally false, the statements have since between retweeted by tens of thousands of people.

It reminded me of what has troubled me most about the 2016 election. I was not bothered by disagreements over policy or platform, or which direction people thought was best for America. I can live with others expressing an alternative worldview. Instead, what disturbed me the most was an apparent disregard for facts, a trend we can expect to continue if the above tweet is a harbinger of things to come.

Considerable attention has been placed on fake news sources and the role they may have played in determining the outcome of the election. Although these sites certainly make it easier to spread misinformation, what if the source is the President himself? What are the implications if individuals believe it in the face of facts to the contrary?

Holding public officials accountable has traditionally been the responsibility of the media, but Americans distrust it more today than any time in recent history. This is somewhat understandable, as it has become increasingly difficult to find objective news, and the lines between reporting and editorializing are often blurry. Bias in the media is unavoidable to a certain degree because the individuals who write the news are human. But a fact does not change simply because of who states it. There is a difference between arriving at a different conclusion based on one’s interpretation of the facts – Democrats and Republicans have been doing this for decades – and disregarding the facts altogether.

All information – whether it originates from the mainstream media or the President himself – should be scrutinized for its accuracy and reliability. We have at our fingertips the totality of human knowledge, a resource that is now available to almost every individual in the United States. We are on the cusp of an era where being misinformed is possible only when one chooses to be. So how do we convince people to choose the alternative?

It appears we may need to begin by teaching students how to tell the difference. In a recent study conducted by the Stanford History Education Group, 4 out of 5 middle school students could not discern “sponsored content” from a real news story. A similar number of high school students were unable to differentiate between real and fake news on Facebook. College students were no exception. Most could not detect the potential for bias in a statistic cited by an organization with a political agenda, and many were unable to recognize information originating from a fringe source.

I was alarmed by the group’s findings, which can be read in their entirety here.

But these statistics should be alarming to everyone, because facts aren’t just for clinicians, or educators, or researchers. Facts are for any individual who makes decisions of consequence, and electing the President is no exception. American progress has been built upon individuals using facts to make the critically important decisions necessary for driving advances in everything from engineering to medicine to civil rights.

Let’s not turn back now.


Image credits: adapted from “American Flag” by Daniel Zimmermann (CC BY 2.0)

Working Hour by Hour: Balancing Procrastination and Progress

After the Orioles game on Friday night, I dropped by the office at around 10 pm to grab some things on my way to the parking garage. As I was leaving, I saw several students studying in the lobby and it reminded me of some of the late weekend nights I would spend preparing for a major Monday exam. If I only knew then what I do now…

When approaching a major task, whether it be studying for an exam or tackling a work-related project, most people choose one of two general time management strategies: setting aside large blocks of time to complete the task in as few sittings as possible (with one inevitably being right before the deadline), or making slow but steady progress gradually over time. I hope to convince you that the latter is probably a better way to work, and one that may even give you back some of your weekend.

First, maintaining focus on a single task over a long period of time can be a challenge. Attention peaks at the beginning of a task and steadily decreases over time, with the greatest drop in focus occurring at around an hour. Fortunately, taking a break for 10-15 minutes can restore this loss in attention and return you to peak productivity. According to a study highlighted in a 2014 piece in The Atlantic, the ideal formula is a 17-minute break for every 52 minutes of work, but few of you probably work in these increments, so breakdowns of 45 and 15 minutes or 50 and 10 minutes will probably be easier to remember.

Second, a lot of unfinished tasks are probably competing for your attention beyond the one with a looming deadline, and these intrusions can make it even more difficult to focus. This can be partially explained by the Zeigarnik effect, named after the Gestalt psychologist who first described the phenomenon in the 1920s. She postulated that unfinished tasks introduce a type of mental tension, leading you to persistently recall them until they can be effectively resolved. Attempting to focus on a single task over long periods of time can make you especially vulnerable to the Zeigarnik effect, as unfinished work will undoubtedly start to pile up. However, if you divide your time into smaller increments and dedicate each to a separate task, you can move forward on a variety of unfinished tasks over the course of a day.

Finally, trying to get everything done in one or two large blocks of time can actually impair some of the most valuable processes your brain undergoes when managing complex tasks. This is especially true for creative thinking, which rarely thrives in the shadows of a rapidly approaching deadline (although there are certainly exceptions). Striking a fine balance between procrastination and progress was the subject of a recent TED Talk by Adam Grant, an organizational psychologist and faculty member at the Wharton School. Based on research he performed as part of his book on original thinkers, he describes this balance as being crucial for fostering the creative thinking necessary for big ideas.

So how can you put these concepts to work for you? Here are a few simple steps:

  1. Allow yourself 45-50 minutes to focus on a single task. Set any mobile devices aside and use this time to its fullest (more on multitasking in a later blog).
  2. Next, take a break for 10-15 minutes. You can even use this time to reward yourself with the distractions you had to put away in #1 above.
  3. When you return, spend the next 45-50 minutes on a new task. If you’re really pressed for time with an upcoming deadline, you can return to the original task, but the goal is to make progress on all of your projects simultaneously.
  4. Continue to arrange your day in increments of 50 and 10 minutes (or 45 and 15). I automate this process by blocking off my calendar for an hour at a time (see below) and setting alerts for the next task to fire at the 45-minute mark by default. These alerts are a gentle nudge to finish up my current task in the next 3-5 minutes and prepare for a break.
  5. For simple tasks that are not part of a major project and may just take a few minutes to complete, bundle these together in a single block. I usually block these off as “Miscellaneous.”


