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Dear Director,
I’m trying to take a real vacation this summer and get away from the office, but I have a hard time disconnecting from my cell phone and email.  Is it OK for me to fully disconnect, and how can I go about doing it responsibly?

Emergency physicians, perhaps more than any other medical specialists, value their time away from the hospital. We recognize the importance of finding the time to rest so we can come back recharged for the next shift.  The same is true for ED medical directors.  Coming back to work refreshed after a vacation can increase motivation and productivity while decreasing burn out and frustration.  While we all have different comfort levels when it comes to “disconnecting,” there are steps that can help the process run more smoothly.

Get organized
I’ve been blessed to always have a phenomenal “number two” who is comfortable taking the reins when I go out of town.  This is such an important issue that it was mentioned as a selling point before I took my first Chair job. The conversation went something like this: “Hey Mike, Bob is a great assistant director so at least you’ll be able to take a vacation and not stress that the place will fall apart.” After all, if you leave and nothing gets done – or worse, problems fester – you come back to even more work and stress. Therefore, before escaping and turning off your cell, identify what roles you need covered and who the right people are for those roles. Be thorough; you’ll need coverage for everything from patient complaints to billing questions. Be sure to ask these people if they are comfortable with these responsibilities before signing them up. This ultimately helps to engender trust and gives people who are interested in ED administration a little insight into your job.  Although administrators all think of themselves as irreplaceable, if a crisis occurs, the hospital brass need to see that we have back-up, people in place to troubleshoot problems.

Setting ground rules
Make sure whoever is covering for you understands what to handle on their own and what you should be interrupted for.  If the purpose is to get away from your email, you need to give your replacement enough authority, and trust, to deal with basic issues. On the other hand, if you think Joint Commission might show up and you’re only a couple of hours away and would want to return, you should set that expectation as well. I’ve also greatly appreciated when the doc covering for me withheld information that wasn’t time sensitive, but which he knew would distract me from my vacation.

This is also the time to set the “out of office” response on your voicemail and email.  You should not only say that you’re away on vacation, but tell people that you’ll respond to their voice/email when you return (give the date) and that emergencies are being handled by calling the ED and asking for the ED administrator on call. In addition, you may actually provide the physician’s name and number. If you’re pretty good at responding to emails and you suddenly drop off the face of the earth, colleagues in the hospital will either get annoyed or think you’re sick. Obviously, the “out of office” response resets their expectations; it’s amazing how many things cease being urgent once the sender finds out that you’re away.

I hate getting a voicemail on my office phone.  Walking into my office and seeing that red light on my phone always irks me.  After all, it’s usually a complaint, and I often can’t understand all the details in the message. But I can’t remember the last time I came back from a vacation and had to retrieve a message since I started changing the message on my voicemail to one that clearly states that I’m away, including the day I’m returning.

The final ground rule is one you set for yourself. If you tell people you won’t be returning emails, don’t return routine emails.  If you do, you’re inviting that person, and anyone else they speak with, to continue to email you. So put your smart phone down. Disable the “push” alerts so that you aren’t constantly getting pinged. If you don’t think you can be trusted with your phone, and your goal is to unplug, consider asking a family member to remind you of your goal when they see you on it.

There is one major caveat to this lesson in unplugging: it may be worthwhile to be completely reachable by the hospital CEO. If they know you are on vacation, they are unlikely to contact you.  However, they will appreciate your availability and this will avoid frustration if they can’t get in touch with you. Remember, if something really bad happens, you need to be aware and be involved. People (CEOs) will forgive, but they may not forget.

Re-entry
I completely understand the desire to disconnect on vacation, but by the end of a trip, I’m definitely ready to reengage and see what I missed. Honestly, I’ll usually scan some of my email throughout the week and, depending on where I am and how much fun I’m having, I might call the doc who’s covering for me mid-week to get caught up on any big news. The night before my first day back in the office I spend time going through all of my emails. You should also try to get an email update or telephone conversation with the doc who covered for you.  If you can’t do this before you show up at the office in the morning, schedule a debrief as early as possible. Hopefully nothing eventful happened, but if it did, you’ll want to know about it before you run into the hospital CEO in the cafeteria. I also block at least one, but usually two, full non-clinical days when I return to the office to get completely caught up on everything I’ve missed and to take care of the week ahead. 

Weekends Away
All of these steps are great if you’re actually out of town and want to disconnect, but even a weekend away can have negative implications if the hospital is trying to reach you and can’t. Nobody expects to reach you on your hospital phone or email over the weekend, but you need to be accessible for an emergency.  Although I spend most weekends watching my kids run around a field, I love to go to the beach in the summer.  Since I can’t get back to the hospital easily from there, I need back up in case something happens that I can’t handle over the phone. Assuming I’m going somewhere with good cell reception, I’ll just keep my phone with me like it’s any other weekend and have a doc available to cover for me. If you’re going somewhere remote, make sure you’ll have cell coverage and then let the ED (and one of your docs) know that someone locally is covering the ED administrative call. 

Conclusions
Getting a mental break from work is important, even essential. But just like any other project we do for work, some preparation ahead of time will make things run much smoother.  Spend time to develop the skills of another physician who can act in your absence and who knows how to troubleshoot common problems.  But at the end of the day, remember that hospital emergencies can be extremely serious, and administrators need to be able to reach you – or the acting medical director – 24/7.


Michael Silverman, MD, is a partner at  Emergency Medicine Associates and is chairman of emergency medicine at the Virginia Hospital Center.


 

 

 

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