Actually, The Primary Care Doctor Can’t Go Unplugged…

Last weekend, I enjoyed a whole 48 hours without checking my clinical account. That meant not checking on lab or imaging results, patient messages, or colleague’s messages through the electronic chart portal. I did, however, check my work email, since real emergency-type things will trigger a backup notification sent to that account. I felt good about this, as nothing emergency came over email, and by Sunday night, I was totally relaxed and ready to face the workweek.

Well, Monday morning back at the office was a disaster. I had left the office at 4 pm Friday afternoon, and somehow, in the space between then and Monday, I had an unusual number of patient and colleague messages, a few of which were somewhat urgent. The poor on-call doctor had to deal with those, and I could tell that it wasn’t ideal: time-consuming and stressful for her to quickly review charts and figure out what was going on, and awkward for patients to have to explain issues that I was already familiar with. EXACTLY the type of extra work and annoyance I try to prevent.

In addition, there were a number of messages and results that, while they weren’t things that had required same-day attention (like pneumonia on an X-ray, cancer on a biopsy, or a positive strep culture, for example) they were still important and ideally, would have involved a call from me to the patient over the weekend (see the below).

So, Monday morning found me not only prepping for my busy afternoon clinic, but also backtracking and covering all these issues from the previous week and over the weekend: a lady with an osteoporotic vertebral compression fracture that required further workup and better pain control; a complex patient with more questions than could have been answered by the on-call; pain medications refills that only the PCP is allowed to handle; low-grade abnormal labs that required notification and action.

I ended up feeling stressed, unprepared for my Monday clinic, and behind from the very beginning of it. I left later than usual that evening without my all of my charting or administrative work completed. My colleagues know that I’m compulsive about having ALL of my clinical notes and billing done, signed and submitted before I leave for the day, every day. It KILLS me to leave work with work undone.

So, in retrospect, I wish I had logged into my clinical account BEFORE Monday morning. It was NOT to my advantage to be completely unplugged!

That’s why I got up at 5:30 am this lovely Sunday morning. Ironically, there was nothing at all requiring my attention. Figures.

But, I feel a lot better, headed into tomorrow…

This raises the question: When can the primary care doctor unplug? Everyone from every walk of life needs to unplug sometimes. Don’t they?

More on my perspective on this later…

2 thoughts on “Actually, The Primary Care Doctor Can’t Go Unplugged…”

  • The primary care doctor must be able to unplug. My patients with schedule II prescriptions were told up front, by me, that they would not be able to get refills over weekends or off hours. On call should cover, period, and then have at least a day off to recover…we really can’t be indispensable. It’s not good for us or, ultimately, for our patients. Why couldn’t the on-call manage the pain control for the compression fracture? The workup can wait until Monday.

    When I did primary care, I absolutely did unplug, especially on vacation, and it always irritated me that my partners did not, because it made me feel as if was taking advantage of them. It wasn’t equitable. Plus they took up staff time trying to manage things from far away when I could deal with them in the office.

    • I hear you… Luckily, sometimes when I go away, it’s to Central America, and I really CAN’T log in. Thank God. But generally, if I’m on vacation, I’m still willing to help out when there’s issues with my longtime complicated patients. It’s just easier for everyone…

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