Age isn’t important. I’ll be 60 this summer, and I’m still learning and growing.

The third of my six factors determining financial productivity is the time spent on non-paying medical activity. By “medical activity” I mean any professional time that is not recreational. If you are a social butterfly and enjoy medical society meetings, that’s recreational. So is serving on a hospital committee, if you’d rather do that than watch a football game, or reading the New England Journal of Medicine, if you prefer that to the Wall Street Journal.

Besides having the misconception that family medicine pays poorly (it often does, but doesn’t have to), students and residents often feel overwhelmed by the knowledge demands of a generalist. Let me see if I can help you get a grip.

From an historical perspective, things were much harder in the good old days. When I started practice, I had a notebook full of “pearls," which were difficult to access, and a whole library of books to help me find the information I couldn’t remember. I rarely consult the library anymore. Between my PDA and laptop search engines, information is amazingly accessible, so that time waster is gone.

That leaves the problems that haven’t disappeared in the information age.

The first is knowing what you don’t know. This is an issue of experience and conscientiousness, for which there are no shortcuts. But specialists have the same problem. That’s why medicine is an apprenticeship trade, and why we all undergo at least seven years of training after college. Knowing what you don’t know enables you to, as the book by Dr. Oscar London is entitled, “kill as few patients as possible.”

The second problem is learning what you don’t know, but need to know. In every field, physicians must have certain knowledge and skill at their fingertips. A surgeon who has to consult an anatomy text halfway through a Whipple’s procedure won’t be a surgeon very long. A family physician who has to review the treatment of impaired glucose tolerance three times a day will contribute to lowering the average salary of the specialty.

An analogy in industry would be “just on time” delivery of component parts, which has markedly raised productivity. Some things you just need to know; the rest you must find very quickly. That’s why I’ve never been a fan of review articles.

The authors of a review, or a textbook chapter, experience a powerful hidden incentive. They absolutely, positively cannot allow themselves to be “bagged” by some smart-aleck who finds an obscure item missed in the differential diagnosis. For them, that is a recipe for academic suicide; for me, information overload. It makes my eyes glaze over. And it wastes my time.

When I read, I’m searching for something I need to know. Medical writers in the lay press have gotten so good that I usually encounter important research results in my daily newspaper. I can scan the NEJM in just a few minutes, looking, always, for something I should do different in my daily practice. As you gain experience, and your practice patterns become second nature, this demands less and less time.

The third problem is developing practice strategies that are based on evidence and common sense, and sticking to them. There are several strategies for managing hyperlipidemia, diabetes and hypertension: the "Big Three" of family medicine. Pick one strategy for each, and be consistent. Don’t fly by the seat of your pants. Every clinical decision shouldn’t be ad hoc.

That wastes your time, and it confuses your staff. A confused staff will waste more of your time. They want to help you; they would like to read your mind. Give them a chance. If you alter from your usual pattern, explain why. Draw them a picture. Diagram your algorithm. When they are confident that they know what you would do, they won’t have to ask.

Productivity isn’t magic, and it isn’t really difficult. But you’ve got to want it. It's the result of intention, not accident.