EPtalk by Dr. Jayne 7/11/24

It’s a milestone week at HIStalk as this edition of EPtalk marks my 1,400th post. I was struggling with ideas on what to write about, but a veritable treasure trove of topics came my way.

First is the health system that hasn’t updated its content in several years. I won’t name it to avoid unnecessary shame being heaped upon the good people who work there, but someone in a leadership position needs to allocate some resources to remove outdated banners from several clinical modules. The eyebrow-raising content included a strongly worded reminder that I shouldn’t be treating COVID-19 with unapproved medications such as ivermectin or hydroxychloroquine. The year 2021 called and it wants its alert back, folks.

From IT Guy: “Re: my company’s return to office policy. I’m not thrilled about it, so I was intrigued by a headhunting email. On a whim, I decided to check out the company. Check out their leadership page.” Employees apparently get a custom bobblehead figurine after they’ve worked there a certain number of years, and that’s how key company figures are represented on the website. Two of the three founders are depicted without shirts. Although I appreciate the detailed artistry of the washboard abs on the bobbleheads, I’m not sure what this representation says about workplace culture.

From Lady Go-Live: “Re: my implementation project. I had a strange encounter with a physician today. We are literally days to go-live and have been conducting dress rehearsals in critical areas of the hospital to make sure that nothing is missed. During today’s walk-through, I was berated for using a checklist to make sure that everything was covered. The physician told me that if our system was so easy to use, I should have been able to run the checklist from memory. The reason it was so strange? He was a surgeon.” It’s funny how resistant certain people can be to checklists, even ones that have been proven to avoid serious patient harm. Pilots and other critical workforce members had been using them for years before they were introduced to healthcare, and still people balked. Atul Gawande’s bestseller “The Checklist Manifesto” was released in 2009, but some people act like it’s still a brand new concept. Maybe if checklists were run by AI, people would get on board, because after all AI makes everything better.

I’ve written before about the stresses that early discharges and hospital at home can place on family members. This week the Journal of the American Medical Association published a research letter that addresses caregiver burden and hospital at home programs. The authors surveyed a representative sample of US residents about their willingness to perform care in the home. The survey was distributed from August to October 2023 and included nine questions that followed a description of hospital at home. The survey had a 92% cooperation rate and 47% of respondents reported acceptability of the idea, with 36% being neutral and 16% saying it was unacceptable. Interestingly, the percentages didn’t vary significantly across characteristics such as health insurance coverage, health status, or sociodemographic factors. The authors acknowledge that they didn’t measure some factors, including the respondent being part of a multigenerational home, and also acknowledged the challenges of working with self-reported data. It would be interesting to construct a longitudinal study of attitudes at baseline, after a recommendation for home-based care for a loved one, during that care, and at the end of the episode of care. Researchers, get cracking.

I’m spending some quality time out of the office this week, experiencing some of the finest humidity the continental US has to offer. As I was trying to figure out a nice way to have my auto-responder message say “Look, I told you I would be completely off the grid, please for the love of all things respect my need for a little time off.” However, that’s not good business etiquette, and even if there was a socially appropriate way to word that message, it wouldn’t be acceptable in working environments where managers expect people to be available 24×7. Just because nearly all of us carry smartphones doesn’t mean we need to check our work email, but I’m betting more of us do than we admit. Some people do it so that they can delete items in real time so they don’t come back to an overstuffed inbox. Others do it almost as a compulsion, especially if they’re better at being busy bees than they are at taking a break.

I reflected a bit on some of the most memorable out-of-office messages I’ve seen. One former co-worker decided to go bold and announced that she was out of the office to travel to see Taylor Swift, with no apologies for taking time off to do something that was clearly important to her. On the flip side, I once had a co-worker document that he would be out of the office from 10 a.m. to 2 p.m. for a medical appointment and to please text him during that time. If he truly had something urgent going on at work as well as from a medical standpoint, I feel bad that his employer left him so completely without coverage that he felt the need to post that message. I’ve been in work situations with that kind of pressure, but having also had people’s lives literally in my hands, I decided that non-clinical needs would just have to wait until my return.

It also gave me the opportunity to reflect on some of the best supervisory relationships I’ve had over the years. One of my favorite leaders was highly intentional about time off. She not only made sure that her direct reports took all of their allotted time off, but made sure we carried the practice forward into our teams. She would remove people from email threads when she knew they were out of office and provided gentle reminders if someone tried to add an absent colleague back to the discussion. Because of behaviors like that, we knew that not only did we not need to check our email when we were out, but that we most certainly shouldn’t respond to anything unless we wanted to reveal the fact that we were disregarding her instructions to “enjoy the time away and don’t worry about work, because we’ve got you.”

What is the most memorable out of office message you’ve seen? Leave a comment or email me.

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