Doctors' "vacations"

This week, a read a good article on KevinMD's website, "Doctors still work while on vacation" (originally from the Jewish Journal) by Afshine Ash Emrani, a cardiologist who explained how doctors can never *really* take a break. While I don't have kids (yet!) and I'm not a cardiologist but rather a primary care doctor (whose burden of guilt due to continuity feels like it is even greater), I found this article spot on in how it explains our constant stress/worry/workload and the feeling that "it never ends!!!" Here it is in full text, with my comments in purple.

"Last week, I took a 6-day vacation.  Two days before and two days after, I put in a total of 32 unpaid hours of work which was cut short by a call from my daughter asking me why I am working during my time off.  While away with my family, I ran into people of different walks of life and noted that few understand what goes through the mind of a doctor when he or she takes time off.  Here’s a glimpse.

Doctors don’t take much time off.  We realize that disease and illness does not pay attention to our schedule, but our patients’.  I am now in my 18th year of practice and this is the second year that I am taking a week off at a time.  I work most weekends and holidays.

(I definitely take more than a week "off" a year, but yes, work countless weekends and holidays.  Wish I had a whole summer off. And yes, the workload is twice as heavy when you come back, leading us to often wonder, "Was this break worth it? My stress is immediately back.")
 
Doctors work while on vacation.  Because of the Internet and electronic health records, we steal time away from our family to connect and review labs, refill medications, answer emails while away.
(So that we have less to catch up on when we're back).

Doctors put in hours alone in the office.  The workload doubles the week before and after the vacation.   So much work is done in the absence of patients on behalf of patients, such as reviewing lab results and discussing care with other consultants and writing letters to insurance companies to get necessary treatments approved.
(Ah; it would be so nice to have a *real* 9-to-5 job.... where patient calls, results review, refills, documentation, as well as seeing the patients had neat and tidy work hours. 


Doctors pray a lot that patients don’t get sick. We are true patient advocates; we win when our patients win. When we are away, we pray that no one gets sick, so we can be there in their time of need. 
(Selfishly, we also hope that patients don't get sick or come to the ER from 9pm to 6 am so we could get a good and full night's sleep once in a while.)

Doctors feel guilty all the time.  We feel guilty that we have limited time for our patients.  We feel guilty that we don’t have time to attend to our growing children who will be at that special age only once.  We feel guilty that we forget anniversaries because we were too busy worrying about our patients.  We feel guilty that we cannot do more for our patients with difficult diagnoses or limited resources.  There is tremendous pressure from every angle that we impose on ourselves.  And, yet, we feel guilty for taking time off from our practices.
(This is the biggest thing of all. I am so riddled by guilt most hours of the day that it really is unhealthy.  Work-life balance is terribly difficult for most primary care doctors who feel that "everything" is our responsibility. [We also get dumped on quite a lot from other specialists, who make far more money and have far better hours than we do)].)

Doctors study during vacation time.  With the rapid development in medicine and science as well as the requirements of keeping up with continuing medical education and required board certifications, many doctors schedule their family vacations at the same time that they are attending conferences.
(Denver was a CME conference and getaway. It was definitely more relaxing than seeing patients all day, although I was checking my inbox multiple times per day.)

Doctors worry about costs of taking time off more than others.  There is the issue of paying someone to cover the practice.  The overhead continues to mount without incoming revenue, unlike other businesses.  And employees must be paid while we are off.
(I have never taken a sick day.  Leave (i.e. maternity) and vacation is another whole issue. See the "guilt factor" above. Luckily with my position, I don't have to worry about private practice "overhead" but still...)

Doctors don’t know how to relax.  Knowing how to let go is an art most of us have not mastered. We are worry freaks.  We worry what if there is an emergency and I am not there?  What if a long term patient dies and I cannot be there for the last days?  What if an important fax comes in and I review it late?
(THAT's an understatement.)

Doctors are socially awkward and end abruptly.  We attend a party and spend half of it away from people on our phones, not buying and selling stocks, not trading, not even making any money — just trying to take care of the after hour calls from the hospitals and sick patients begging for help.  When we return to an unfinished conversation, we seem dazed, as part of us is still thinking what we could do for the patient that was on the phone, why the nurse could not understand our simple orders, which consultant we should call.  We carry this personality into our vacations.
Sorry, the hospital is calling.  I have to run."
(I rarely make social plans when on call due to getting interrupted so much. Goodbye, social life!)

But when I get to be present at births, some of the most memorable moments of families' lives, see patients grow and change, and see help them make positive changes in their lives, the job is pretty good. Even if vacations could certainly be more restful.