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Episode: Inbox Management

Author: Michelle Chestovich MD
Duration: 00:23:11

Episode Shownotes

Physician coach Michelle Chestovich MD shares some simple tools to deal with this everyday monster!Ideas to share, drop an email: michelle.chestovich@gmail.

comWant to chat about how coaching might help you?Click here to sign up for a free consult: https://mamadocscheduling.as.me/

Full Transcript

00:00:00 Speaker_00
You are listening to Episode 170 of the Remind Yourself Podcast. Welcome to the Remind Yourself Podcast, the podcast for physician moms just like you who want to ditch mom guilt, stop yelling, and start enjoying their lives today.

00:00:21 Speaker_00
I'm your host, Rachelle Chestevich, certified life coach, family physician, and mom of four. If you want to overcome overwhelm for once and for all, this is the place for you. Hello, Mama Docs, and welcome back.

00:00:40 Speaker_00
I sure hope that last week got you in a great place and a plan to dig out from backlog if you have it. Today, I'm going to tackle another issue that comes up very frequently to physicians that I work with, and this is dealing with your inbox, right?

00:00:57 Speaker_00
I mean, it seems to me that there's a common refrain here. It's not. necessarily the seeing the patients in the early hours and late hours, although when it adds up to too much, that certainly is a big issue that contributes to our burnout.

00:01:10 Speaker_00
But it's dealing with these things that, quote unquote, we didn't sign up for when we went to medical school. But fighting reality doesn't make it go away. So let's just start with the premise. Okay, inboxes exist at this point.

00:01:25 Speaker_00
And now how are we going to deal with them? So I'm going to talk with you about several things. And thank you for those of you who commented. I put a post in Facebook, you know, what are your biggest struggles, and people gave me feedback.

00:01:38 Speaker_00
I had some ideas, but I got some new ideas of where you're struggling and how I can help you. I want to help you manage your inbox so that you can get your work done more efficiently, so you can have time in the evening to do what you want.

00:01:53 Speaker_00
Okay, number one, you need to have a plan. So many of us are living reactively. Oh my gosh, I've got messages. What am I going to do with them? Every day, there will be messages.

00:02:04 Speaker_00
It might be interesting to keep track, on average, how many messages do you get per day, so then you can create an even better plan. But let's just start with, I get messages every day, and I'm going to need some time to deal with it.

00:02:17 Speaker_00
When is best for you? Now, again, there's not a right answer. Your brain's going to spin in a decision. I don't know. I'm not given time. Well, I will give you some ideas and you can try something and then you get to evaluate. Is this working?

00:02:30 Speaker_00
What's not working? Some clients that I've worked with say, hey, I'm going to do this, you know, 15 minutes at the beginning of the day, 15 minutes at the end of my lunch, and maybe 15 minutes, you know, in the middle of the day.

00:02:42 Speaker_00
or the end of the day after done seeing patients.

00:02:45 Speaker_00
There's not a right way, but you need to figure out a plan and communicate it clearly with your staff, with the medical assistant that you're working with, maybe the nurses, and just say, hey, I'm trying this new thing.

00:02:56 Speaker_00
I'm not going to be answering messages all day long, so I'm going to look at them. Here, here, and here. So if there's something very emergent that's coming in, number one, probably shouldn't be coming to me emergently. They should be calling 911.

00:03:07 Speaker_00
But if there's something more urgent that you think I need to know, please let me know and I will help decide whether that needs to be dealt with earlier.

00:03:15 Speaker_00
It's important that we do have this communication with our staff because interruptions are another thing that contribute not being efficient and not getting our work done. So be clear about what your plan is. And then again, maybe this isn't it.

00:03:27 Speaker_00
We're going to evaluate. Our ultimate goal is to get it done more timely, but we're going to try some iterations for sure. It might not work the first time. The second thing that's going to really help you with this is to set some very clear boundaries.

00:03:45 Speaker_00
with yourself, with your patients, and with your staff. What do I mean with yourself? Well, your brain is going to want to veer off and go look at patient messages when you're supposed to be finishing your chart. Ask me how I know.

00:04:00 Speaker_00
You come out of a difficult patient and your brain would much rather do another task, right? Especially if something's been flagged red. That's what happened in my system. My brain would be like, oh, I have to go deal with that.

00:04:10 Speaker_00
So you have to set some boundaries with yourself. No, this is when I'm doing the messages, okay? Lovingly, kindly redirect your brain back to the task at hand. Number two, you're going to have boundaries with your staff. Please don't interrupt me.