Do you have additional suggestions? Want to share your workflow strategies? Please leave your thoughts in the comments section below!

Back to School

This past week marked my first week of classes for the 2016-2017 academic year.

Normally that would refer to my role as an instructor. However, in the above context it also means my first week of taking classes.

Earlier this year I decided to return to graduate school part-time to pursue a Master of Science in Applied Psychology, with a concentration in Industrial/Organizational (I/O) Psychology. For those of you unfamiliar with the field (I certainly was until this past year), I/O psychology is essentially the study of how humans behave and interact in the workplace.

The desire to study I/O psychology may seem unusual given my career path up to this point, but I think it helps explain why I have become less interested in the content of my work and more interested in the processes by which I and others do that work. For example, I find it incredibly disheartening that so many people enter health care because of their desire to serve others, yet they are cast out into complex systems that seem to present them with nothing but barriers to their success. The results have been devastating, as burnout among health care professionals seems to have reached an all-time high.

What is it about health care that does that to people? Is it a sense of altruism among health care professionals that leads them to put others’ needs above their own, even to the detriment of their physical, mental, and emotional well-being? Is it because our system often perversely incentivizes quantity over quality, whether it be the number of procedures performed (or documentation boxes checked) rather than the actual care provided? Or is it our collective refusal to question some of the more ingrained traditions that drive our existing processes, such as the organization of postgraduate training or the hierarchal structure of health care?

These are the kinds of questions that interest me, and the ones I hope to research after completing the I/O degree.

The Psychology of Branding: An Art and a Science?

Last week, the theme of TED Radio Hour was the concept of branding and how we assign value to the things we purchase or experience. Research seems to indicate that most of the value we assign to certain brands is the result of our perceptions rather than any measurable differences in quality. For example, how many of the individuals you know who purchased a MacBook did so after concluding that OS X offered them a superior computing experience? There may be a few, but it is probably far fewer than the number of people who purchased a MacBook because of how it made them feel.

You are probably familiar with studies showing that people tend to rate wine more highly when being told it is expensive. I was too. As a health care professional, I’ve also seen this concept play out when patients claim that one drug works better for them than a therapeutically equivalent alternative. But the research that really got my attention during last week’s podcast was one where participants who were told wine was more expensive not only claimed it tasted better – the activity of their brains also changed to match it.

The study consisted of 11 participants who were told they would be sampling five different wines identified by price. However, only three different wines were actually used. Two of the wines were given to the participants twice, once with the true price and a second time with a fake price. The third wine was assigned its true price. Functional magnetic resonance imaging (fMRI) was used to measure brain activity while participants sampled each wine. As expected, participants claimed the more expensive wines tasted better, even if it was the same wine assigned an artificially higher price. However, what made the study so interesting was that fMRI results indicated that brain wave activity in the medial orbitofrontal cortex (i.e., the part of the brain that processes pleasure) also increased when participants were told they were drinking more expensive wine, even if it was the same wine they had already tasted at a lower price.

I recognize the study is small and not one upon which you can base any final conclusions, but it does seem to suggest that there may actually be physiologic reasons for why we prefer certain products and experiences to others. In other words, it’s not just that we perceive them to be better – we may actually derive greater pleasure from them because our brains have been conditioned to associate price with quality.

So what should we take away from this study? Well, other than providing some justification (to yourself or perhaps to your spouse/significant other) that it is perfectly reasonable to upgrade to the more expensive product or experience, I think it also illustrates the powerful influence that branding can have on human behavior. For example, I will probably respond less smugly to a patient who claims a generic product does not work as well for them, even if I know there is no actual difference in its efficacy compared to the branded alternative. As it relates to work, I think it also emphasizes the importance of curating a personal brand, and how that can influence the way people perceive you. If you can develop a reputation for doing good work, clients may be more likely to seek your expertise in the future, even if you do not have a measurable advantage over your peers.


If you would like to learn more about branding and its impact on decision-making, check out the August 12 episode of TED Radio Hour. The study described above is also featured in a 2011 TED Talk by Paul Bloom, a psychologist at Yale University, which you can watch below:

Please Pardon the Dust

Ever since I first registered the domain, I had hoped to create a space for myself on the web that existed apart from my perspectives on health care. I had hoped to create a portfolio of my work as well as an avenue through which I could explore new opportunities. I also hoped to continue writing while not feeling constrained to focus only on those topics related to cardiovascular medicine, the profession of pharmacy, or health care in general. Instead, I wanted to begin examining some of the forces that help shape human behavior, especially as individuals interact within complex organizations like the health care system.

This website is intended to be the realization of all of those things. Although it is not yet finished — thus the reference to “dust” — I hope to continue to build it while also developing new content. As I head back to graduate school this fall, I remain optimistic that there will be no shortage of ideas to explore. Thank you for stopping by, and I hope you’ll continue to visit in the future.


P.S., If you’re looking for content related to cardiovascular medicine, please check out the ATRIUM Cardiology Collaborative, which I co-founded with my colleagues at the University of Maryland School of Pharmacy.