How I Manage My Time - The Triage System

If you've ever felt like there aren't enough hours in the day or that your to-do list just keeps on getting longer no matter what you do, then this video is for you. In this video, we're gonna go over the six components of the triage system, which is a method of time management that I learned during my eight years of medicine, first as a medical student and then as a doctor. It's the same system that I use today to manage my time, to run multiple businesses, to write books, and it's completely changed how I think about managing my time and my priorities. So when I worked as a doctor in the hospital, there was one key principle that changed how I thought about managing my time, and it wasn't about being more efficient or having more discipline or building better habits, it was about understanding the simple truth that the order in which you do things matters more than how many things you got done. So think about an emergency room. When patients come in, they are not seen on a first-come, first-served basis. That would be absolutely catastrophic. Instead, the medical team uses a system called triage. They assess who needs attention most urgently. If someone is there with a heart attack, then they're gonna get seen before someone who's there with a sprained ankle, even if the guy with the ankle got there first. But this is where it gets interesting because in the emergency room, just like in life, the work never stops. There is always another patient coming in through the doors. There is always more that could be done. The to-do list is infinitely long. And this is actually the reality that we're all facing today because your to-do list is never actually finished. There is always another email you could send. There is always another project you could start. There's always another skill you could learn. You could always be building your personal brand a bit more by writing more on LinkedIn and making a YouTube channel and all this stuff. The problem is not that we have too much to do. The problem is that we are trying to do everything. And this is the fundamental mistake that we all make with time management. We think that it is even theoretically possible to get on top of everything, to take off all of the items on our to-do list. When in reality, the mindset shift we wanna have and the one that completely changed everything for me is to recognise that in a world where the to-do list is literally infinitely long, it is physically impossible to get through the to-do list. And therefore, all we can do is what doctors in the emergency room do every single day, which is triage. We've gotta make sure that fundamentally, we are tackling things in order of priority and actually being okay if some stuff on the to-do list just never gets done because it's not sufficiently important. And so now we're gonna talk about the six core principles behind this triage method. These are principles that work together to help you not just get better at managing your time, but actually to make sure that what matters most is the stuff that actually gets done. So when I was in medical school and I first started my placements in the hospitals, there was one thing that I noticed pretty early on that was quite surprising, which is that every single doctor seemed to walk around with a folded piece of paper in their pockets and they seemed to be writing things and scrolling things on that folded piece of paper and using that as their daily to-do list. And then at the end of the day, they would take that folded piece of paper that had their daily to-do list, they would stick it in the shredder machine-y type thingy because they couldn't carry it home because of patient confidentiality. And then the following day, they would take a blank piece of A4 paper from the printer in the hospital and that would become their to-do list for the next day completely fresh. Even back then, and this was like 10 years ago, I was a productivity enthusiast. And so I thought like, surely doctors around the world have found a better way of managing their tasks rather than just this blank piece of paper that they just sort of refresh every single day. And so I remember at the time asking one of the doctors that I was working with, why do you guys use this like paper manual system? Why not use an electronic system or use the electronic patient records where you can keep track of all the tasks that have to be done for all the patients? And she pulled out this piece of paper that had all of these like scrollings and markings off on it and everything. And what she said was partly that the messiness of the to-do list was the point because every single time you cross something out, every single time you write something down, you're making a conscious choice about is this thing sufficiently important for me to do or action today? Over time, I realized this is actually really powerful and this is where the idea of the daily reset comes in, which is that every single day, you are working off a fresh piece of paper rather than having all of your infinite different tasks on a to-do list where you're just being overwhelmed by like the incredible number of things that you have to do. It's still important to have one of those like master task managers or project lists or to-do lists or whatever, so that you don't forget stuff. But the idea behind the daily reset is that every single day, you are asking yourself afresh, what are the most important things for me to do today? The way that I do this in my life these days is something that I call the