“I can't keep up with the volume of paper!” “I'd like to see the top of my desk again.” “I know I can't read everything, but how do I figure out what is essential reading?” “Just walking in my office and seeing stacks of papers and journals stresses me out.” Can you relate to any of these concerns? If so, you're not alone. Many family physicians share the same frustrations.

Dealing with the growing volume of paper coming into your office may seem like an overwhelming challenge, but there is a way to take control. The first and most important step is to evaluate your work space.

The best work space is one that supports your priorities. An effective work space says action — paper moving in and out in a timely manner. Your personal office should be set up like an emergency room — with an effective paperwork triage system and the tools you need to handle whatever comes in the door, with the tools you use most within arm's reach.

Do you have a good sense of where and how information is stored in your office? Can you locate specific materials in three minutes or less? Could someone else find papers in your office if you were gone? Do you routinely clean out files and throw outdated material away? If you answered “no” to one or more of these questions, it's time to evaluate how your work space is organized and make some changes.

Before reading on, close your eyes and imagine throwing everything in your office out into the hallway except the desk, bookshelves, computer and file cabinets. Now, imagine that you are going to put it all back together in a more efficient and effective manner. Here's how.

Get rid of your in-basket

Before the information explosion, people approached their in-baskets with the idea that they would act on each item right then and there. Today, most of us don't have time to stand by our in-baskets and deal with every piece of paper to completion. So what happens? If an item is pending or you're not sure what to do about it, you don't take any constructive action. It goes back to the in-basket, a process that may be repeated numerous times.

You've almost certainly heard that the cardinal rule of paper management is “Handle a piece of paper only once.” In many cases, that's an oversimplification. Whether you handle a piece of paper once or many times, the key is to avoid handling it in the same way over and over again. In an efficient paper management system, a sort tray — or “triage tray,” if you want to continue the emergency room analogy — replaces the traditional in-basket. It serves as an entry point for papers, medical records, X-rays, mail, journals and conference brochures. The goal is to move everything from this tray into a specific action area (e.g., priority tray, tickler file, work-in-progress files). If certain items can be dealt with quickly, such as obvious throwaways and easily delegated tasks, by all means move them directly from the sort tray to completion. Otherwise, move items in the sort tray to the next appropriate stage of action. Virtually everything from the sort tray that you can't deal with or discard immediately should end up in one of five areas: your priority tray, your tickler file, a work-in-progress folder, a delegation folder or a reference file.

Set up a priority tray

The center of your desk (the area in front of your chair) should be clear. Think of this as your command center, the area where you focus your complete attention while working on a task. The action area nearest this command center should be your priority tray, which should be close enough to draw your immediate attention. Typically, this tray should contain only work that you consider important enough to complete by tomorrow at the latest. You may want to divide priority material into two categories — perhaps using two stacked trays: items that need to be done today and items that need to be done within 24 hours. By learning to prioritize, you'll be better equipped to differentiate between tasks that are both urgent and important and tasks that are simply urgent, unimportant demands on your time.

Maintain a tickler file

What do you do with items requiring action in the future? Perhaps you keep a “pending” file on your desk for such materials. The drawback to this approach, as you've probably learned, is the lack of organization. You must go through all of the items routinely to uncover what you need (and to discover what you've overlooked). You also may use a bulletin board to flag important conference dates and other activities. Unfortunately, a bulletin board can easily become cluttered, with important information buried beneath an interesting news clipping or funny cartoon.

A much better way to keep track of dated material and time lines is a tickler system. It consists of 12 files labeled for the months and 31 files numbered for the days of the month. Items that you want to make a priority at a later date and correspondence reminders, for example, can be housed in the tickler file. You may want to include job-related and personal materials in the same file or create separate ticklers.

To use the tickler system, simply place anything you want to be reminded of later in the file for the month when you want it brought to your attention. At the beginning of each month, go through the material in that month's file and move each item to the numbered day folder for the day you want to deal with that item. Then, each day, move the items in that day's folder to your sort tray for action.

