The Right To Be Left Alone: Even Doctors
By
Leonard Zwelling
https://www.nytimes.com/2024/04/01/opinion/lake-lieberman-kennedy-trump-biden.html
It was a very small mention in the weekly conversation between conservative Bret Stephens and liberal Gail Collins in The New York Times on April 2.
“A California assemblyman named Matt Haney has proposed first-in-the-nation legislation that would give employees the legal right to ignore all communications from their employers during off-hours.”
Now this is a great idea.
E-mail, text messaging, and the expectation of immediate response are all part of the culture of work that has invaded people’s personal space. Some supervisors expect their workers to be on social media call 24-hours a day. Just because your boss is a workaholic, doesn’t mean you have to be unless your performance review and annual bonus depend upon it. This would be a way to negate that in theory, although I have no idea how this could be adjudicated. Can you imagine a law suit from a non-promoted employee against a non-promoting employer for emailing him after five and expecting an immediate response?
But, let’s think about this a little bit. One of the major gripes of physicians now is the huge amount of after-hours paper work asked of them because they have to see a patient every 15 minutes and Epic demands certain information in every note if the employer of the physician is to be paid. Such notes cannot be generated within the 15 minutes allowed for a visit. No time.
Thus, it is not unusual to have doctors doing several hours of work after clinic every evening. If we could extend the ban from emails and texts to include Epic, perhaps supervisors would be pressed to allow for 20-minute clinic visits with five minutes at the end of every physician encounter to do the paper work before 5 PM.
And then there’s the late-night phone calls, emails, and texts when the boss gets an idea and just cannot wait to share. The boss may need to learn to wait under California’s new ordinance should it pass although, again, how to make sure the employee who turns off her phone at five is not penalized, is still an issue.
I believe that one of the contributing factors to physician burnout is the fact that each clinic day doesn’t seem to end. After a day of seeing patients, a clinical faculty member has emails to attend to and charts to complete. If the clinic runs until 6 PM, the day may not end until 9, with or without a break for a meal. That was fine for a year when the doctor was an intern (excuse me, a PGY-1), not when the doctor is a faculty member. Although, I doubt the PGY-1s work the hours we did in 1973.
I don’t think it is too much to ask doctors to work more than forty-hour weeks, but I also think everyone deserves a little peace and quiet from their job at some point every day and that should not begin at bedtime.
Medicine is more complicated than ever because doctors can be so much more effective than they used to be. Diagnostic tests are more accurate and can diagnose illness with more precision and earlier. Interventions, both surgical and medical, are also more effective, particularly in oncology where the added tool of radiotherapy obtains and there’s a new anticancer drug in every issue of The New England Journal of Medicine.
In 2002, I had symptoms of heart arrhythmia which upon catheterization were associated with severe coronary disease. The cath was done on Saturday and I was offered immediate by-pass surgery. The BW said, “no way. We don’t do elective cardiac surgery on Saturday.” Dr. David Ott fixed me Monday morning. Genie wanted a rested surgeon in my chest.
All patients want their doctors to be at their best when it comes to their care. No system is perfect, but a rested, clear-thinking physician should be the goal of any system of patient care. That goal would be furthered with less for doctors to do after hours.
Assemblyman Haney has a good idea.