morning manifesto. This is a three to five minute journaling little prompt thing that I try my best to do every morning. This is what it looks like. It is in my LifeOS Action Google Doc and it's got three components, prime, remind and plan. So prime, let's connect to a body and prime our day with gratitude. Remind, let's remind ourselves of our key priorities. So what were our quarterly quests and how are they going? More details in that video up there. There'll be a link down below as well about what the hell a quarterly quest is. I ask myself, what were our top three outcomes for the week and how are they going? This helps with prioritisation. And then within plan, I ask myself the question of what is today's adventure, i.e. single most important task going to be and is it in the calendar? And so this is one of the steps in my daily reset where every single day I'm asking myself what is today's highest priority item that I need to get done? Sometimes I didn't manage to do the thing yesterday and so the thing might carry over to today but then again, it might not. Part of the triage system is recognising that it's physically impossible to get through everything on your to-do list. Therefore, we just got to focus on what are the most important things. And this is one of those questions that helps us figure out what is that most important thing. I also ask myself that if we have time, what other one to three tasks will we complete today? Are those written down somewhere easily accessible? For example, an index card or the today view of our to-do list app, et cetera. And this is where I use a pen and paper system. I take a fresh sheet on my little journal type thing and I write down physically by hand what specific tasks I want to get done today. And I try and limit myself to just three things. So I have my one most important thing and then I have one, two or three different extra tasks that I can do in addition to that. And those are written down on a piece of paper. By the way, if you're interested in how this entire system works together, it's still a part of LifeOS which is my personal productivity system that'll be linked down below. Now, speaking of things that I learned in medical school, another thing that I discovered is the importance of mental wellbeing. And one way to improve your mental health and wellbeing is through therapy provided by BetterHelp who are the very kind paid partners of this video. BetterHelp is the world's largest therapy service and it's 100% online. With BetterHelp, you can tap into a network of over 30,000 credentialed and experienced therapists who can help you with a wide range of issues. It's a platform that makes finding a therapist easy because it's online, it's remote and by filling out a few questions, BetterHelp can match you to a credentialed therapist very quickly. Then you can talk to your therapist however you feel comfortable, whether it's via message or chat or phone or video call. Regardless of whether you have a clinical mental health issue like depression or anxiety, or if you are just a human who lives in the world who's going through a hard time, therapy can give you the tools to approach your life in a very different way. You can message your therapist at any time and schedule live sessions whenever it's convenient for you. And if your therapist isn't the right fit for any reason, you can switch to a new therapist for no additional charge. So let BetterHelp connect you to a therapist who can support you all from the comfort of your own home So if that sounds good, you can check out betterhelp.com slash Ali Abdaal, which will be linked down below as well. Or you can enter my name Ali Abdaal during the signup process and that will give you an exclusive discount. So thank you BetterHelp for being the paid partner in this video and let's get back to it. The handwritten box method for to-do list management. Now this is the method that most doctors that I met were following to do their to-do lists. And this is the method that I still use for my to-do list many years later, even though I'm not a doctor anymore, it's still really, really helpful as an entrepreneur, as a creator and so this is how it works. Basically, the idea is you create a box every time you have a new to-do, nothing particularly fancy about that. In my case, these are three of the things I need to do today. So book Valentine's Day dinner for me and my wife to film this time management video and to apply for my Hong Kong ID. Now in a traditional checklist, once you've done with the task, you would put a little tick in the little box. But what I noticed when I was working in medicine is that doctors never really ticked the box off. Instead, they did something a little bit more sophisticated, which is, they had different levels of what happened to the box based on what the status of that particular task was. So there's a few different statuses that something could have. You could have this, where you've kind of made a start on the task, but there's still quite a lot of stuff to do. So for example, if you needed to do a blood test on a patient, you might use the diagonal line to indicate that you've requested the phlebotomist to take the blood. Then when you saw that the blood was taken and had been sent off to the lab, you would half shade in the box, which shows that the task is 50% done or whatever. And then a few hours later, when the blood test is back from the lab and you have checked the blood test result and acknowledged it and acted on it, you would fill it in and then you would cross the thing out. And