Sunday, July 4, 2021

the never ending box

Coming back to the blog after brief hiatus of getting stuck in the cycle of [drop kids off, daycare, work, pick kids up, make dinner, put to bed, random chores, repeat]. Whoof. In the middle of it all there’s been some shining moments. Baby girl is now 6 months old and sitting up and infinitely less breakable. Preschool boy is now super into legos - we’ve found my husband’s old lego sets at his mom’s house which have been so much fun to put together again as a family. 

However the last few months have been a little tough. I always knew primary care attending life would be more like a marathon with residency being more like high intensity interval training (sometimes you’re working nights and weekends on service, sometimes you end up shadowing a urologist for a few days and you take the breaks you get). But I’m struggling with the sheer never ending weight of my inbox. We did so much over the patient portal and electronically in 2020 during COVID restrictions and when we were short staffed - however now that the clinic is fully open, it’s still much easier for patients to try and get medical advice for free through the patient portal rather to make a clinic appointment that I have protected time for. Can’t really say I blame the patients because I’ve been there and done that too - it really is soooo much more convenient. However some requests are really inappropriate to be handled via email exchange and I don’t think patients get it. And yes - someone did send me an online message while they were literally having a heart attack. 

There are some shimmers through the clouds - administration is really working on getting nursing more involved in taking care of the things they can take care of within their scope, but still - the box is always there. I also think life will also be easier when I’m done pumping in 6ish months, and administration is also piloting longer office visits to make up for the increase in online work we’re all feeing. It’s also a little worse now while everyone else is on vacation and I’m covering their stuff and I don’t have any wiggle room left for vacation myself between maternity leave and sick kids. So there’s hope, especially for 2022 Kicks.

I did have to take a step back. I spend a couple nights a week catching up on things when I’d rather be taking personal time or hanging out with my family. I don’t really think my kids have suffered (I’ve used after bed time for catch up time) but I miss my husband and watching TV together. So I decided something has to change and I am dropping down to 0.9 FTE. I might try 0.8 if this still isn’t enough to protect my sanity (but the way my schedule is designed I bet I would do almost as much work at 0.8 and just get paid less). 

Today is a good day - the perks of outpatient medicine being a 3 day weekend every so often, but I’m still working on some balance. I had a professionalism consult recently in which my advisor reminded me I’m still new (only 2 years out of residency and practicing now longer in a COVID world than a nonCOVID world) and it takes several years to really master the clinic flow. 

Any other tips from my outpatient colleagues on how to conquer the work-outside-of-work? 



  1. First off, I feel you! Second, two thoughts:
    1) Are your expectations of yourself unrealistic (eg. EMR says "your doctor will message you back within 72hr" but *always* message within 12 hrs because you believe that is what a 'good doctor' does.) Would slackening off and batching these inbox times help?
    2. They can ask, but you don't have to answer. Eg. If a patient messages about content that requires an office visit, could you message back something along the lines of, "thank you for these great questions. There is a lot here! I want to be sure we have time and space to communicate in more detail so I have asked the schedulers to call you to coordinate an office visit/telemed visit"). If you follow through by providing excellent care in the office visit, I have to believe the patients would be sympathetic to that approach.

    1. Thanks for the tips - I’ve gotten better at #1 by making sure I’m caught up by Tuesday afternoon and Thursday mornings which should generally capture everyone in that 72ish hour time frame but kind of fell off that track so I think I’m going to refocus on those times. Definitely have a list of stock phrases similar to #2 - much needed and should probably use more!

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