EmmaPeel
07-09-10, 12:31 PM
Can a Doctor Take a Vacation?
Greg Hood, MD, Internal Medicine, 01:20AM Jul 2, 2010
Medscape
It's summer. Patients are coming in to request early refills on their blood pressure medications before they leave on vacation. Others are missing their appointments because they didn't check their calendar before they left on vacation. It's time for your vacation, but the critical question comes to your mind... will you be able to relax this time?
To practice medicine at its best requires repetition. Listening, observing, analyzing, treating, and monitoring, over and over again, day after day. Such repetition builds habits, and momentum, two very difficult things to stop when your calendar tells you it is time for "vacation". Personally, it used to take me 3 ½ days to get into "vacation mode". I'm better about that now.
In surveys less than half of Americans report that they are rested and rejuvenated after their vacations. With trusted partners, 24 hour emergency departments and other health care options to cover developments and contingencies we should be able to rest, relax and recharge. I suspect; however, that physicians may perform less well on indices of vacation rejuvenation than the average American. After all, obsessiveness is one of our most cherished traits, is it not?
You can take it with you...should you?
Some debate whether it is best to leave all charts and calls at the office, not having any contact until returning to the office, or if it is better to be plugged in, with internet access to the EMR and a cell phone so that a "little" attention each day prevents returning to a mountain of untended work. Neither option is perfect. Regardless of whether you work while you are away, there is the increased work volume which the interruption in patient access to you creates. The days out of office mean overpacked schedules in the days leading up to your leaving, as well as the days after your return.
Interestingly, the lack of patient volume during the days you are gone can make the reentry into practice routine nice because there is an obvious dip in the numbers of returning lab reports, ancillaries etc.. In these pressure packed days of modern healthcare delivery there is perhaps no more obvious means of demonstrating that you are overworking to see how life is for those first few days back, seeing patients, but not inundated to the usual degree with paperwork.
I've vacationed both ways. Vacationing before we had an EMR, and a couple of times since when we went to places too remote to connect, I have left it all behind. If you do it this way and really, truly relax then the vacation days can be truly lived to the fullest. The downside is returning to over a hundred untended charts in a task basket filled to the fullest. This can lead one to question whether leaving was even worth it.
Vacationing with EMR access can work out OK, if there are rules. The most critical rule is likely that your spouse or partner agrees to you having access. Even so, one must limit severely the amount of time each day one spends checking messages. An hour early in the morning and an hour at the end of the afternoon can be a good guideline. Setting a particular day or days when there won't be any checking whatsoever can be especially liberating. You don't want to be so connected that colleagues and patients don't even realize you've been gone. It's also helpful to realize that if you have some particular messages that are not critical but are loo-loo's to deal with it's OK to leave them a few extra days until your return.
Think of checking in periodically while you're away as practicing prevention... preventing a mountain of messages to erase your memories from the cabin in the mountains!
Some physicians have so much trouble relaxing that they never take a vacation, ever. In times past this was even a revered trait in some circles. Now we know that such an approach can impair objective medical judgment. Our human minds require periodic respite or they lose efficiency. Always being in "go mode" creates a chronic stress state within the body which may also lead to muscle tension, altered bowel function, even chronic pain, depression, anxiety and burn out. We need to listen to our own bodies. We need to listen to our own advice.
How can you maximize your vacation?
Another holiday trap is to continue to practice your driven nature while on vacation only changing its mode of expression. Cramming as many activities into every vacation day as actions one takes during an overbooked clinic at the height of flu season is no way to unwind. Fun activities lose their luster and restorative power when they are too crammed in too tightly to breathe.
It's also advisable to leave a reorganization and preparation day at the end of the vacation prior to returning to work. Returning home at 11PM the night before being on call at 7AM begs for a connecting flight to be cancelled - not very relaxing.
This is not to say that a vacation must comprise lying motionless on the sand by the ocean for days, intentionally motionless. This would drive many high performing, hard charging physicians nuts.
Engaging in a physically or mentally challenging vacation can be just what the doctor ordered, if the challenges are pursued in moderation.
Self awareness in planning your vacation can pay large dividends. If you're deeply craving returning to your favorite place in the whole world for peace and quiet then, by all means, return there. Otherwise, consider trying a new place, or new activities.
Satiate your curiosity for places you've never visited. Try the cooking school or other hobbies you've always envied others for being able to do.
Be very careful to not schedule the vacation days like a morning's office schedule. Rough in some big blocks for a few things you'd like to do, but leave leeway time in between for unscheduled activities. Above all, be flexible enough to change the day's schedule if it's not working out, rather than stressing or fighting about it.
Contrary to popular opinion, exercise is not a four letter word. Exercising on vacation, or even picking a vacation designed around an exercising activity such as canoeing or hiking can refresh you and restart your habits towards a goal of better personal fitness.