so this becomes a very nice way of not having to remember what the status of specific tasks is, but just having it straight on the piece of paper. In my case, what it looks like, for example, for filming this video, I would do the diagonal line thing once I have finished filming the video. I would half shade it in when I have got the footage onto my computer and set it to upload to Google Drive. And then I would fully shade it in and cross it out when it's been uploaded to Google Drive and now it's gone to my team and it's not my problem anymore so I can safely forget about this particular task. Depending on what you're doing with your work and your life, your status system might be different depending on what the task is, obviously. But I find this to be a very useful and also very satisfying way of managing a to-do list. One of the core principles I learned around like what motivates us when I was doing research for my book, Feel Good Productivity, is that we feel really good at taking things off a to-do list, right? Everyone's had that experience. Like the experience of making progress on a task feels good. The problem is if you're only allowed to take it off once you've completed the whole thing, the thing might have multiple steps. Here with this method, you get the benefit of being able to see straight up what the status of a task is, but you also get that little dopamine hit of being able to move that status of that task forward even if you haven't fully completed it just yet. Back when I was a doctor, I did not have the luxury of only ever having three things on the to-do list. I would have like dozens and dozens and dozens of things. Each time a new page or whatever would come in from a nurse, I would have to add a new task to the list. But then managing this infinitely long list of tasks, that is when we get onto component number three, real-time triage. And this is really the crux of this time management method. It's really about recognising, as we said at the start, that the to-do list is always gonna be infinitely long. You can never get through all of it. And so your job as a competent professional, whatever profession you're in, whatever you're doing in your work or your life, is to focus on triage, i.e. to do the most important highest priority things first. When you're a doctor, for example, you can have your enormous list of all the bloods you need to check and all the things that you have to do. But then if you get a crash call, if a patient's having a heart attack or whatever, and you have to drop everything and sprint across the hospital, if you're part of the crash team, to hopefully do something about that. And then while you're there, you're getting three different pages on your pager. And so straight after dealing with a cardiac arrest situation, you find a phone, you ring up all the people, all the wards who paged you, you add new tasks to your to-do list. And in every moment, you are strategically re-triaging, re-prioritizing your to-do list. Just because you wrote things down in a particular order, it doesn't mean that is the order they should be done. In fact, it probably isn't the order that they should be done. And this applies so much in life outside of medicine as well. Whatever we are doing, we are always faced with the choice of there is an infinite number of things we could be doing, but what is the next most important priority right now? Something like the morning manifesto helps with this because you define your most important priority for the day right at the start of the day. But then if you're a professional, you're gonna get some kind of inbound. You're gonna get Slack messages coming in. You're gonna get emails. You might get a call from the boss. If you're running a team, you might find out some information that like, oh crap, we're having a personnel issue that requires my urgent input right now. And based on that, the theoretical to-do list that you created at the start of the day might go out of the window, but that's okay because you are always focusing on the next most important thing. There is a danger here, which is to always think about what is the most urgent thing. So urgent and important are two different types of things. In the world of productivity, there is this thing called the Eisenhower matrix that you may have come across. And that is kind of getting at this idea that the stuff that is important and urgent, you have to kind of do immediately. The stuff that is not important and not urgent, you should probably just delete or ignore for now. The tricky thing with this is, what do you do about the things that are important but not urgent? And what do you do about the things that are urgent but not important? And I think with these two categories is really where the skill of being a competent professional or someone who's good at managing the time and priorities comes in. Because what I found in my life is that the truly important stuff is rarely urgent. And the truly urgent stuff is rarely particularly important. This is of course different than in medicine where you're often dealing with life and death. And so the urgent and important often do sometimes go together, but still not always. And one of the biggest needle movers I found for my own productivity is to recognise when I can ignore something that is urgent but not important for the sake of something that is important but not urgent. And this requires the ability to be okay with things dropping. Being okay with all of the different balls that you're juggling, some of them being dropped. This is what I