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Is A Doctor Ever Really 'Out Of Office'?

As I clicked the final button “sign encounter” and looked at my completely empty Epic InBasket, I suddenly felt a huge sense of relief, as if a weight had been lifted off my shoulders. The Inbasket was empty and I had ten whole days off! Ten whole days without the jarring, repetitive beeping of my pager. Ten whole days without watching the clock in clinic all day long to make sure I don’t fall too far behind. Ten whole days without my Epic InBasket. I suddenly felt so liberated. I opened up Outlook and selected my “out of office” message and promptly turned off my pager and logged out of Epic.

A day and nearly 1800 miles later, I found myself in the Hamptons on my vacation, sitting poolside in one of the most impressive homes I have seen in a long time. I had decided to bring my laptop on the vacation with me, but I had told myself repeatedly that it would only be to check my emails once or twice in the week. The first day, I kept my promise to myself and disconnected from all my devices, leaving my laptop, iPad and even my phone in my bedroom when I went out. But, on day two, after I had spent the morning enjoying a lovely brunch with my family, I found myself in my bedroom remotely logging into Epic to follow-up on a Cr value that had been slowly nagging me since I arrived.

This was an elderly patient of mine whose volume status, severe tricuspid regurgitation and chronic kidney disease made “just the right amount of diuresis” very challenging in her. Her baseline Cr was 1.3 and after a few days of additional Lasix, her Cr had increased to 1.7. Yet, clinically she still appeared very volume overloaded, so I had decided to push her diuresis further and just keep a close eye on the Cr. Her basic metabolic panel was the message I had been anxiously awaiting in my InBasket… the message that stood between me and my mental relaxation. So, I logged in and checked… a whole bunch of non-urgent messages had already piled up in the empty InBasket I had left behind just a day ago, but not the message I was looking for. I decided to send my nurse a staff message and told her to call me on my cell phone when it returned because I knew this complex patient better than any of my partners would and making the call on a complex patient is always hard when they are not one of your own. I was about to close my computer when I had another thought… while I was looking at this ever-growing list of messages, why not respond back to a few of them so I don’t have giant heap waiting for me on the day I return? And a few quick replies turned into 45 minutes of Epic time and increasing irritation with myself for my inability to disconnect from work and truly enjoy my “away” time.

It was then that I realized that we as doctors can’t ever really be out of office, can we? Doctoring is the utmost privilege… but, with this privilege, comes the ultimate sense of responsibility. We give patients medicines that can slow down or stop their hearts, damage their kidneys, permanently affect their thyroid, lungs, liver and for the most part, patients comply with our orders without asking too many questions. So, isn’t it our responsibility at all times to ensure that our interventions are closely monitored and not causing harm? Can doctors truly go on vacation and completely disconnect from their patients with a completely carefree mind? When it comes to the life of a cardiologist, I think we spend much more time in “systole” than we can in “diastole.”

Now, let’s say you are lucky enough to work within a medical system where there is an excellent system for coverage of labs, test results, etc when you are away and you can truly get away without checking your InBasket for 10 days (lucky you!)… Aren’t you welcomed back to the office with all that work just waiting for you? I know for me, that first day back from vacation is always full of dozens of InBasket messages, which always feels like (even though it isn’t) a painful slap in the face for taking time off. So, sometimes I find it easier to just take 45 to 60 minutes every night on vacation to “keep up” with my InBasket and emails so I am not buried when I get back. But, doesn’t that seem unfair to have to do so?

To add to it all, you never really stop being a doctor (and society doesn’t really let you) no matter where you are…. Whether it’s an emergency you are responding to on a plane or a cocktail party full of your non-medical friends bombarding you with questions about their cardiac health, you can never really “turn it off” completely. That, mixed with the fact, we ourselves often find thoughts about our patients’ care can easily invade our personal time – for example, sometimes I find myself musing on a patient’s differential diagnosis while waiting in line at the grocery store and other times, I find my thoughts drifting to a challenging patient when I am lying in bed at night, before I fall asleep. The very nature of what we do is so fundamental to life that a doctor can never really truly be “out of office.”

Now this isn’t unique to us… I think it involves all service-oriented disciplines that are dealing with life and death, such as police officers, firefighters, etc. But, I seriously doubt that my accountant has ever worked on my taxes in the middle of his beach vacation or stayed awake at night wondering if he got me all the deductions he possibly could. So, is this why we burnout so much more than the accountants do?

The next day, my nurse called me about that patient when we were in the middle of our family lunch. I stepped out, took the call and tried my best to come back to the table as soon as possible, feeling happy the Cr had come back down to 1.4. It was then that I realized that I could not ever truly control myself from thinking about my patients, even when I was out of the office on vacation. And I realized I didn’t have to because, for me, patient care, time with family, and relaxation time weren’t mutually exclusive.

What do you think? Can doctors ever truly be “out of office”? Should we try to completely disconnect from patient care when we are away with our families? Or do you think once you become a physician, thinking about your patients’ well-being becomes a 24/7 responsibility that doesn’t follow work and vacation schedules?


Image by Grinbox / Shutterstock


Payal Kohli, MD is a cardiologist and a 2018–2019 Doximity Author.

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