Navigating the tricky minefield of email communication.
Dear Director,
My medical director likes to send out emails with things I need to do on weekends, and it drives me crazy. The last thing I want to do on my weekend is think about work. I got into emergency medicine thinking I wouldn’t have an office-like responsibility. What’s up with this?
About a year ago, our hospital patient relations team would email out the weekly complaints about the ER at 7 p.m. on Fridays. While those of us who reviewed the complaints knew we didn’t need to respond before Monday, none of us liked having that work hanging over our heads, and we were also afraid we might forget it by Monday.
Therefore, for a few months in a row, we were fervently sending texts to each other about who was going to review what over the weekend and respond. In the end, the Friday evening emails drove us crazy as well. We are all too well connected to our emails to let things slide and we’re all entitled to a little downtime away from the office and the shifts. With that in mind, I met with the patient relations director to discuss the workflow and how we could get these same emails on Monday morning.
Not surprisingly, despite our 24/7 clinical schedule, most of us like to do our office work in the 9-5 setting. And we generally don’t like to be interrupted on our weekends off. Of course, many of us also spend time doing emails at the end of the shift while we’re waiting for a hospitalist to call back, and this could apply to your director as they’re finishing a shift. So all bets are off.
Although most ER docs don’t want to spend a lot of time doing email, there are a few truths we need to recognize.
- Communication among the team that staffs an emergency department is critical for the ED’s success. It’s very challenging, if not impossible, to get the entire group together for a meeting. Therefore, many directors communicate via email. I would be willing to bet that most regular emails to the physician group from a director are about information related to flow, quality, etc… and can be read prior to your next shift. Rarely, is there something that requires your immediate attention when you’re outside the hospital. With the COVID pandemic, I’ve seen many groups go to weekly phone calls or Zoom sessions to improve communication. While I see a lot of motivation for docs to participate in weekly calls during a pandemic, I’m not sure the same enthusiasm would be to discuss routine issues while you have a day off.
- Unless you’re using your hospital email for all work emails, you may need to keep track of two email accounts. Most of my docs use a non-hospital account for their general email address. This is fine for day to day interactions, but emails that contain protected health information (PHI) need to be sent through a secure system. This means encrypting an email or sending a file password protected or just using your hospital email system between the two parties. While my associate director and I are on our hospital email every day, I recognize that most of my docs don’t check it that often. Therefore, if I’m sending them a question about a case that has come up for a QA review, I’ll usually email the doc on their preferred address and text them with a heads up to check their work email.
- Some emails are time-sensitive. The Joint Commission has time frames around how quickly complaints need to be resolved or I may need the doc’s take on an event if it’s a high profile case. If the hospital chief medical officer asks me to look into a case in the morning, I’m generally trying to have an answer for them within a few hours. I can buy time if someone is on vacation or post-night shift, but I will usually send a text and/or email letting the doc know I need to talk to them.
- As a side note about complaints and Joint Commission: If patients make a complaint (verbal or written) when they’re in the hospital, the hospital (typically within the Patient Relations Department) can respond to them verbally as long as the patient is still in the hospital (unless the patient requests a written response). Given the typical short length of stay so many have, this ups the emphasis to have a thorough and timely medical review. It’s often better for the patient relations representative to have a conversation with the patient than to respond via letter. Hospitals are required to provide a formal response for all patient grievances, which are complaints presented in writing and complaints received after a patient is discharged from the hospital. The hospital must provide a written acknowledgment of the concerns within seven days of receiving the grievance and provide a formal response within two weeks of sending the acknowledgment. Many times, if cases are straight forward and reviews can be accomplished, the hospital will combine these two steps into one and respond within seven days. You can imagine how quickly one to three weeks goes from the perspective of the patient relations department. They receive it and take a day or two to review it. They send it to the medical director or their designee who frequently doesn’t review it right away because they’re addressing other priorities. You can lose a week pretty quickly. Tack on any additional time for the treating doc to review the case and respond and time continues to tick towards the deadline. And yes, Joint Commission actually does review the logs that Patient Relations keeps when they come for their regular inspections.
- Although many emails you receive, like the daily FYI emails from your chair, don’t require a response, there are a handful of instances where you do need to respond. Certainly, emails that request your opinion or recollection of a case or an interaction require a response. For some of these, the appropriate response would be to suggest a phone call discussion rather than putting it down in writing. Unless you’re on vacation, telling your chair that you haven’t looked at your email for a few days so you didn’t realize there was an issue is generally unacceptable. This is especially true if you’re receiving an email on your personal email address that we all know goes to your phone.
There are a few things that chairs can try to do for their groups. First, we must recognize that there is always someone coming off a night shift, working clinically who likely won’t respond immediately, and someone who just finished a string of shifts and is taking a well deserved day or two off. I try to send the large majority of my emails during “business” hours. At least this provides some predictability to the group. I’ll do email after evening shifts, but those are usually in response to an email I got earlier in the day from a non-clinical hospital person.
One of my favorite features of my email is the “schedule send.” This way, I can write an email late in the evening and then schedule it to be sent at a future time. I usually use 8 a.m. the next day, but sometimes I schedule an afternoon time. As I said before, I typically text docs if I’m sending them an email to their secondary account (usually hospital email when I need to send PHI).
I’m generally in the office every day so one of my own pet peeves is when I get an unscheduled phone call in the night (like 9 p.m.). And let me separate these random calls from friends or people who you communicate with via text/email and make a plan to call each other at a future time. Although I’m always available to troubleshoot issues in the ED and/or the hospital, and I definitely want my docs calling me for those, the calls I’m talking about are from other clinicians (typically within my hospital system or staffing company) who usually start the conversation with “Hey, Mike. Do you have a minute? I just finished a shift and wanted to talk to you about X project we’re working on together.”
This happens to pretty much every chair I talk to and it’s a tough balance between keeping regular hours and scheduling appointments versus the do it on the fly approach so many of us take. I would hope that chairs have the same respect for their docs. While I think unscheduled phone calls have a time and a place, getting an unsolicited call from the boss may be uncomfortable, and might be better to have a text as a warning. I’ll frequently want to talk to my docs when they get off of the nightshift. Sometimes it’s to talk about a trauma or volume, but my usual M.O. is to text them and ask them to call me on their way home or when they wake up. This puts the call on their schedule.
For better or worse, email is expected of professionals, including ER docs. Most emails aren’t urgent, but you should plan on regularly going through your personal and professional email accounts and understand that some emails need a more timely response than others.