00:04:23 Speaker_00
This is when I'm going to be doing the messages. And in fact, you're going to get them on board with you to help further the message that you want to portray to your patients, right?

00:04:34 Speaker_00
You're gonna come up with, these are the top things that are coming into me, and they are gonna be a part of your plan to get messages off your portal ahead of time. I'll get to that in a moment.

00:04:43 Speaker_00
And thirdly, and most importantly, you need to set some boundaries with your patients. You're gonna decide right now what automatically should be an appointment.

00:04:53 Speaker_00
My thought is, if you're going back and forth asking questions, if you're gonna be prescribing a medication, if you're asking about side effects and or if things would be getting worse, this is what you do, my goodness, that person deserves to be seen.

00:05:05 Speaker_00
So, when people send you a missive and wondering what you think and could you please prescribe this medication, it could just be a no-brainer, this needs an appointment. That's the sort of boundaries that I'm setting.

00:05:16 Speaker_00
Of course, patients wanna come in through the inbox. It's not a problem. This is how they've always done it. It's easy to get access. It's often free for them.

00:05:25 Speaker_00
Like, of course, it's, you know, maybe a preferred way for them to get in and get their message across to you. But we're going to set some boundaries, and we can even let patients know when they're in. I love being your doctor.

00:05:37 Speaker_00
This is how I'm going to take care of you moving forward. I'm going to see you quarterly for your chronic disease management and or yearly for your physical.

00:05:44 Speaker_00
And if you have other issues in between, I invite you to make an appointment either virtually or in the office. Right? So let people know ahead of time. Set that up. You know, a lot of you take care of kids. Let the parents know.

00:05:56 Speaker_00
This is going to be the plan. And if you send a message, I will get to that, but it may take up to, you know, 72 hours and or a week. So that's not the quickest way to get access to me, right? So we can just let people know ahead of time.

00:06:12 Speaker_00
And of course, they're going to like cross over this boundary, of course, patients are going to send us messages saying, well, my previous doctor did it this way, or could you please just send a prescription.

00:06:21 Speaker_00
But again, you get to decide what your boundaries are going to be. And we're going to stand by them. And this is where it gets a little bit tricky for us as people pleasers and wanting to make everyone happy.

00:06:33 Speaker_00
We're not going to make everybody happy when we set boundaries. No other profession that I can think of allows people to send messages and try to get information and get a diagnosis, if you will. via an email or a text, right, or a MyChart message.

00:06:51 Speaker_00
None, absolutely 100% none that I can think of other than the medical profession. So, oops, we've got to backtrack. We've allowed this floodglade of MyChart messages to come in.

00:07:02 Speaker_00
And a lot of patients think that that's just how they're going to get their care. Now, some organizations have taken the step of maybe saying, you need to pay for this. But still, my thought is, when does it get done? Even if we get paid, that's great.

00:07:14 Speaker_00
That's a step in the right direction. But when does this get done? Some organizations say, ah, we value this, and we know it's taking a lot of extra time. And so we are going to pay for someone to answer all these messages during the day.

00:07:28 Speaker_00
Wow, that's great. But in the meanwhile, what can you do to set some boundaries? Knowing that, of course, when we set up boundaries, people who have benefited from us not having boundaries may be a little disappointed. And that's okay.

00:07:42 Speaker_00
Because I'll tell you that we need to gain back control, and we need to be the leaders in this. Working for night and on weekends, answering all these messages for free is unacceptable.

00:07:54 Speaker_00
It is making your job absolutely unsustainable, and it starts with setting some clear boundaries. And we'll keep coming back to this. I'm saying it so firmly. I get it. It's not easy. It takes some progress.

00:08:08 Speaker_00
But just setting that intention, ah, I need to set some boundaries. And how can we make this easier for ourself? I love telling you that it's helpful to make a dot phrase. Wow, that sounds like a really important topic.

00:08:22 Speaker_00
Please set up an appointment at your convenience. And you just, you know, however you do it in your EMR, either cut and paste it or dot phrase it in. You can also get your staff involved.

00:08:32 Speaker_00
Hey, these are the things that are always going to need an appointment, so please do that for me. Okay, this brings up one of the struggles. I'm going to go back and forth between our plan and then the struggles that I hear.

00:08:41 Speaker_00
So when I give this, I think a lot of you have the sense that I need to have some boundaries and have patient come in, but I feel so bad that I'm booking out for several months.

00:08:49 Speaker_00
Okay, folks, there is an overwhelmed medical system, but the broken medical system does not need to run on the altruistic back of us physicians needing to take care of our patients at all hours of the day.