love about Oliver Berkman's writing in 4,000 Weeks and Meditation for Mortals, really good books, is that if we assume a world where there's all these infinite number of things we could be doing, and we also therefore assume that it's physically impossible to do everything on the list, it follows naturally that it's actually impossible to have it all. It's impossible to be executing at full-on efficiency, productivity, creativity across all of the different domains of our life. We are gonna have to let some things go. We're gonna have to embrace mediocrity and embrace imperfection in quite a lot of the different areas of our life if we wanna make real meaningful progress in others. And so there may well be seasons of your life where you don't reply to every WhatsApp message or every email that comes in your way. There may be seasons of your life, you know, I'm about to be a parent where work takes a bit of a backseat because I wanna be present with the family or whatever the thing might be. But in a world where we are trying to take everything off the to-do list, trying to do all of the things, that is the true recipe for overwhelm and anxiety and stress. And so coming back to this idea of real-time triage, in every moment, we need to be asking ourselves, is this thing I'm about to do really the most important thing I could be doing right now? And in a world where you only did one or two things each day, but those one or two things that you did were the most important things for you to have done that day, you would make an enormous amount of progress in a whole year. Compared to that situation that a lot of us find ourselves in, where we take off all these things on our to-do list and we get to the end of the day and we think, hmm, I feel like I did a lot of stuff, but I don't feel like I made a lot of progress. We have a lot of movement, but not a lot of progress. And if you're working in medicine and you're doing all of the lower priority, urgent things that seem kind of urgent, but you're forgetting the important stuff that you really need to get done, you're gonna get fired pretty quickly because that's not the job of a doctor. The job of a doctor is not to do everything on the to-do list. The job of a doctor is to do the most important things on the to-do list. And I would extend that to the job of us as professionals who are trying to make the most of our time, trying to be efficient, productive, trying to get stuff done, trying to achieve our goals. Our real goal as it relates to time management is not to try to do everything. That would be a recipe for failure. Our real goal is to make sure that we are prioritizing the most important things. Component number four, the ward round protocol. So there is something that happens in hospitals at the start of every day, which is that you do a ward round, i.e. you go around and you look at all of the different patients that you've got on your ward. And for each of these patients, you go to them, you talk to them, you look at the notes for the patient, you look at all the different vital signs and all the different like blood test results. Do you have any medical conditions at all? And you figure out what is the next action step in the patient's plan that will move them forward in their trajectory to get them better and get them fundamentally out of hospital. How the hell does this apply if you are not a doctor? Well, the reason it applies if you're not a doctor is that we can use that same concept as it relates to our projects. And so this is the system that I use to keep track of my different projects. I use a to-do list manager called Things 3, but you can use whatever app you want. Now, these are all of the different projects I'm working on in work and in life. I've got my primary quarterly quest for my own life and for my work. My primary quarterly quest for life is the martial arts setup. And my primary quarterly quest for work is to make LifeOS, which is my productivity course and absolute banger. And you can see next to these, I have a little emoji. So green means it is on track. So yellow means it is off track with a plan. And red means it's off track without a plan. I do sometimes also use blue, which means it is on ice, which means I'm not focusing on this thing right now. It's just, it's being stalled by something or other. This is a very useful thing to be keeping track of. It's like every quarter, every 90 days or whatever, we have a finite number of key projects that we wanna move forward. I recommend having one primary quest. This is the quarterly quest, which is the one most important thing that you wanna move forward in each quarter in work and in life. But then for all of the other projects, it's worth having a status to know, okay, how far along is this project? And is it still relevant? I also like to make sure that I've always ordered my projects in order of priority. So actually, these are my weekly review questions. Every week, so I did one this morning. Part of plan is have we updated our to-do and project list? So quests and projects are arranged in priority order. Every project has a clear next action and every project has an up-to-date status. On track, off track with a plan, off track without a plan, and on ice. So each week, and I did this this morning, for example, I look at this thing and I'll be like, all right, cool. Are quests and projects arranged in priority order? Okay, well, actually, you know what? The creator club thing is actually more important than the art thing for now. So let me just sort of like reorient that or whatever the