Boundaries and Patient Care
I don’t usually turn on my phone or computer before 7 am, but today I wasn’t sure if we would have a meeting to discuss grant writing with one of my patients who has a program for young women. She hadn’t replied by the time I powered down my computer 11, after a late-night zoom meeting for my work in California. Sleeping until 6:30 is a new and exciting development for me, and I owe it partly to my dogs who ate our neighbor’s rooster when it jumped into our yard last week (turns out, this is culturally acceptable if it happens in your yard). I never knew how quiet mornings could be without that one rooster.
So I turn on my phone and I see that one friend messaged me at 4:30 am because they were feeling sick. They wanted to be seen right away, but I was planning to work from home during the morning and see patients in the afternoon. I advised my friend about a home COVID test and offered to see him in the afternoon. At 7:30 another friend messaged me, one who doesn’t usually mix medical concerns with messages, but we are in the middle of a cholera epidemic and she was starting to have symptoms, so she needed to know what to do. We don’t have tests for cholera and symptoms can worsen quickly, so I advised about oral rehydration and offered to see her if she came in during the afternoon. Then I finally checked my messages and the other patient wanted to meet by zoom at 8:30, but it was already 8:00, so I told her we would need to schedule further in advance in the future. There were patients emailing me about forms to complete and tests to follow up and another wanting an appointment who couldn’t get through to the front desk. I tried calling a few times, too. I also couldn’t get through to the front desk to book.
These days, I only let the front desk book afternoon appointments from 1:30 to 3:30. That way, if someone contacts me to be seen directly, I can confidently tell them that I am free at 1:00 or 4:00. It also means that I have less empty appointments in the middle of the afternoon with more people taking early and late appointments. So it is nice that I can know when to show up and not have people waiting for me, or come in early only to find that nobody booked an early spot. But it also means that, on days when I only have 5 appointments in an afternoon, my clinic days can be as short as 4 hours. This is a huge change for me, because it means that I can get an entire half-day of work in before clinic (or after if I am taking calls in the US). Overall, I have reduced the time I spent in clinic in 2021 and 2022, though I am still seeing more patients than the two years before that. These days, I usually help twice as many patients virtually, through email or phone calls, than I see in clinic. I guess that is good for a preventive medicine doctor, keeping patients out of the clinic if they don’t have to come in, but I still have to work on boundaries to make sure that I’m taking time off when I need to.