(http://boards.medscape.com/forums?128@129.cuxuahS4tqu@.2a0018a8%21comment=1)
Greg Hood, MD, Internal Medicine, 01:20AM Jul 2, 2010
Medscape
It's summer. Patients are coming in to request early refills on their blood pressure medications before they leave on vacation. Others are missing their appointments because they didn't check their calendar before they left on vacation. It's time for your vacation, but the critical question comes to your mind... will you be able to relax this time?
To practice medicine at its best requires repetition. Listening, observing, analyzing, treating, and monitoring, over and over again, day after day. Such repetition builds habits, and momentum, two very difficult things to stop when your calendar tells you it is time for "vacation". Personally, it used to take me 3 ½ days to get into "vacation mode". I'm better about that now.
In surveys less than half of Americans report that they are rested and rejuvenated after their vacations. With trusted partners, 24 hour emergency departments and other health care options to cover developments and contingencies we should be able to rest, relax and recharge. I suspect; however, that physicians may perform less well on indices of vacation rejuvenation than the average American. After all, obsessiveness is one of our most cherished traits, is it not?
You can take it with you...should you?
Some debate whether it is best to leave all charts and calls at the office, not having any contact until returning to the office, or if it is better to be plugged in, with internet access to the EMR and a cell phone so that a "little" attention each day prevents returning to a mountain of untended work. Neither option is perfect. Regardless of whether you work while you are away, there is the increased work volume which the interruption in patient access to you creates. The days out of office mean overpacked schedules in the days leading up to your leaving, as well as the days after your return.
Interestingly, the lack of patient volume during the days you are gone can make the reentry into practice routine nice because there is an obvious dip in the numbers of returning lab reports, ancillaries etc.. In these pressure packed days of modern healthcare delivery there is perhaps no more obvious means of demonstrating that you are overworking to see how life is for those first few days back, seeing patients, but not inundated to the usual degree with paperwork.
I've vacationed both ways. Vacationing before we had an EMR, and a couple of times since when we went to places too remote to connect, I have left it all behind. If you do it this way and really, truly relax then the vacation days can be truly lived to the fullest. The downside is returning to over a hundred untended charts in a task basket filled to the fullest. This can lead one to question whether leaving was even worth it.
Vacationing with EMR access can work out OK, if there are rules. The most critical rule is likely that your spouse or partner agrees to you having access. Even so, one must limit severely the amount of time each day one spends checking messages. An hour early in the morning and an hour at the end of the afternoon can be a good guideline. Setting a particular day or days when there won't be any checking whatsoever can be especially liberating. You don't want to be so connected that colleagues and patients don't even realize you've been gone. It's also helpful to realize that if you have some particular messages that are not critical but are loo-loo's to deal with it's OK to leave them a few extra days until your return.
Think of checking in periodically while you're away as practicing prevention... preventing a mountain of messages to erase your memories from the cabin in the mountains!
Some physicians have so much trouble relaxing that they never take a vacation, ever. In times past this was even a revered trait in some circles. Now we know that such an approach can impair objective medical judgment. Our human minds require periodic respite or they lose efficiency. Always being in "go mode" creates a chronic stress state within the body which may also lead to muscle tension, altered bowel function, even chronic pain, depression, anxiety and burn out. We need to listen to our own bodies. We need to listen to our own advice.
How can you maximize your vacation?
Another holiday trap is to continue to practice your driven nature while on vacation only changing its mode of expression. Cramming as many activities into every vacation day as actions one takes during an overbooked clinic at the height of flu season is no way to unwind. Fun activities lose their luster and restorative power when they are too crammed in too tightly to breathe.
It's also advisable to leave a reorganization and preparation day at the end of the vacation prior to returning to work. Returning home at 11PM the night before being on call at 7AM begs for a connecting flight to be cancelled - not very relaxing.
This is not to say that a vacation must comprise lying motionless on the sand by the ocean for days, intentionally motionless. This would drive many high performing, hard charging physicians nuts.
Engaging in a physically or mentally challenging vacation can be just what the doctor ordered, if the challenges are pursued in moderation.
Self awareness in planning your vacation can pay large dividends. If you're deeply craving returning to your favorite place in the whole world for peace and quiet then, by all means, return there. Otherwise, consider trying a new place, or new activities.
Satiate your curiosity for places you've never visited. Try the cooking school or other hobbies you've always envied others for being able to do.
Be very careful to not schedule the vacation days like a morning's office schedule. Rough in some big blocks for a few things you'd like to do, but leave leeway time in between for unscheduled activities. Above all, be flexible enough to change the day's schedule if it's not working out, rather than stressing or fighting about it.
Contrary to popular opinion, exercise is not a four letter word. Exercising on vacation, or even picking a vacation designed around an exercising activity such as canoeing or hiking can refresh you and restart your habits towards a goal of better personal fitness.
(http://boards.medscape.com/forums?128@129.cuxuahS4tqu@.2a0018a8%21comment=1)