thing might look like. Now operation don't die. You know what? Actually, that's, you know, right now, baby supplies takes priority over that because I need to go to the local department store to pick up like some items for the baby that's due to arrive in a few months. And so I'm just sort of making sure I've ordered thing in priority order. Again, speaking to this idea that it's not about doing everything, it's about doing the right stuff in the right order of priority. And then crucially, the next thing is that every project has a clear next action. This is one of the things that I really learned when I was doing these ward rounds, when I was working as a doctor and when I was a medical student, which is that every single day, you wanna be making a plan for the patient and continue is not allowed to be a plan. Like I would often hear doctors complain about this. Like if one of their colleagues wrote continue as the plan, they'd be like, oh, continue is not a plan. Continue is not a plan because every single day, we need to make sure there is one action that we can take to help that patient progress on their journey. Similarly, we need a next action for every single project. So for my make life or worse a banger, I've got my next action point, which is talk to Kaylin regarding what needs to be done. And I've got a meeting with Kaylin later today. VoicePal, I've got a few different actions. VoicePal is an app that me and my team have built to help make writing easier and more fun. So if you have lots of writing to do in your work or life, then you might like to check it out. For company relocation, I've got WF, which means waiting for. Waiting for TSJ, our accounting firm, to come back to us with some sort of plan for like relocating my business to Hong Kong. And it's totally okay for waiting for to be a next action step. In medicine, it will often be sort of waiting for occupational therapist and physiotherapist input or waiting for a nursing home to get back to us. But we have to write that as an action step because you're awaiting input from some other external service. It must be documented as part of the plan. For baby supplies, my next action step is a trip to Sogo. For my art adventure, my next action step is to actually draw something. For create a club, my next action step is to post on socials. For martial arts setup, I don't have a next action step, but it's all, it's basically there because I've booked my next few sessions of Muay Thai. And so the next action step is sort of basically within this little stuff that I've got here. When I do events and stuff and people ask for my advice about how to manage their to-do list or like projects or priorities or when I'm doing my core sessions, I see that almost no one does these two things. Almost no one has a status for each of their projects and almost no one reliably has a clear next action step for each of their projects. If you just do those two things, just like color code it in terms of status with a traffic light system and make sure, as David Allen tells us in getting things done, that every single project has a next action step, you will be way better at managing your time than most people are because almost no one does these two very sensible things, which doctors do as part of the ward round protocol, where you make sure you have checked the status of every single patient and you've made sure you have a next action step as part of their management plan. All right, so that brings us to component number five, which is intentional incompletion. This is a story I wrote about in my book, but basically in my first week of being on the emergency department, I had a run in with one of the senior doctors because I was feeling a bit of a hero complex. And I was like, you know what? I'm gonna see all these patients. I'm here as like a junior doctor, first year out of medical school and I'm gonna save the day. And I saw my first patient and it took like an hour and then I looked at the list and I looked at the waiting room and it was absolutely teeming with patients. Like it was completely full. And I was like, all right, cool, I'm gonna be a bit more efficient with the next patient. And so I saw the next patient in like 50 minutes. I was like, yes. And then I looked at the waiting room and it was still completely full. And then I saw the next patient in like 50 minutes and I looked at the waiting room and it was still completely full. And then it got to lunchtime and I said to myself, you know, I'm gonna skip lunch because I wanna make sure I can like get through these patients. Maybe I've been a little bit inefficient because it's like my first week here. And so like, I'm just gonna power through and I'm just gonna see more patients. And I had a conversation with one of the consultants who was on call whose job it was to sort of manage the junior doctors and make sure they were taking their breaks. And what he said to me at the time was that, you know, no one is going to die because you've taken a lunch break. The waiting room will always be full. The patients will always be there to see. It's more important for you as the doctor to be rested so that you can be on form for the other patients that you're seeing rather than burning yourself out because you're like choosing not to take a lunch break just because the waiting room is full. And this was something that in almost every single placement that I did when I was working as a doctor and even when I was a medical student, the consultants were always looking out for are the juniors taking enough of a break? Are