By Christopher P. Cannon, MD

The inbox: on the surface, it seems harmless. When your email inbox is filled with hundreds of unopened messages, it can become more intimidating, and the task of plowing through it becomes daunting. The pressure to monitor email has seemed to invade our subconscious. How many unopened messages are sitting in my inbox? Am I forgetting to respond to anyone? When will I find time to clean out my ever-growing inbox? As I’m sure you’ve experienced before, sometimes I have moments of hesitation before opening the email program.

Let’s start by looking at the positive aspects: email is such an efficient way to work. We can dash off quick notes to collaborators or stay in touch with friends and family scattered across the world. Although, there are many other social media venues for that; as my son told me last week, “Dad, no one uses email anymore.” I countered that it is useful for work, as a means of sending documents quickly. Indeed, it is not that far in the past when we relied on floppy disks and WordPerfect to create our files. We even had to mail or FedEx them to others. Seems crazy, right?

Now when we write a paper, we just email it to our co-authors; when performing a trial, we use e-newsletters or memos to provide updates to the whole study team. It certainly cuts way down on postage and FedEx costs!

Another great advantage: it reduces lag time in responding. If we have a pressing question, we can send it off to a collaborator and he or she can answer when it’s convenient for them. In the “olden days,” I can recall frequently answering a question from a colleague with, “I have a call in to Dr. So-and-so, but I haven’t heard.” This delay in response time is reduced with email. For someone who checks email frequently, it’s almost like they’re never out of contact.

Now for the downside. The advantages of this type of communication have made it so prevalent, thus our current issue of “the email treadmill.” All those emails streaming in, and so little time. You may recall an earlier column where I lamented the number of emails awaiting me when I returned from vacation. After 1 week, I came back to 692 unopened messages. For me, that was a tremendous number; amazingly, other people might receive that many in a couple of days.

The treadmill I’m referring to is the never-ending, incessant need to monitor and respond to emails. And then, when you finally get down to a manageable number, more come in. It is an endless jog on a wheel, like a little mouse in a lab.

I use a prioritizing strategy when I begin to tackle a full inbox: delete the spam that got through the filter, glance at the various random email conversations I’m cc’d on, and glance quickly at the news ones. Then, there are all the “online before print” notifications. It used to be that a journal released papers once a week (and prominent ones still do), but the recent trend has been to publish online as soon as a paper is accepted. The “online before print” postings from some journals pop up multiple times a week. Circulation does this, and with the six “baby” Circulation journals, that makes for a lot of emails. At this point, I’m usually down to the messages that include documents that need review and revisions or some added work tasks that have to be done. And, for me at least, it seems like the larger and more complicated that task is, the longer it sits in the inbox waiting to be handled.

With smartphones and other modern technology, we’re also able to monitor emails on the go. Although this can be helpful and time-saving, the also means we are in a constant state of checking our emails. That can be pretty distracting—the message alerts always interrupting your thoughts before they have time to fully form, which inevitably leads you to think about all sorts of other work problems or issues. It’s certainly a tiring endeavor.

Is there a way to stop the treadmill? It seems like the only workable solution I have found is to hop off the treadmill every now and then. I recently implemented a policy of not checking emails on the weekend—or, let’s be honest, maybe checking in just once or twice. This helps to save my weekend for the activities I can’t really get to during the week, such as outside activities or catching up on writing or reading papers. Come Monday morning, I crash through the emails in a dedicated chunk of time. It is interesting how quickly you can dispense with emails when you are facing large numbers all at once. For instance, all the back-and-forth correspondence among other groups can usually be resolved without my direct interaction, and so a whole thread of messages can be read at once! I have adopted this recently and I’ve found it helpful. I must admit, though, that I do have a pile of emails I still need to respond to….

I am sure you have your own strategies to keep up and sincerely hope for some day when the treadmill will slow down.

Christopher P. Cannon, MD, is a professor of medicine at Harvard Medical School in Boston, Massachusetts. He is also the Editor-in-Chief of CardioSource Science and Quality.