00:09:02 Speaker_00
Because I will tell you that there could be a line out the door, and you could be seeing patients 24-7. And some of you nearly are. So we have to right-size this.

00:09:10 Speaker_00
I know it's not ideal, because you love your patients and you want to take great care of them. It doesn't feel good to say, hey, make an appointment, knowing that your next opening is in two months.

00:09:20 Speaker_00
But hey, this is where we can get curious and creative. Okay, I notice that I'm saying this like five to six times per week, for instance. Again, keep track. Have a little index card. What are the top things that are coming in?

00:09:32 Speaker_00
How many times do I say you need to make an appointment? Get some real data. Okay, so say you say six times during the week, please make an appointment. Where do you have these spots that's not two months out? What would be ideal for you?

00:09:44 Speaker_00
What if you said, hey, every day from two to three, I'm going to have a block on my schedule that only I or my medical assistant can fill?

00:09:51 Speaker_00
Now, again, I know some of you try to have these things on your schedule, and they fill in with med check, follow-up, physical, stuff like that. We need to stop that. We need to actually have access for our patients who we're saying need to come in.

00:10:04 Speaker_00
So that's one way to create a solution. The other thing is just to realize, wow, that stinks. I'm booking out two months. But to remember, hey, this patient has agency. If they're unable to wait for me, they'll see one of my partners.

00:10:19 Speaker_00
They'll go to the urgent care, something like that. No, I know it's not ideal to keep pushing patients into different cues, if you will, and yet. All you can do is what you can do, right? You don't have to feel bad that you're booking out two months.

00:10:34 Speaker_00
That means you're likely over-paneled, and this is a system problem. So to have an organizational meeting with your data, hey, these are how many patients that need to come in. This is how far I'm booking out.

00:10:45 Speaker_00
What could we do to help the patient with this? And or, hey, you want these messages to get dealt with. Who could we pay to do that during the day? Because it's really hard for me when I have 24 patients on my schedule to do that.

00:10:57 Speaker_00
So that is something that you're going to do some problem solving. Get some data, do some problem solving.

00:11:02 Speaker_00
Along with this, many times people say, oh my gosh, it's so stressful because patients expect me and my organization expects me to get back to the patient within a day or 48 hours or something like that. Here's what I'll tell you.

00:11:18 Speaker_00
The quicker we jump to it, the faster the patients think that they should be getting a response. I mean, that makes sense, right? It's just like a cycle. This is not fast food, people. People need to wait.

00:11:30 Speaker_00
If they want to send a MyChart message, they need to wait in line.

00:11:34 Speaker_00
And again, your organization hopefully has realistic expectations that they share on the portal, like these will be answered within maybe 72 hours and or within a week, whatever, right?

00:11:47 Speaker_00
And if you're noticing that it is going longer than that, or you're worried about patient safety, bring that up.

00:11:54 Speaker_00
I love bringing up to the organization, hey, I'm concerned about patient safety, and I'm unable to get to all of these messages every day, and I'm no longer going to do this for free in the evening.

00:12:05 Speaker_00
So I'm curious what your ideas are on how we can make sure that things are not falling through the cracks, to make sure that we're not going to have a patient safety event. Who's gonna sit up and listen then?

00:12:18 Speaker_00
The broken medical system does not need to continue running on the backs of altruistic physicians. Again, I know that we care so much about the patients, but doing all of this work for free at night has to stop.

00:12:31 Speaker_00
The more we keep doing it, the more they keep offering it to us. Right? So again, you get to decide what's right for you. But having that conversation with your administrative staff is going to be very important. Hey, what's expected?

00:12:45 Speaker_00
And how would you like me to find time to do that? Because currently I'm doing it at 9 to 10 at night, and I'm no longer going to do that. So be very clear. A lot of times, too, guilt comes up. We're perfectionists.

00:12:59 Speaker_00
We don't want to not have the patients be happy, and we certainly don't want to leave a few unfinished tasks in your box at night. I'm just going to tell you, you're going to have to get over that.

00:13:08 Speaker_00
You're going to have to set some boundaries, give yourself time at the end of the day to just make sure that perhaps there aren't any, you know, red flag type things, and you're going to leave it for the next day. I want you to practice that.

00:13:18 Speaker_00
It feels gross. It feels uncomfortable. And yet, maybe you don't get it all done today. And, or if you're like, no, absolutely. I have to get every single message done. Great. How can you make that work? Do you stop seeing patients an hour earlier?