The role of a tickler file is to draw your attention to a particular item at the appropriate time. Without a tickler, an effective paper management system is doomed to failure.

Delegate and disperse material efficiently

Some items in your sort tray need to be delegated or taken to another location. These materials should be “batched” — organized according to the nature of the task or the person who is to receive them. Consider using colored folders (e.g., a blue folder for your nurse, a red folder for materials to be copied). Place these folders in clear view — on the corner of your desk or a credenza. If someone else picks them up (i.e., if you use a traditional out-basket), make sure your notations of the destinations and purposes are clear. Consider having two or three of each type of folder so that you can fill one while another is out being processed. If you will be distributing the items yourself, save them to distribute in one trip. That way, you'll reduce your exposure to the distractions that lie in wait for you when you leave your office.

Keep current project files close at hand

Files should be created to house all pieces of paper related to current projects. These works-in-progress files are best kept close by your command center so that notes, phone messages, reminders and related items can be placed quickly in the appropriate files. Once a project is completed, the material may be placed in a reference file or discarded.

You may also want to keep files on people you are working with. When an item you need to discuss with a particular person comes across your desk, toss it in his or her file and refer to the file during your next phone conversation or meeting.

Categorize your files

The files mentioned to this point are ones you use. Other files are likely to be ones you store. The more files you can have stored outside your office, the better. By limiting the amount and types of materials you keep in your office, you limit the clutter you have to deal with and the number of times you'll be interrupted by staff needing certain paperwork or background materials. If you do store any files in your office, they should be divided into three categories: very active files, reference files and archives. In general, the more active the file, the closer its storage should be to your command center.

Minimize reference materials

When was the last time you took stock of the reference books and manuals in your office? This section of your workplace should be lean. Keep only those materials that are current and that support your highest priorities or interests. Other references should be kept farther from your work space, perhaps in the practice's library or resource area.

Throw away those sticky notes

No matter how good your system of trays and ticklers and files, it can be overwhelmed by a swarm of sticky notes and loose slips of paper if you're not careful. Whether you use a yellow tablet, spiral notebook or an expensive planner, the key is to keep notes, memos, to-do lists, phone messages, schedules and the like in one place. Organization by little pieces of paper or sticky notes is not organization; it creates clutter and causes confusion.

Learn to prioritize your reading materials

What do you do with all those journals and newsletters — the ubiquitous “to read” pile? If you find it hard to determine what is essential, ask yourself these questions: 1. Might this information enhance my performance or increase my productivity if I read it now? 2. Is it possible that this information is outdated and probably won't affect my priorities or practice? 3. Is this information primarily for my general interest? If so, could it be eliminated without serious effect on my priorities or practice? Hopefully, your responses will motivate you to find the time to read some material, throw some of it away and, perhaps, shelve selected items for future reference.

To better manage this material, keep the following tips in mind. Tear out articles of interest and throw away the rest of the journal or newsletter. Assign these articles to the appropriate action area (e.g., priority tray, works-in-progress files or tickler). Carry some reading materials in your briefcase so that you can take advantage of snippets of time resulting from delays in meetings, late appointments, etc. Finally, if you seem to be accumulating more and more paper as a result of your reading, it may be time for a house cleaning. (See “Are you a pack rat?”)

Hit the ground running

Now that you've dealt with the stuff you moved out into your imaginary hall — either put it in its place or discarded it — you've created a less stressful, better organized work environment. Many physicians report that this paper management system releases energy previously blocked by clutter and frustration. It also plays a key role in time management.

To ensure that your new system works well, remember that 15 minutes of planning sets you up for eight hours of productivity. It does not guarantee a full eight hours, but it helps maintain priority focus. Set aside those 15 minutes at the beginning of the day to sort whatever has accumulated in your sort tray, move items from your tickler to your priority tray or to the file for another date, and consult your planner or to-do list to plan for the day's scheduled events. You will find it easier to say no to certain interruptions if your priorities are clear, and you will find the day's flood of paper less daunting if you can put it in its place because you've already prepared just the right place for it.