A guest column by the American College of Physicians, exclusive to KevinMD.com.
I’m writing this as both an observation and confession.
The observation is that my professional colleagues are increasingly unwilling or unable to disengage from work-related technology in what would otherwise be considered “personal” time.
It is increasingly common to receive work-related emails or see non-urgent entries in the electronic health record (EHR) in the evenings, very early morning hours, and anytime over the weekend. Most dramatically, even when I know when someone is on vacation and physically away, it isn’t unusual for them to continue communicating much as if they were still at work. I’ll periodically send or copy a routine email to a colleague expecting nothing until they are back, receive a return out-of-office message indicating that they have limited access to email and are unable to respond, and within minutes a lengthy reply to the message shows up in my inbox.
It seems as though there is no longer such a thing as time off, and truly being “out-of-office” is a thing of the past.
The technology that allows us to be in contact with our colleagues and patients on an almost continuous basis has remarkably transformed our ability to exchange information and the ability to effectively care for our patients. I’m old enough to recall when such technology was not so ubiquitous – you’d spend hours on the phone trying to reach patients and colleagues, frequently playing “telephone tag” in an attempt to reach people who had called. This obviously made the timely exchange of important information difficult and time-consuming. However, in the era of being able to communicate through the EHR, email, text messaging, and social media, this is now rarely a problem. However, despite the many practical benefits of this technology, it has also had the effect of remarkably accelerating the pace of our lives both at work and at home.
I think this is because it plays to our best (and possibly) worst instincts as physicians – the same drive that pushes us to thoroughly care for our patients and fulfill our professional obligations with our fellow physicians, even if this means making significant personal sacrifices, also leads us to interact with this technology in less-than-healthy ways.
When I ask colleagues why it is increasingly difficult to unplug from technology even for relatively short periods of time, several themes emerge.
One is simply an extension of their innate desire to work on behalf of their patients, and a sense that failing to respond as soon as possible to patient-related issues when they arise (regardless of when that is) represents an unnecessary delay in care and a feeling that they may not be taking optimal care of their patients.
Another is a sense of professional obligation. Most of us dislike the feeling of not being available to colleagues or “burdening” them with dealing with issues or needing to make clinical decisions about my patients that I could easily manage in a matter of seconds.
And perhaps one of the most significant is more practical and related simply to survival. Given the rapidly increasing volume of messages, requests, and orders that come so quickly via current technology, any fear that not keeping up with this throughput will result in their being “buried alive” when they return, a problem only made worse the longer they stay unplugged.
We therefore prefer to stay connected, although these days this is pretty much a continuous process. It tends to turn days away into “checking-e-mail-and-the-EHR-from-our-phone days,” and answering messages and addressing issues from the first thing in the morning to the last thing at night, even if only periodically, similarly to being at home or work.
My confession is that I also share this mighty struggle with unplugging from technology. I’ve tried multiple different ways of placing boundaries around my “off hours” and time away from work, such as by limiting time spent checking messages or labs to only once (or twice, or three times) a day, or attempting to go entire days without “checking-in.” However, these self-imposed restrictions have been largely unsuccessful in solving for the feeling of being “out-of-touch” or addressing the anxiety that results from not being constantly in-the-loop. And this occurs even though I clearly recognize that this is not healthy.
The true cost of this difficulty in unplugging from technology is significant. To begin with, the inability to escape 24/7 work sets an extremely poor precedent for work-life balance. We know that having truly free and unstructured time is extremely important to our mental health. It is when we can free ourselves from more mundane distractions, engage in meaningful thought and reflection, and better understand the “bigger picture” of our lives and work. It also allows for uninterrupted recreation where we can pursue our own individual creative activities and those non-medical things that bring joy to our lives.
And instead of improving patient care and our professional lives, it may actually diminish these key aspects of being a doctor. We know that taking care of ourselves is a critical aspect of physician well-being, and that without the time and space for us to relax and recoup, our ability to help others is likely to be significantly impaired. These are the things we are losing by our inability to unplug.
Unfortunately, I don’t have an easy answer to this conundrum. However, I don’t believe we have to make a choice between the significant benefits of this technology or becoming victims of it. There is certainly a middle ground that should allow us to harness its power but not be unhealthily controlled by it. And I suspect that the best approach will be unique to each of us.
Personally, I have yet to find that optimal balance – but I’m working on it.
Philip A. Masters is vice-president, Membership and International Programs, American College of Physicians. His statements do not necessarily reflect official policies of ACP.
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