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  • Rosalind Kaplan, M.D.

Heal Yourself: Take Some Time Off!


Summer. Time for vacation, right? This year, when I go on vacation, I will have the luxury of actually being on vacation. I have deadlines for my writing program, but I can plan to have enough work done so that I don't have to work on my manuscripts over vacation, unless I want to. I have control over my own schedule! I can ignore my email if I want to. Nobody needs me urgently. If family or friends need to find me, they'll text or call. And, for the first time in hmmm...I'm not sure how many years...I have no inbox to worry about.

Now, let's be rational. There really is no reason why a practicing physician shouldn't be able to take a vacation and have someone else cover their inbox, right? Unless you happen to be some kind of super specialist who knows something that NOBODY else knows, somebody should be able to cover you for a vacation. And if you do know something that nobody else knows, you really owe it to the world to teach it to some other doctors. Then if you're not available (you're sick or injured, or you have to sleep or God forbid, you die), someone else can help your patient. And an added benefit is that someone can cover your inbox on vacation.

I practiced as a general internist. I certainly didn't know anything that nobody else in the world knew. Yet for the last several years, I often covered my own inbox when I went on vacation. And even though I worked part time, I always covered my own inbox on my days off, which began to defeat the purpose of working part time.

This wasn't always so. Before the Electronic Medical Record, if you weren't there, you weren't there. Back then, 7 or 8 years ago, I was working with just one partner. We both worked part time. When one of us wasn't there, the other was, so we took any important messages for each other, dealt with any critical labs, and refilled prescriptions that couldn't wait. A day off was usually a day off.

Next, I worked in group practice. I worked 4 days a week. On my day off, another internist in the office dealt with phone calls and medication refills that needed immediate attention. On weekends, I only worked if I was on call. When I was on vacation, I had a 'box buddy', someone in my practice who covered my inbox when I was on vacation. In return, I covered her inbox when she went on vacation. We were kind to each other. The idea was to leave as little as possible for the doctor returning from vacation, so we tried to take care of everything we possibly could- we sent lab results to each others' patients, filled prescriptions, answered calls and portal messages...

Over time, inboxes started to get more crammed with SCUT (remember what that stands for? Some Common Useless Tasks) as more and more administrative tasks started to fall on us. The pace of communication seemed to speed up as the patient portal took hold and test results started to be automatically released to patients, and electronic prescribing became the norm. Suddenly, I was covering all my own patient care on my day off. And there was a lot of it. In fact, I sometimes spent most of my day off on my computer, leading me to wonder why I took a day off. I'd get calls from the office all day long, too, when my patients had problems, because nobody else in the office had time to handle these issues.

My very full inbox meant that my days at work were busier, too. And that meant I was writing notes in the evenings, and sometimes on the weekends, trying to catch up.

And then, I had a change in practices 3 years ago. Suddenly, I didn't have that vacation box buddy anymore. There was inbox coverage for vacations, but my patients weren't satisfied. They were used to someone responding to their calls and messages in short order. When that didn't happen, I started getting emails (no, I didn't give out my email address, but most academic institutions have a standard email address for faculty; it's not difficult to figure it out) and the patients who did have my phone number in case of emergency started using it a little more freely. When I came back from vacations, my inbox was a mess. So it became easier to just work my own inbox while I was on vacation.

I'm not going to say I didn't enjoy my vacations, but last fall I remember hiking this fantastically beautiful trail near Bryce Canyon on a sunny, breezy early fall day. It was so close to perfect. Except I had an abnormal lab value nagging at me. I needed to remember to call that patient and adjust her medication when I got back from my hike!

Pretty soon, a couple years had gone by and I had not had more than a day or two away from patient care at any given time. I was in a state of high alert all the time, because I was always on call, even when I wasn't. All that cortisol and adrenaline isn't good for anyone!

If you are a doctor who works on vacation and on your days off, you are probably 'used to it.'

You might feel like this is 'normal'. 'Everyone' has to do it. Think again.

We all need time to recharge. We need to detach and unplug and be away from work. It's amazing how much more refreshing vacation is when you actually make it a vacation. The sad truth is, many physicians don't even take all the vacation time they have available, much less actually make good use of it.

When I finally left my primary care position, I went to a 10 day writing residency for my master's program. I had no inbox. I was engaged in writing workshops and seminars all day, so I turned off my phone and didn't look at email or texts. What I found was that I was fully engaged in what I was doing- writing- and in the people I was with at the time. Of course, that's not vacation, it's school. But I think a vacation should work the same way. Be fully engaged in your family and friends and environment and activities- nature, or culture. Rest, relax, exercise, sleep, dream, meditate, write. For me, keeping a diary of my lovely vacation days helps me hold onto that feeling of peace. For some people, taking some nice photos does it. But mostly, just BE there. Try not to share your vacation with work. I wish I'd done that over the last few years.

Take a look at the blog Auscultation from last week- there's a great description of an unplugged vacation!

I was thinking about the idea of job-sharing for outpatient doctors. I asked about it at the health systems I worked for, but administration wouldn't consider it. It really makes sense for part time physicians. You work as a team, 'share' a panel of patients, who know that if one of you isn't available, they'll see the other, and you cover each other's inboxes for time off and vacations. You both know the patients, so either one of you can answer phone calls or portal messages. You also share support staff. Having two sets of eyes on more complex cases could also improve care. It seems like a great solution. So why isn't this a model we use to help prevent burnout?

#medicine #primarycare #physicianwellness #writing #patientcare #health #physicianburnout #physician #doctor

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