00:13:34 Speaker_00
Before you make some drastic changes there, I want you to consider whether or not you're getting paid for this work that doesn't generate RVUs. For most of us, seeing patients is where we bring in revenue for the entire organization, right?

00:13:48 Speaker_00
We're not better humans than anyone else, but we're the only ones in the organization who bring in revenue. It behooves us to be seeing patients, making a diagnosis and a plan, coding and billing. That's how the lights stay on.

00:14:00 Speaker_00
That's how all our staff gets paid. That's how administration gets paid, right?

00:14:04 Speaker_00
So doing this work for free in your evening hours or say you even block your schedule from four to five to answer messages, but if you're not getting paid for that, that is not helpful.

00:14:15 Speaker_00
So again, just to bring this to forefront of your mind and to bring this conversation forward to your organization, hey, this is not billable time and I think it should be, so how should we make that work?

00:14:29 Speaker_00
So that went pretty long around the boundaries, but I think it's so important, and it spills into all these different things, and why it is that we have a hard time with boundaries.

00:14:38 Speaker_00
So I kind of talked about why it's important to have boundaries with ourself, our staff, and primarily our patients, and why that's hard.

00:14:45 Speaker_00
We're booking out, and we feel bad, and we think that these patients have these expectations, that then we continue to feed by answering them right away. So it's not easy, and this is a work in progress, and I know that you can do it.

00:15:01 Speaker_00
This was one of the most difficult things that I struggled with in my day-to-day clinical practice.

00:15:07 Speaker_00
And when I figured out that I could set boundaries and I could just have a phrase, please come in, please come in, please come in, sorry I'm booking out two months, but make an appointment with a colleague and or make an appointment for two months.

00:15:19 Speaker_00
life all of a sudden seemed so much more manageable. And of course, I was working with a coach who helped me deal with the perfectionism and people pleasing tendencies that I and many of you listeners have.

00:15:30 Speaker_00
Getting back to strategies, the next thing you're going to do is you're going to keep track of who needs to be seen. I kind of talked about this, but this is just a different clear thing. I want you to gather some data.

00:15:42 Speaker_00
How many messages are you getting a day? How many patients typically need to be seen in a regular week? And how many hours of open spots do you need to have that can only be filled by you and or your medical assistant?

00:15:55 Speaker_00
And then talk to someone and give it a try. Talk to your office manager. Say, hey, this is what I'm noticing, and I really think it would be best for my patients and their safety to not be booked out two months.

00:16:05 Speaker_00
So I would like to do a pilot of having, you know, a couple afternoons a week with openings that I can put these people in. See what happens. And again, I just want to tell you the next thing is that And people aren't going to love it.

00:16:19 Speaker_00
People don't love change. Of course people love what I used to call coming in the back door, right? Sending you a message and getting a response right away. Of course people love that. It's easy. It's convenient.

00:16:30 Speaker_00
And yet, it's contributing to an unsustainable workplace for you.

00:16:35 Speaker_00
So when I talk about inbox management, yes, you're gonna have a plan, yes, you're gonna create some space for people, but more than that, it's realizing that you do have more control than you think, and that it starts with saying, I just can't do all this, and how are we gonna make it work?

00:16:51 Speaker_00
It's a patient access problem, right? I mean, ultimately, it's a patient access problem. Why are patients sending messages? Yeah, it's easy. And probably they called and they were told they couldn't get in for two months. So it's, I get it.

00:17:02 Speaker_00
It's a much bigger problem, but I want to give you the empowerment to say, hey, these are some little changes that I'm going to make that are going to ultimately make a big difference.

00:17:13 Speaker_00
Another thing that I suggest is when it's time to get to the inbox and or labs and refills, Just get through it, right? Don't cherry pick. Don't jump around. So many times people start one thing, reading a patient message. Well, I don't know.

00:17:27 Speaker_00
I'm going to have to think about that. And then they put it aside and then they jump to labs. I'm going to think about that for a little bit. Stop it. Have a plan of when you're going to do it and just go through systematically.

00:17:38 Speaker_00
Yes, some things might take a little bit longer because you need to think about it. But my thought is if you're needing to think about a patient visit, they deserve to have an appointment.

00:17:46 Speaker_00
So you can do a little bit of reading, talk it over with them, that sort of thing, gather more data. And as far as labs, just go and order. Quit cherry picking.

00:17:55 Speaker_00
This reminds me, another thing that came up as a difficulty is sometimes the funnel of things that come in in your inbox is huge. So I'm hoping that your system, you know, can separate out patient messages, labs, refills, consultant notes.