they taking a lunch break? Are they taking a little coffee break? Are they leaving work at a reasonable hour? And so really the skill you end up cultivating as a doctor is intentional imperfection, recognizing that it is part of my job to take a break even though there is still stuff to do. It is part of my job and part of my role to go home at some point in the evening even though there is still stuff to do. Again, it comes back to our point that we made at the start. There's always gonna be stuff to do. I find that this is something that a lot of my entrepreneur friends struggle with. My wife is also a creative entrepreneur and she really struggles with it. She gets it, it gets to 8 p.m. She's been grinding at work all day. There's still stuff to do. And she's like, oh, but I feel like I haven't gotten through all of the things in my to-do list. And I have to be like, Izzy, come on. Like when was the last time you felt like you actually got through everything on your to-do list? She was like, basically never. And I was like, yeah. Like, how about we start like winding down? How about we have some food? Let's go out for dinner. You know, all that kind of stuff. I kind of have to coax her through. I hope she won't mind me saying this. I'm sure she won't mind me saying this. But I have to kind of coax her through getting off the computer because she has this thing of like, I need to make sure I get through the to-do list. And so for me, after that first week in the emergency department was when I realized, oh, okay, it's okay to leave things unticked off and to leave some patients waiting to be seen so that I can go grab lunch, so that I can grab a coffee. It's okay to hand over things to the evening team if there's truly stuff that's urgent and important that needs to be done overnight so that I can go home when it hits five, six, 7 p.m., whatever, whenever my shift is supposed to end. Of course, every now and then there's gonna be like some life-threatening emergency that means you stay around for an extra two or three hours. But for the most part, if that's happening all the time, that is just a recipe for burnout in whatever profession you're doing. And so we're gonna end with component number six, which is the two for one hour rule. This is something that I learned from one of our professors in medical school where she had like an email newsletter that she would send to the medical students. And one of the things in it was a really good quote that I think about a lot, which is an hour before nine is worth two after five. I now think of this as the two for one hour rule. Like if you get up early and do something before work, before 9 a.m., that actually gets you twice as much output as waiting till after work to do the thing. The thing with medicine and the thing with pretty much every kind of demanding job is that it's really hard to get home from work and not feel frazzled. There's lots of ways you can do that. Part of my book, Field of Productivity is about making your work energizing and enjoyable so that you get home from the end of the day of work with energy left in the tank. But even then, even then admittedly, it's really hard to get home from work with energy left in the tank. I've heard this from so many sort of YouTubers as part of my YouTuber Academy and so many other people being like, I wanna do the side hustle. I wanna start a business. I wanna start a YouTube channel. I wanna write a book. But by the time I get home from work, I just don't have any energy and I just wanna blop out and watch Netflix or whatever the thing might be. And so in those cases, I remember the advice from this medical school professor, which is an hour before nine is worth two after five. If something is truly important to you and it requires creative energy, it is a lot more effective to get it done before work rather than after work. So a lot of my YouTube videos that I made, I would get up earlier and I would film the videos before work because I knew that that's how they would get done. When I was at work, I would actively volunteer for the later shifts. My favourite shift to do of all time when I was working as a doctor was 4 p.m. until midnight. I would try my best to swap with my colleagues who had families and stuff because they didn't want that shift because they wanted to be there with their families. But I would love that shift. Man, start work at 4 p.m., finish at midnight. That means I've got the whole day where I can do my YouTube videos and do my business and stuff. And then I can drive to work at 3 p.m. after having a nice leisurely lunch. And then I can work from 4 p.m. to midnight. And I can drive for an hour home until like 1 a.m., sleep until like 10 a.m. And then from 10 a.m. to 3 p.m., I've got that time to be able to work on my side hustles. I absolutely loved those shifts because I realised I just always had more energy before work compared to after work. And so that's a final component of this time management system. If you have something that's really important to you that you actually wanna get done, think about doing it first thing in the morning rather than hoping you have the energy after work or after school or whatever the situation you're in. All right, so I hope you found this video useful. If you wanna dive more into the concept of quarterly quests and how I do things like 90-day goal setting and make sure I actually achieve those goals, that'll be linked in the video right over there. Thank you so much for watching. Have a lovely day, and I will see you hopefully in the next video. Bye-bye.