Conversations With Kohli | Are We Ever Really Out of Office?

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As I clicked the final “sign encounter” button and looked at my completely empty Epic In Basket, I felt as if a weight had been lifted off my shoulders. Next up: 10 days of vacation! I was liberated for 10 whole days from the jarring, repetitive beeping of my pager and from watching the clock the entire day in the clinic to make sure I don’t fall too far behind. Ten days without my Epic In Basket. I set my “out of office” message, promptly turned off my pager and logged out of Epic. Disconnected. But… was I?

A day and nearly 1,800 miles later, I was sitting poolside in the Hamptons. The first day was relaxing and disconnected. My laptop, brought with the promise to myself to be used only once or twice for checking email, my iPad and even my phone were stashed in the bedroom. But, on the second day, after enjoying a lovely brunch with my family, the nagging thoughts since I’d arrived about the creatinine level for one of my patients led me to log into Epic remotely.

She was an elderly woman whose volume status, severe tricuspid regurgitation and chronic kidney disease made “just the right amount of diuresis” very challenging. Her baseline creatinine was 1.3 and it had increased to 1.7 after a few days of additional Lasix. Yet, clinically she still appeared very volume overloaded, so I’d decided to push her diuresis and closely monitor her creatinine. I’d been anxiously waiting for a message about her basic metabolic panel – the message that stood between me and my mental relaxation could be in my Epic In Basket. But it wasn’t there, just a bunch of nonurgent messages that had piled up in just a day.

I sent my nurse a staff message asking for a call to my cell phone when the metabolic panel came in, because I know this complex patient better than any of my partners. Making a decision about a complex patient is always hard when it is not your own patient.

But, then, as I was about to close my computer I thought, why not respond to a few of the messages in the ever-growing list? There’d be less of a heap when I return to work. 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 as doctors we 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 and liver, and for the most part they comply 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.”

Can doctors ever truly be “out of the office?” Should we disconnect completely when we’re on vacation or during family time? Or as a physician, does thinking about our patient’s well-being become a responsibility that’s not confined to office hours? How do you find balance to prevent burnout?

Share your thoughts on Twitter using #CardiologyMag and #ConvosWithKohli. Tag @ACCinTouch.

Now, let’s say you’re lucky enough to work within a medical system with an excellent system for coverage of labs, test results, etc, when you’re away and you can truly disconnect from your In Basket for 10 days (lucky you!). Aren’t you welcomed back to the office with all that work just waiting for you? For me, the first day back from vacation with the dozens of In Basket messages feels like (even though it isn’t) a painful slap in the face for taking time off. Sometimes it feels easier to just take 45-60 minutes every night on vacation to “keep up” with my In Basket and emails so I am not buried when I get back. But, doesn’t it seem unfair to have to do so?

We never stop being a doctor (and society doesn’t really let us) no matter where we are… whether it’s an emergency we respond to on a plane or a bombardment of questions at a cocktail party about cardiac health, we can’t turn it off completely. Plus, thoughts about our patient’s care often and easily invade our personal time. I may be standing in line at the grocery story, but I’m musing about my patient’s differential diagnosis. Or my thoughts may drift to a challenging patient as I also drift to sleep.

Indeed, our work as cardiologists is fundamental, making it difficult to tune out and be away. This is true for other professions, especially the service arena like fire and police. But I seriously doubt 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 possible deductions! So, is this why we burnout so much more than do accountants and others?

Back to my patient, my nurse called the next day during lunch with my family. I stepped out, learned that her creatinine was back down to 1.4, and I quickly returned to lunch. I realized then that I will always think about my patients, even when on vacation or out of the office. Moreover, I realized that for me, patient care, time with family and relaxation time aren’t mutually exclusive.

Cardiology Magazine Image

Cardiology Magazine Image

Payal Kohli, MD, FACC, practices at the Heart Institute of Colorado in Denver, where she treats a variety of cardiovascular diseases. She is also the lead physician of the Women’s Heart Center.

Keywords: ACC Publications, Cardiology Magazine, Tricuspid Valve Insufficiency, Renal Insufficiency, Chronic, Work-Life Balance

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