Many physicians are accustomed to waking prior to dawn. Morning rounds and early operating room schedules often mandate an early start to the day. Despite this, it was with surfing that I first developed into a true morning person. Favorable early morning winds and the opportunity to be among the first to experience the ocean’s glassy, unbroken surface compelled me to comfort myself with warm car rides and steaming cups of coffee in the predawn light. As my medical career progressed and clinical responsibilities increased, mornings to surf became scarcer but no less sacred.
After drowning two pagers carefully wrapped in ostensibly waterproof plastic bags, I was forced to entertain the horrifying thought that surfing and a medical career may not be compatible. Then waterproof connectivity emerged in the form of a watch. When I first received and answered a page on my smartwatch while floating on a surfboard in the Pacific Ocean, I felt like every stereotype of a 21st century California physician, but in the best way possible. Work-life balance, check me out!
I have since realized that near constant connectivity is a double-edged sword. Advances in the reach of cellular service, WI-FI, and virtual private networks allow for versatility outside of traditional working hours, enabling me to tuck my children into bed before turning to my charting. Unfortunately, these same advances also intrude on the precious few hours not formally allocated to clinical obligations. Reading non-urgent patient messages, emails, and test results after hours and on weekends has become common practice.
My father, a retired Otolaryngologist, spent most of his career without electronic in-baskets, virtual pagers, and a constant barrage of messages. Tasks were handled exclusively during the working day. Non-urgent matters did not have the opportunity to disrupt life outside of working hours. While I saw in my father the stress that any caring physician in medicine experiences, I do not recall our home life punctuated by frequent patient care interruptions. Connectivity has blurred the line between work and home.
As I reflect on a trip to Italy for my best friend’s wedding, I realize that I spent nearly an hour in the electronic medical record each day replying to patient messages, finding openings in my schedule to book patients, and signing refills. I was unable to completely unplug even on my vacation! The anticipation of tasks building up in my absence was sufficiently persuasive to press me into remotely logging into the medical records system at least once each working day.
I have wonderful colleagues to help with emergencies and in-person matters but assigning them the task of monitoring my in-basket strikes me as a burdensome. My in-basket is like a large boulder that I roll up the hill each working day, only to have it roll over me the very next day. Shielding my colleagues from this burden while I am on vacation feels appropriate when Wi-Fi is ubiquitous, even in the remote Tuscan countryside.
I used to intentionally spend much of my vacation time surfing in Central America because the infrastructure for connectivity was less developed. I was forced to arrange coverage as I could not count on reliable internet or phone service. As a result, I felt more rested, happier, recharged, and my surfing skills improved as well. Today, I feel guilty arranging coverage for electronic tasks, even if I am 9 time-zones away.
As the ideal amount of connectivity may be different for each individual, we are responsible for setting appropriate expectations with our patients and other physicians in order to protect our time off. The balance between our patients’ well-being and our own is inherently unique to each clinician.
Finding harmony in the overlap between my professional and personal life is an ongoing process. I am constantly working to take excellent care of my family, friends, patients, and myself. Part of my personal growth process has been acknowledging that replying rapidly to non-urgent messages does not necessarily make me a better physician. Turning off the setting that made my phone vibrate every time I received a non-urgent email or alert from the medical record has tremendously reduced my personal level of anxiety and reduced frictions at home.
Today, my smart watch spends most of its time in a drawer except when connectivity on a surfboard is essential. This adjustment allows me to appreciate and savor the magical mornings that I spend gliding along waves as stars fade and day begins.