00:18:09 Speaker_00
If not, I would definitely recommend talking to your IT. How can we make this smoother so it's more clear to me where I should start my workflow? All the FYIs, so many people were talking about that on the Facebook question that I posed.

00:18:24 Speaker_00
All the FYIs that you're getting from consultants in hospital, oh my goodness, there must be a way to shut this off or put it way off to the side. I don't know the answer. If you do have an answer, please send me an email.

00:18:38 Speaker_00
I will put a link in the show notes because I want to figure this out and be able to share it with all of you. FYIs are not... Emergent. We think everything is emergent and urgent in medicine. And just because you have these tasks on your list, no.

00:18:52 Speaker_00
Take a deep breath. It feels very urgent. We think we need to handle all of the things to clear it all out. But I'm going to invite you to remember, what are we doing anyway? We're seeing patients. We're listening carefully.

00:19:07 Speaker_00
We're coming up with an accurate assessment and a plan. We are providing excellent care for our patients. We are documenting this and we're billing for it. That is your number one, two, and three priorities, I would have to say. Perhaps refills.

00:19:24 Speaker_00
getting back to patients about their labs. Those would I would say would be the next things that you need to do. All this other stuff clutters it up. But again, you get to decide what's right for you.

00:19:36 Speaker_00
But if there's a way that you know how to get rid of like those FYIs on your patient charts, let me know.

00:19:42 Speaker_00
And this brings up, I feel like I'm just having all these ping pong ideas, even though I've got my outline here, I'm remembering other things I wanted to mention. And another one is like,

00:19:51 Speaker_00
messages that people can send you, not patient messages, but like chats from other people. My thought is you shut that down.

00:19:59 Speaker_00
I remember a year or two ago working with someone in the hospital, and she's like, I keep getting all these messages throughout the day. I'm like, you need to shut it down. You need to let your nurses know. I'm not going to respond to this.

00:20:08 Speaker_00
And in fact, if it is an emergency, you need to call me because I'm not looking at this. So I know every organization is different, but how can we stop all the chatter?

00:20:17 Speaker_00
Taking care of patients is number one, documenting it, getting their labs back to them on the regular. Those are the most important things.

00:20:25 Speaker_00
So I think to do some brainstorming with your colleagues and with your organization to say, how can we optimize patient safety and how can we optimize revenue generating activities? Because just answering patient messages for free is not helpful.

00:20:41 Speaker_00
I'm trying to think what else. Yeah, I think those are the main things. I'm sure I can get feedback from all of you. And I would really love for you to implement a couple of these strategies.

00:20:54 Speaker_00
Give it a try for the next week or two, and then evaluate what's working with this, what's not working, and what will I do differently. And I imagine that I'll be coming back around and having, you know, another manager inbox 201.

00:21:05 Speaker_00
This is manager inbox 101. There will be another one coming up. Because again, I want to help you dial this in. because it is such a huge contributor to what makes our jobs unsustainable. But I want you to know that you have more control than you think.

00:21:20 Speaker_00
But it starts by saying, no, I'm not going to do that. I'm not going to answer all these messages every day. I'm not going to answer all these messages for free in my evening hours. I am done.

00:21:30 Speaker_00
What if you just said, absolutely, I will not do messages at night anymore? What would happen? It could be that in a day or two, patients start calling and saying, why are people not getting back to me?

00:21:40 Speaker_00
So again, I believe it's helpful to have these conversations with our organization before we just totally put the kibosh down on answering these messages. But I want you to stop doing them at night and on the weekends.

00:21:51 Speaker_00
And how can we turn the dial and make that work? I continually talk about making progress and not aiming for perfection. So inbox zero is perfection. And many of you are making yourself crazy, staying up super late, going for that.

00:22:06 Speaker_00
How can you make some progress during the day to become more efficient so you can get more of this work done?

00:22:13 Speaker_00
And again, to me, it just comes back to boundaries, boundaries, boundaries, and knowing that you need to allow the discomfort for yourself and knowing that not everybody's going to love it. Okay, my friends, I am here to help you.

00:22:26 Speaker_00
This is the work that I do with physicians, along with all kinds of other things on the regular in my group and my one on one coaching practice. If you'd like more information about that, click on the link in the show notes.

00:22:38 Speaker_00
And otherwise, go forth, set some boundaries today and let me know how it goes. Until next week, peace and love to all of you. Are you ready to take control of your life and put these tools into action? I'm here to help.

00:22:54 Speaker_00
I offer free consultations for physician moms to see if my one-on-one coaching package is right for you. You can sign up for a free consult at www.MamaDocLifeCoach.com.